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  • NUR-514: Organizational Leadership and Informatics Essay Assignment Discussions

    NUR-514: Organizational Leadership and Informatics Essay Assignment Discussions

    Describe a scenario in which there was a conflict between nurses working in your current or previous work environment. What was the primary cause of the conflict? What conflict resolution strategies would you employ to manage this conflict and promote civility in the workplace and why?

     

    Compare and contrast servant leadership with another leadership style or theory such as transformational leadership. What are the primary characteristics of each? What appeals to you about them and what strengths and drawbacks do you see with each in terms of influencing organizational culture as a nurse leader? NUR-514: Organizational Leadership and Informatics Essay Assignment Discussions.

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    Discuss organizational factors that can drive the change within a health care organization. Also, discuss the ethical, social, legal, economic, or political implication of the change within an organization and on the profession of nursing. Integrate a specific example of organizational change you have witnessed in your response.

     

    You have been selected to serve on a community outreach committee within your state’s nursing organization. The committee includes registered nurses of different specialties. At your first meeting, it becomes evident that not everyone is in agreement with a recent position statement about the role of spiritual care, with some members arguing they will no longer support the committee if the position statement is not revised or reversed. NUR-514: Organizational Leadership and Informatics Essay Assignment Discussions. As a nurse leader, how could you draw from change theory to address these concerns and encourage collaboration on the committee?

     

    Imagine you are working in an outpatient specialty office. Your nursing director has informed you that due to “accountable care” your office might be penalized by having too many diabetic patients that are above the hemoglobin A1C (HBA1C) goal of 8. The national benchmark is that only 20% of your population should be above 8 and your office shows 40%. NUR-514: Organizational Leadership and Informatics Essay Assignment Discussions. Your physicians have also been informed by their management of the same issue.

    Develop a plan using enhanced communications with patients to reach the benchmark goal. What might you do if you had the resources to accomplish this? You should consider all the technology you might be able to use such as a patient portal, wireless home monitor, texting, and secure messaging for example. NUR-514: Organizational Leadership and Informatics Essay Assignment Discussions.

     

    What challenges do current reimbursement models pose for nurse leaders in their obligations to promote quality, cost effective patient What strategies can effective nurse leaders use to overcome those challenges? Discuss any specific examples you may have witnessed a leader implement in the practice environment in your response.

     

    Review the Graduate QSEN Competencies. Focusing on the areas of Quality Improvement (QI), Safety, and Informatics, summarize the essential knowledge, skills and attitudes that an advanced registered nurse should possess to competently promote the use of health care data and information to improve care in the clinical setting. NUR-514: Organizational Leadership and Informatics Essay Assignment Discussions. Discuss two specific ways information and technology can improve clinical practice, administration, education, or research in your response.

     

     

    Discuss a key event in the evolution of nursing informatics and the characteristics of nursing informatics as a specialty. In what ways do the roles of informatics nurses and nurse leaders intersect?

     

    What are the primary challenges related to interoperability and the exchange of health information in the practice environment and how might these impact patients’ access to the best care? NUR-514: Organizational Leadership and Informatics Essay Assignment Discussions. Discuss a particular challenge with clinical provide order entry (CPOE) in your response.

     

     

    Discuss the benefits and drawback of clinical decision support systems, including the challenges of avoiding alert fatigue. Considering your interactions with patients and systems in the clinical environment, what best practices related to human factors and user-centered design would you recommend to designers of such systems?

     

    Discuss an example of a personal health, mobile heath, or telehealth-related application that you think can improve patient care. What are some of the primary challenges with integrating data from a mobile device or application with data within an EHR? Do you think most patients are comfortable with sharing their personal data in the clinical environment? Supposing the sharing of such information is beneficial for their health, what can be done to help patients overcome their reticence?

     

     

    Review HIPAA, protected health information (PHI), and requirements for privacy and confidentiality in EHRs. Discuss one ethical and one legal issue related to the use of EHRs that directly impact advanced registered nursing practice. Discuss possible consequences for compromising patient data and measures you can implement in your own practice to protect patient privacy and confidentiality. NUR-514: Organizational Leadership and Informatics Essay Assignment Discussions.

     

    What quality standards or performance measures guide your role or specialty as an advanced registered nurse? Using these standards, discuss how informatics can be used to improve quality of care. NUR-514: Organizational Leadership and Informatics Essay Assignment Discussions. Make sure to discuss meaningful use and incorporate the topic materials, such as the American Health Information Management Association (AHIMA) and Information Governance websites in your response.

     

     

    There are several project management methodologies available to nurse leaders for supporting the implementation of quality and performance improvement initiatives in the practice environment. Two well-known ones are Lean and Six Sigma. Compare and contrast two project management methodologies you think are promising in the health care environment. Discuss their relative benefits and drawbacks and discuss why you think they can be successful for implementing quality improvement initiatives. NUR-514: Organizational Leadership and Informatics Essay Assignment Discussions.

  • A young girl with difficulties in school – Child Abuse Case study – Katie ADHD Essay

    A young girl with difficulties in school – Child Abuse Case study – Katie ADHD Essay

    BACKGROUND

    In psychopharmacology you met Katie, an 8-year-old Caucasian female, who was brought to your office by her mother (age 47) and father (age 49). You worked through the case by recommending possible ADHD medications. As you progress in your PMHNP program, the cases will involve more information for you to sort through.

    For this case, you see Katie and her parents again. The parents have reported that the medication given to Katie does not seem to be helping. This has prompted you to reconsider the diagnosis of ADHD. You will consider other differential diagnoses and determine what information you need to accurately assess the DSM-5 criteria to make the diagnosis of ADHD or another disorder with similar diagnostic features.

    When parents bring their child to your office, they may have read symptoms on the internet or they may have been told by the school “your child has ADHD”. Your diagnosis will either confirm or refute that diagnosis. A young girl with difficulties in school – Child Abuse Case study – Katie ADHD Essay.

    Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine a differential diagnosis and to begin medication, if indicated. The PMHNP makes this diagnostic decision based on interviews and observations of the child, her parents, and the assessment of the parents and teacher.

    To start, consider what assessment tools you might need to evaluate Katie.

    Child Behavior Check List

    Conners’ Teacher Rating Scale

    The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised” 
    (Available at: https://www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/GetPdf.cgi?id=phd000099.1 )
    . This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, makes careless mistakes in her schoolwork, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. She has difficulty interacting with peers in the classroom and likes to play by herself at recess. A young girl with difficulties in school – Child Abuse Case study – Katie ADHD Essay.

    When interviewing Katie’s parents, you ask about pre- and post-natal history and you note that Katie is the first born with parents who were close to 40 years old when she was born. She had a low 5 minute Apgar score. The parents say that she met normal developmental milestones and possibly had some difficulty with sleep during the pre-school years. They notice that Katie has difficulty socializing with peers, she is quiet at home and spends a lot of time watching TV.

    SUBJECTIVE

    You observe Katie in the office and she is not able to sit still during the interview. She is constantly interrupting both you and her parents. Katie reports that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds some subjects boring or too difficult, and sometimes hard because she feels “lost”. She admits that her mind does wander during class. A young girl with difficulties in school – Child Abuse Case study – Katie ADHD Essay. “Sometimes” Katie reports “I will just be thinking about something else and not looking at the teacher or other students in the class.”

    Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. She offers no other concerns at this time.

    Katie’s parents appear somewhat anxious about their daughter’s problems. You notice the mother is fidgeting with her rings and watch while you are talking. The father is tapping his foot. Other than that, they seem attentive and straight forward in the interview process.

    MENTAL STATUS EXAM

    The client is an 8-year-old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. Affect is neutral. Katie says that she doesn’t hear any ‘voices’ in her head but does admit to having an imaginary friend, ‘Audrey’. No reports of delusional or paranoid thought processes. Attention and concentration are somewhat limited based on Katie’s short answers to your questions.

    Decision Point One

    BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHAT IS YOUR DIAGNOSIS FOR KATIE?

    In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.

     
    299.00 Autism Spectrum Disorder (ASD), mild and co-occurring; 300.23 Social Anxiety Disorder

    Decision Point One

    299.00 Autism Spectrum Disorder (ASD), mild and co-occurring; 300.23 Social Anxiety Disorder

    Decision Point One

    299.00 Autism Spectrum Disorder (ASD), mild and co-occurring; 300.23 Social Anxiety Disorder

    RESULTS OF DECISION POINT ONE

     Client returns to clinic in four weeks

     You have selected Autism Spectrum Disorder along with co-occurring Social Anxiety Disorder. Based on this choice, outline the remainder of the diagnostic evaluation that you will conduct on this child and their parents. Be sure to include standardized assessment instruments that you would administer. A young girl with difficulties in school – Child Abuse Case study – Katie ADHD Essay.

    Decision Point Two

    Based on your diagnosis and the parents’ concerns, you decided to begin Risperal 0.5 mg po BID

    RESULTS OF DECISION POINT TWO

     Client returns to clinic in four weeks

     Upon her return to the clinic in 4 weeks, Katie’s parents feel that Katie is calmer, but no changes in her school performance have been noted. Additionally, her parents have noticed that she seems more “tired” than usual, and report that she seems to ‘space out’ more often. They further report that she has been falling asleep during her usual television shows.

    Decision Point Three

    Increase Risperdal to 1 mg po BID

    Guidance to Student

    The information provided in the scenario is not suggestive of the diagnostic criteria for autism spectrum disorder (ASD) or co-occurring social anxiety disorder. Even if it were, Risperdal is not routinely used to treat autism-spectrum disorder- in fact, there are no FDA approved drugs for treatment of this disorder. Antipsychotics are only used to treat violent or self-injurious behaviors in ASD, and in those cases, used off-label. Antipsychotics did slow Katie down, but also gave her a other side effects, and did nothing to treat the primary presenting problems of inattention.

    While CBT has evidence of efficacy in both autism spectrum disorder and social anxiety disorder, and while video modeling and video-self modeling therapy has some evidence for efficacy in ASD, these therapies will not, in and of themselves, help Katie as she does not have ASD with co-occurring social anxiety disorder.

     

    BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.

    Based on your diagnosis and the parents’ concerns, you decided to begin Risperal 0.5 mg po BID

    Decision Point Two

    Based on your diagnosis and the parents’ concerns, you decided to begin Celexa 20 mg po daily

    RESULTS OF DECISION POINT TWO

     Client returns to clinic in four weeks. A young girl with difficulties in school – Child Abuse Case study – Katie ADHD Essay.

     Katie’s parents feel that Katie is no calmer, and that there have been no changes in her school performance. Her parents are also concerned that Katie has been asking them “odd” questions such as “where do you go when you die?” and “when you die, do you get to see your pets that have died?” Her parents indicated that she had never had such questions before.

    Decision Point Three

    Increase Celexa to 40 mg PO daily

    Guidance to Student

    The information provided in the scenario is not suggestive of the diagnostic criteria for autism spectrum disorder (ASD) or co-occurring social anxiety disorder. Even if it were, Celexa is not routinely used to treat autism-spectrum disorder- in fact, there are no FDA approved drugs for treatment of this disorder. Antidepressants may be considered if the child has co-occurring depression and/or anxiety disorder, but only after careful consideration of risk/benefits associated with antidepressant therapy in a child. The Celexa did nothing to alter Katie’s behavior, and in fact, Katie developed what appeared to be some morbid thoughts, possibly suggesting a fascination with death. While there is insufficient information to suggest that she was entertaining suicidal ideation, her parents clearly indicated that she was not having these thoughts before the antidepressant therapy was initiated.

    While CBT has some evidence for efficacy in ASD and social anxiety disorder, it will not help Katie as she does not have either of these diagnoses. A young girl with difficulties in school – Child Abuse Case study – Katie ADHD Essay.

     

    Based on your diagnosis and the parents’ concerns, you decided to begin Celexa 20 mg po daily

    Decision Point One

     
    299.00 Autism Spectrum Disorder (ASD), mild and co-occurring; 300.23 Social Anxiety Disorder

    RESULTS OF DECISION POINT ONE

     Client returns to clinic in four weeks

     You have selected Autism Spectrum Disorder along with co-occurring Social Anxiety Disorder. Based on this choice, outline the remainder of the diagnostic evaluation that you will conduct on this child and their parents. Be sure to include standardized assessment instruments that you would administer

    Decision Point Two

    Based on your diagnosis and the parents’ concerns, you decided to begin Celexa 20 mg po daily

    RESULTS OF DECISION POINT TWO

     Client returns to clinic in four weeks

     Katie’s parents feel that Katie is no calmer, and that there have been no changes in her school performance. Her parents are also concerned that Katie has been asking them “odd” questions such as “where do you go when you die?” and “when you die, do you get to see your pets that have died?” Her parents indicated that she had never had such questions before.

    Decision Point Three

    BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.

    Increase Celexa to 40 mg PO daily

    Guidance to Student

    The information provided in the scenario is not suggestive of the diagnostic criteria for autism spectrum disorder (ASD) or co-occurring social anxiety disorder. Even if it were, Celexa is not routinely used to treat autism-spectrum disorder- in fact, there are no FDA approved drugs for treatment of this disorder. Antidepressants may be considered if the child has co-occurring depression and/or anxiety disorder, but only after careful consideration of risk/benefits associated with antidepressant therapy in a child. A young girl with difficulties in school – Child Abuse Case study – Katie ADHD Essay. The Celexa did nothing to alter Katie’s behavior, and in fact, Katie developed what appeared to be some morbid thoughts, possibly suggesting a fascination with death. While there is insufficient information to suggest that she was entertaining suicidal ideation, her parents clearly indicated that she was not having these thoughts before the antidepressant therapy was initiated. A young girl with difficulties in school – Child Abuse Case study – Katie ADHD Essay.While CBT has some evidence for efficacy in ASD and social anxiety disorder, it will not help Katie as she does not have either of these diagnoses.

    Augment with CBT

    Reconsider Diagnosis

    Based on your diagnosis and the parents’ concerns, you decided to begin Olanzapine 5 mg po daily.

     

    Decision Point One

     
    315.0 Specific Learning Disorder with Impairment in Reading and 315.1 Impairment in Mathematics

    RESULTS OF DECISION POINT ONE

     Client returns to clinic in four weeks

     You have selected 315.0 Specific Learning Disorder with Impairment in Reading and 315.1 Impairment in Mathematics. Based on this choice, outline the remainder of the diagnostic evaluation that you will conduct on this child and their parents. Be sure to include standardized assessment instruments that you would administer. A young girl with difficulties in school – Child Abuse Case study – Katie ADHD Essay.

    Decision Point Two

    Begin Donepezil 10 mg po daily

    RESULTS OF DECISION POINT TWO

     Client returns to clinic in four weeks

     Katie’s parents feel that Katie is no different. She has had no changes in school performance, but has been having trouble falling asleep at night

     Additionally, Katie has reported having “scary dreams” to her parents and has been feeling “stomach sick”

    Decision Point Three

    BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.

    Explain that the side effects will abate with time and increase to 15 mg orally daily. A young girl with difficulties in school – Child Abuse Case study – Katie ADHD Essay.

    Augment with Trazodone 50 mg po at HS.

    Reconsider Diagnosis

    315.0 Specific Learning Disorder with Impairment in Reading and 315.1 Impairment in Mathematics

     
    314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation

    Decision Point One

     
    314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation

    RESULTS OF DECISION POINT ONE

     Client returns to clinic in four weeks

     You selected Attention deficit hyperactivity disorder, predominantly inattentive presentation. Based on this choice, outline the remainder of the diagnostic evaluation that you will conduct on this child and their parents. Be sure to include standardized assessment instruments that you would administer

    Decision Point Two

    Begin Wellbutrin 75 mg orally daily

    RESULTS OF DECISION POINT TWO

     Client returns to clinic in four weeks

     Katie’s parent report that the teacher has indicated that Katie seems to be paying more attention during class. They have also noticed that Katie is able to attend more closely to her homework. However, her parents are somewhat concerned that Katie has been asking them “odd” questions such as “where do you go when you die?” and “when you die, do you get to see your pets that have died?” Her parents indicated that she had never had such questions before. A young girl with difficulties in school – Child Abuse Case study – Katie ADHD Essay.

    Decision Point Three

    BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.

    Assure the parents that the questions Katie are asking are age-appropriate and increase dose of Wellbutrin to 150 mg daily

    Implement psychodynamic therapy

    Change drug to Concerta 18 mg orally daily in the morning A young girl with difficulties in school – Child Abuse Case study – Katie ADHD Essay

  • Home visit with Sallie Mae Fisher’s Health History and Discharge Orders Essay Assignment Paper

    Home visit with Sallie Mae Fisher’s Health History and Discharge Orders Essay Assignment Paper

    Sallie Mae Fisher Health History

    Ms. Fisher is an 82-year-old female with a history of chronic congestive heart failure (CHF), atrial fibrillation, and hypertension. During the last 6 months, she has been hospitalized four times for exacerbation of her CHF. She was discharged home last Saturday from the hospital after a 3-day stay to treat increased dyspnea, an 8-pound weight gain, and chest pain.

    Ms. Fisher
    is recently widowed and lives alone. She has a daughter, Thelma Jean, who lives in town but works full time and has family issues of her own. Therefore, family support is limited.Home visit with Sallie Mae Fisher’s Health History and Discharge Orders Essay Assignment Paper.

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    Hospital Discharge Instructions

    Mountain Top Home Health to evaluate cardio-pulmonary status, medication management, and home safety.

    Medical Equipment Company to deliver oxygen concentrator and instruct patient in use. O
    2
    at 2 liters per nasal prongs PRN.

    Prescriptions given at discharge:

    Digoxin 0.25 mg once a day

    Lasix 80 mg twice a day

    Calan 240 mg once a day

    Order written to continue other home meds. Home visit with Sallie Mae Fisher’s Health History and Discharge Orders Essay Assignment Paper.

    Sallie Mae’s Home Medication List

    Zocar 50 mg once a day

    Minipres 1 mg once a day

    Vasotec 10 mg twice a day

    Prilosec 20 mg once a day

    Furosemide 40 mg once a day

    Effexor 37.5 mg at bedtime

    Lanoxin 0.125 mg every other day

    Multivitamin once a day

    Potassium 40 mEq once a day

    Ibuprofen 400 mg q 4 hours as needed for pain

    Darvocet N 100 mg q 4 hours as needed for pain

    Nitroglycerin ointment, apply 1 inch every day

    Sallie Mae Fisher’s Health History

    and Discharge Orders

    Sallie Mae Fisher Health History

    Ms. Fisher is an 82-year-old female with a history of chronic congestive heart failure (CHF), atrial fibrillation, and hypertension. During the last 6 months, she has been hospitalized four times for exacerbation of her CHF. She was discharged home last Saturday from the hospital after a 3-day stay to treat increased dyspnea, an 8-pound weight gain, and chest pain. Home visit with Sallie Mae Fisher’s Health History and Discharge Orders Essay Assignment Paper.

    Ms. Fisher is recently widowed and lives alone. She has a daughter, Thelma Jean, who lives in town but works full time and has family issues of her own. Therefore, family support is limited.

    Hospital Discharge Instructions

    Mountain Top Home Health to evaluate cardio-pulmonary status, medication management, and home safety. Home visit with Sallie Mae Fisher’s Health History and Discharge Orders Essay Assignment Paper.

    Medical Equipment Company to deliver oxygen concentrator and instruct patient in use. O
    2
    at 2 liters per nasal prongs PRN.

    Prescriptions given at discharge:

    Digoxin 0.25 mg once a day

    Lasix 80 mg twice a day

    Calan 240 mg once a day

    Order written to continue other home meds.

    Home visit with Sallie Mae Fisher’s Health History and Discharge Orders Essay Assignment Paper

    Sallie Mae’s Home Medication List

    Zocar 50 mg once a day

    Minipres 1 mg once a day

    Vasotec 10 mg twice a day

    Prilosec 20 mg once a day

    Furosemide 40 mg once a day

    Effexor 37.5 mg at bedtime

    Lanoxin 0.125 mg every other day

    Multivitamin once a day

    Potassium 40 mEq once a day

    Ibuprofen 400 mg q 4 hours as needed for pain

    Darvocet N 100 mg q 4 hours as needed for pain

    Nitroglycerin ointment, apply 1 inch every day

    Home visit with Sallie Mae Fisher’s Health History and Discharge Orders Essay Assignment Paper

  • Crimes of the Heart: A Case Study on Cardiac Anatomy

    Crimes of the Heart: A Case Study on Cardiac Anatomy

    Read the case study below and answer the questions associated with the case study.

    Crimes of the Heart: A Case Study on Cardiac Anatomy

    Tiffany is worried about her newborn son. Ever since she brought Caleb home from the hospital it has been so hard to get him to eat and he seems to be breathing too hard all the time. She stopped breastfeeding and tried every bottle and formula on the market, but nothing has worked. So, at his one month check-up, her stomach is in knots as they place Caleb on the scale. The nurse says, “9 pounds, 7 ounces.” Tiffaney realizes Caleb has only gained one pound since he was born and she breaks into tears. Crimes of the Heart: A Case Study on Cardiac Anatomy.

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    Tiffaney is worried about her newborn son. Ever since she brought Caleb home from the hospital it has been so hard to get him to eat and he seems to be breathing too hard all the time. She stopped breastfeeding and tried every bottle and formula on the market, but nothing has worked. So, at his one month check-up, her stomach is in knots as they place Caleb on the scale. The nurse says, “9 pounds, 7 ounces.” Tiffaney realizes Caleb has only gained one pound since he was born and she breaks into tears.

    Dr. Baker checks over Caleb in the exam room, taking extra time feeling and listening to his chest. During the exam, Tiffaney explains her struggle with trying to get her son to eat and how he cries almost the entire day. After the exam, Dr. Baker says, “When I listen to Caleb’s heart I hear an extra sound called a murmur. Crimes of the Heart: A Case Study on Cardiac Anatomy I want to use an echocardiogram and an ECG to get a good picture of all the parts of his heart.”

    After a full day of tests, Tiffaney meets with Dr. Baker in his office. He explains, “After a careful review of all the information, I have discovered that Caleb has a hole in the heart muscle wall between his right and left ventricles. We call it a ventricular septal defect. That is probably why he has been so irritable and hard to feed. The hole is not very big, but he will still need to have surgery to repair it.” Although the thought of her tiny son having surgery is terrifying, Tiffaney is relieved to know why things have been so tough at home. Crimes of the Heart: A Case Study on Cardiac Anatomy.

    Crimes of the Heart: A Case Study on Cardiac Anatomy Short Answer Questions:

    1. Dr. Baker spends a long time listening to (auscultating) Caleb’s heart. Where do you think would be the best place to auscultate Caleb’s abnormal heart sound? Explain your answer.

    2. Caleb has abnormal heart sounds that tipped the doctor off to a problem. In relation to the normal heart sounds, when would you expect to hear the abnormal sound Dr. Baker heard? Explain your answer.

    3. The defect in Caleb’s heart allows blood to mix between the two ventricular chambers. Due to this defect would you expect the blood to move from left-to-right ventricle or right-to-left ventricle during systole? Explain your answer.

    4. What happens to Caleb’s systemic cardiac output as a result of his ventricular septal defect (VSD)? Explain your answer.

    5. Based on the location of Caleb’s defect, what part of the conduction system might be at risk for abnormalities? Explain your answer.

    ****Read instructions below and answer bulletin below****

    2)I want to know where you find your nutrition information and how you distinguish quality from quackery. Crimes of the Heart: A Case Study on Cardiac Anatomy. Please identify 3 websites with nutrition information, and provide us with:

    —A link to each site

    —A brief description of the site

    —Reasoning for why you trust or don’t trust the content of the site

    Word Count is your choice for both assignments.

    Formatting is your choice also Crimes of the Heart: A Case Study on Cardiac Anatomy

    Read the case study below and answer the questions associated with the case study.

    Crimes of the Heart: A Case Study on Cardiac Anatomy

    Tiffany is worried about her newborn son. Ever since she brought Caleb home from the hospital it has been so hard to get him to eat and he seems to be breathing too hard all the time. She stopped breastfeeding and tried every bottle and formula on the market, but nothing has worked. So, at his one month check-up, her stomach is in knots as they place Caleb on the scale. Crimes of the Heart: A Case Study on Cardiac Anatomy The nurse says, “9 pounds, 7 ounces.” Tiffaney realizes Caleb has only gained one pound since he was born and she breaks into tears.

    Tiffaney is worried about her newborn son. Ever since she brought Caleb home from the hospital it has been so hard to get him to eat and he seems to be breathing too hard all the time. She stopped breastfeeding and tried every bottle and formula on the market, but nothing has worked. So, at his one month check-up, her stomach is in knots as they place Caleb on the scale. The nurse says, “9 pounds, 7 ounces.” Tiffaney realizes Caleb has only gained one pound since he was born and she breaks into tears.

    Dr. Baker checks over Caleb in the exam room, taking extra time feeling and listening to his chest. During the exam, Tiffaney explains her struggle with trying to get her son to eat and how he cries almost the entire day. After the exam, Dr. Baker says, “When I listen to Caleb’s heart I hear an extra sound called a murmur. I want to use an echocardiogram and an ECG to get a good picture of all the parts of his heart.” Crimes of the Heart: A Case Study on Cardiac Anatomy

    After a full day of tests, Tiffaney meets with Dr. Baker in his office. He explains, “After a careful review of all the information, I have discovered that Caleb has a hole in the heart muscle wall between his right and left ventricles. We call it a ventricular septal defect. That is probably why he has been so irritable and hard to feed. The hole is not very big, but he will still need to have surgery to repair it.” Although the thought of her tiny son having surgery is terrifying, Tiffaney is relieved to know why things have been so tough at home.

    Crimes of the Heart: A Case Study on Cardiac Anatomy Short Answer Questions:

    1. Dr. Baker spends a long time listening to (auscultating) Caleb’s heart. Where do you think would be the best place to auscultate Caleb’s abnormal heart sound? Explain your answer.

    2. Caleb has abnormal heart sounds that tipped the doctor off to a problem. In relation to the normal heart sounds, when would you expect to hear the abnormal sound Dr. Baker heard? Explain your answer.

    3. The defect in Caleb’s heart allows blood to mix between the two ventricular chambers. Due to this defect would you expect the blood to move from left-to-right ventricle or right-to-left ventricle during systole? Explain your answer.

    4. What happens to Caleb’s systemic cardiac output as a result of his ventricular septal defect (VSD)? Explain your answer.

    5. Based on the location of Caleb’s defect, what part of the conduction system might be at risk for abnormalities? Explain your answer. Crimes of the Heart: A Case Study on Cardiac Anatomy

    ****Read instructions below and answer bulletin below****

    2)I want to know where you find your nutrition information and how you distinguish quality from quackery. Please identify 3 websites with nutrition information, and provide us with:

    —A link to each site

    —A brief description of the site

    —Reasoning for why you trust or don’t trust the content of the site

    Word Count is your choice for both assignments.

    Formatting is your choice also Crimes of the Heart: A Case Study on Cardiac Anatomy

  • Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples

    Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples -1

    Psychotherapy is a proven method in the treatment of various psychiatric disorders in both the individual and group setting. Individual therapy consists of the application of a therapeutic process with an individual and the treating clinician and group therapy applies the same concept but consists of two or more individuals seeking therapeutic intervention. Regardless of the setting, the practicing clinician muse be aware of the legal and ethical implications that come with treating clients in both individual and group psychotherapy sessions. Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples.

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    Legal and Ethical Considerations in Individual and Group Therapy

    According to Wheeler (2014), group therapy offers the ability to increase access to care for clients, to diversify one’s practice by offering services other than individual, couples, or family therapy, while at the same time affording clients a cost-effective and evidence-based intervention for addressing their mental health issues. Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples. In both individual and group therapy settings there are certain guidelines that must be maintained to prevent consequential ethical or legal implications. in both individual and group therapy, privacy and confidentiality must be maintained unless the clinician has just cause to believe that either the individual client or a member of a group is a danger to themselves or another person. However, in group therapy these rules do not just span between one client and the treating clinician and the therapist must be cognizant of this fact. According to Breeskin (2011), “Anything that is said between any two or more group members at any time is part of the group and is confidential.”  Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples.

    Another ethical implication seen in both individual and group therapy is informed consent. Informed consent allows the client or clients to have enough information regarding the services provided within the therapeutic environment so that they can decide whether they will participate. All clients should be given an orientation to the therapeutic setting including appropriate boundaries, limits, goal setting, and expected behaviors. In group therapy, all legal implications associated with maintaining the privacy of participants protected health information still applies as seen with individual therapy. Participants within the group should be encouraged during the orientation phase and throughout the duration of the group to maintain the confidentiality of all group members. According to McClanahan (2014), confidentiality should become one of the most important group norms, and it should be discussed openly, throughly and often among group members. This implication also applies to group therapy settings involving minors. Guardians must be informed of the application of confidentiality and given disclosure that complete confidentiality cannot be promised as seen in individual therapy settings. According to Ware & Dillman-Taylor (2014), similar to any intervention involving multiple people, therapists cannot promisr complete confidentiality because of one’s lack of control of other members and possible situations of required reporting and must be discussed with parents.

    When providing services to clients in the group or family setting versus those in the individual therapy environment, the therapeutic environment might be impacted if these factors are not taken into account. The therapist must be aware that the therapeutic dynamic is altered when dealing with a group versus a individual therapy session. Client trust and therapeutic alliance will need to established not only with the group facilitator but also with the group participants to meet the goals of the formation of the particular group session. Group members should feel free to interact within the therapeutic environment without fear of intimidation, judgment or unnecessary disclosure of their private thoughts or experiences. The principles of interpersonal learning, group cohesiveness, and catharsis are all impacted by some of these considerations. The competent psychotherapist will also be aware of their abilities in providing effective treatment using the appropriate treatment modalities. According to Wheeler (2014), proficiency in specific theoretical orientations is a necessity for all practicing psychotherapists, but awareness of the nuances, ambiguities, and subtleties of interpersonal interaction, and how to handle them in the immediacy of the clinical encounter to therapeutic effect; are indispensable. Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples.

    References

    Breeskin, J. (2011). Procedures and guidelines for group therapy. 
    The Group Psychologist, 21
    (1). Retrieved from http://www.apadivisions.org/division-49/publications/newsletter/group-psychologist/2011/04/group-procedures.aspx

    McClanahan, K.K. (2014). 
    Can confidentiality be maintained in group therapy? 
    Retrieved from http://nationalpsychologist.com/2014/07/can-confidentiality-be-maintained-in-group-therapy/102566.html

    Ware, J.N., & Dillman-Taylor, D. (2014). Concerns about confidentiality: The application of ethical decision-making within group play therapy. 
    International Journal of Play Therapy, 23
    (3), 172-186. doi:10.1037/a0036667

    Wheeler, K. (Eds.). (2014). 
    Psychotherapy for the advanced practice psychiatric nurse: A how to guide for evidence-based practice. 
    New York, NY: Springer.

     

    Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples – 2

    Group therapy is a form of psychotherapy in which a group of patients meet to describe and discuss their problems together under the supervision of a therapist (Tracy & Wallace, 2016). Family therapy is a form of psychotherapy that works with families and couples in intimate relationships to nurture change and development (Szapoczni, Schwartz, Muir, & Brown, 2012). It tends to view change in terms of the systems of interaction between family members and emphasizes family relationships as an important factor in psychological health (Szapoczni et al., 2012). Individual therapy is a joint process between a therapist and a person in therapy with the common goals of therapy being to inspire change or improve the quality of life for the individual in therapy (Tracy et al., 2016). Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples.

    Maintaining confidentiality is the foundation of psychotherapy and without the assurance of confidentiality, the clients in either forms of psychotherapy cannot be expected to reveal embarrassing, sometimes personally damaging information in the selected treatment setting (McClanahan, 2014). It is important to remember that the ethical requirement of confidentiality overlaps with the law so some of the answers to situations the therapist will experience can only occur with an understanding of both ethics and law (McClanahan, 2014). Issues of confidentiality are complex and members of the American Psychological Association (APA) report that the most common dilemma for therapist providing individual therapy involve confidentiality (McClanahan, 2014). Those dilemmas become even more complex when group or family is provided (McClanahan, 2014). Definitive guidelines are provided by associations specifically dedicated to group/family work stating group workers define confidentiality and its limits (for example, legal and ethical exceptions and expectations; waivers implicit with treatment plans; documentation and insurance coverage) (McClanahan, 2014). Group/family therapists have the responsibility to inform all individuals participating of the need for confidentiality, potential consequences of breaching confidentiality and that legal privilege does not apply to group/family discussion, unless provided by state statute (McClanahan, 2014).

    Another important difference is the provider during group/family therapy is no longer dedicated to the individual client nor functions exclusively as the client’s agent (Ezhumalai, Muralidhar, Dhanasekarapandian, & Nikketha, 2018). Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples. The provider recognizes the responsibility to participate in activities contributing to an overall improved community (Ezhumalia et al., 2018).

    This can be used in clinical practice by maintaining an atmosphere of trust when holding a group or family session, due to all the members potentially speaking openly about their feelings and talking directly to one another about their personal problems (Ezhumalia et al., 2018). It will be important for the therapist to promote that no one will be forced to divulge their deepest secrets and to promote an environment that group/family member to feel free to relate openly and honestly with others in the effort to discover that they are not alone in their issues (Ezhumalia et al., 2014).

    References:

    Ezhumalai, S., Muralidhar, D., Dhanasekarapandian, R., & Nikketha, B. S. (2018). Group interventions. 
    Indian Journal of Psychiatry
    , 
    60
    (Suppl 4), S514–S521. http://doi.org/10.4103/psychiatry.IndianJPsychiatry_42_18

    McClanahan, K. (2014). Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples. Can confidentiality be maintained in group therapy? 
    The National Psychologist. 
    Retrieved from: https://nationalpsychologist.com/2014/07/can-confidentiality-be-maintained-in-group-therapy/102566.html

    Szapocznik, J., Schwartz, S. J., Muir, J. A., & Brown, C. H. (2012). Brief Strategic Family Therapy: An Intervention to Reduce Adolescent Risk Behavior. 
    Couple & Family Psychology
    , 
    1
    (2), 134–145. http://doi.org/10.1037/a0029002

    Tracy, K., & Wallace, S. P. (2016). Benefits of peer support groups in the treatment of addiction. 
    Substance Abuse and Rehabilitation
    , 
    7
    , 143–154. http://doi.org/10.2147/SAR.S81535

     

    Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples – 3

    Legal and ethics

    Legal and ethical consideration are very important during therapy  to protect patient privacy. And as a practitioner, the code of ethics  requires that I must adhere to the code. Different states have different laws that govern privacy and thus one should familiarize with them and recognize the extent and limits of confidentiality  regulated by law. Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples. Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples. The Health Insurance Portability and Accountability Act (HIPAA) contains a privacy rule that creates national standards to protect individuals’ medical records and personal health information, including information about psychotherapy and mental health.

    Group verses individual therapy confidentiality

    In group therapy and family therapy, confidentiality is not guaranteed, according to McClanahan 2014, the  information revealed to the therapist  is also revealed to other group members, and there is no guarantee that other group members will maintain confidentiality. For individual therapy, at least it’s between the therapist and the client and therefore confidentiality is maintained. According to The APA Ethical Guidelines, there is little specificity regarding confidentiality in group therapy.

    Privileged information

    The difference of group therapy and family therapy from the individual therapy is the privileged information. In most states, privileged communication does not exist in group settings due to the third-party rule, which states that information revealed in front of a third party was not intended to be private and is not privileged, McClanahan (2014). Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples. Therefore, group members may be called to testify against their peers regarding information obtained in group sessions unless provided by a state statute. On the other hand, individual therapy notes  are confidential and privileged. According to U.S. Department of Health &Human Services. (2014), Privacy Rule requires a covered entity to obtain a patient’s authorization prior to a disclosure of psychotherapy notes for any reason, including a disclosure for treatment purposes to a health care provider other than the originator of the notes [45 CFR 164.508(a)(2)].

    Impact your therapeutic approaches

    The impact of these differences on therapeutic approaches is the consequences of breach these confidentiality and privileges. Remember that a breach of confidentiality can be a malpractice liability (Loewenberg, Dolgoff, & Harrington, 2000). The client competence is also important because impaired cognition may impair the understanding of the consents entered between the client and the practitioner or is obtained under duress. Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples. Other consideration that may arise is mandatory reporting and mandated  treatments which may impact therapy approaches.

    References

    U.S. Department of Health &Human Services. (2014). HIPAA privacy rule and sharing    Information related to mental health. Retrieved from http://www.hhs.gov/sites/default             /files/ocr/privacy/hipaa/understanding/speail/mhguidencepdf.pdf

    Loewenberg, F. M.; Dolgoff, R. & Harrington, D. (2000). Ethical decisions for social work          practice, 6th edition. Itasca, IL: F. E. Peacock.

    McClanahan, K. K. (2014) Can confidentiality be maintained in group therapy? Retrieved            from http://nationalpsychologist.com/2014/07/can-confidentaility-be-maintained-in-       group-therapy/102566.html

     

    Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples – 4

    During this week’s group and family therapy sessions, I have been able to witness how different these sessions are compared to individuals’ sessions from previous class. Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples. Some of the differences and challenges, I noted were in relation to different groups and family’s dynamics and issues 

    issues 
    like 
    group
     members 
    privacy and 
    confidentiality.
    It’
    s
     very importance to maintain confidentiality during group or family session to have trust 
    and 
    maintain cohesion failure to which can have major legal and ethical consequences. According to Letitia, Thomas & Emily (2013) as group treatment gains popularity, so does the awareness of the ethical dilemmas that often pose more of a problem in group treatment than in individual therapy. Confidentiality, for one, is an issue warranting much-needed attention in groups. Although therapists are ethically and legally bound, there are no standard rules in place for members of a group engaging in therapeutic dialogue. To reduce the fear surrounding violations of confidentiality, it is speculated that enhancing cohesion and trust among group members will put members at ease. 
    C
    onfidentiality is a cornerstone of healthy therapeutic relationships and effective treatment and is based upon the ethical principles of autonomy and fidelity, and to a lesser degree, beneficence and nonmaleficence. Group members should be encouraged to embrace the concept of confidentiality, making it their own rather than a rule the group therapist has mandated. When new group members join an ongoing group, they may be asked to sign or may have already signed a contract attesting to their commitment to 
    confidentiality
     (
    McClanahan
    , 
    2014
    ).
     

    There are several ethical standards that differential group from individual therapy. 
    According
     Corey et al., (2014) 
    it’s
     
    important
     to scr
    een
     clients in group therapy to ensure that they are in the right group for the topics being discussed and on the same token, screening client ensures that they and their issues are a good fit for the therapist and their level of expertise and experience with those issues is important. 
     Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples.

    One of the issues 
    addressed
     in this 
    week’s 
    video
     
    assignment was how to 
    address 
    client’s 
    confidential
     
    information
     
    in case
     of court 
    subpoena. Each S
    tate and on rare occasional county
     
    addresses
     this issue 
    differently
     and 
    it’s
     on us 
    as therapists
     to stay 
    up to
     date with their jurisdiction mandate. Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples. As already noted, group and family therapy require a different level of 
    confidentiality
     compared to individual therapy session. These differences have major impact on therapy and how the 
    sessions
     are 
    conducted
     including the rules and group members obligations to each other. Therapists 
    must
     consider the group dynamic and objective while ensuring that each individual client in the 
    group is catered 
    for (
    Cottone
     
    & 
    Tarvydas
    ,
     
    2016)
    . 
     

      

    References

    Corey, G., Schneider-Corey, M., & Haynes, R. (2014). 
    Groups in action: Evolution and 
    challenges 
    (2nd ed.). Belmont, Ca: Brooks/Cole.
     

    Cottone, R. R., & 
    Tarvydas
    , V. (2016). 
    Ethics and decision making in counseling and 
    psychotherapy., 4th ed
    . New York, NY, US: Springer Publishing Co.
     

    Letitia, E., Thomas, W., & Emily, E., (2013) Confidentiality and Cohesion in Groups: 
     
    Collaborative Story Building and Telling as a Means of Improving the Therapeutic 
    Experience.  Eastern Group Psychotherapy Society. Vol. 36, No. 4 (Winter 2013), pp. 
     
    317-331
     . Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples.

    McClanahan, K. K. (2014). 
    Can confidentiality be maintained in group therapy?
     Retrieved from  
    http://nationalpsychologist.com/2014/07/can-confidentiality-be-maintained-in-group-
     
    therapy/102566.html
     

     

    Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples – 5

    Psychotherapy is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior and overcome problems in desired ways. Psychotherapy aims to improve an individual’s well being and mental health to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills (Psychotheraphy, 2018). Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples.

    The role of psychotherapy is to facilitate the client’s work in ways which respect the client’s values, personal resources and capacity for self determination. The aim is to empower clients and encourage them to take control of their lives. Only when both therapist and client explicitly agree to enter into a therapy relationship does it become psychotherapy (Stefanazzi, 2018).

    Ethics are important, because they provide a map, a science of morality, which can support us to determine where our duty lies, what is the right course of action to take, that will cause no harm, and is not limited to personal advantage (Stefanazzi, 2018). Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples.

     

    References

    Stefanazzi, M. (2018). Psychotheraphy. 
    IHIAP
     .Retrieved from https://iahip.org/inside-out/issue-58-summer-2009/ethical-issues-in-psychotherapy

    Psychotheraphy. (2018). 
    Wikipedia
     .Retrieved from https://en.wikipedia.org/wiki/Psychotherapy

     

    Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples – 6

    Group therapy is a cost-effective choice for many patients without insurance (Wheeler, 2014). Group therapy provides therapists the opportunity to treat multiple patients at once allow greater access to treatment for clients (Wheeler, 2014).  Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples. Approaches for individual psychotherapy offer understanding of the client from an intrapsychic, interpersonal, humanistic-existential, or cognitive behavioral perspective while family therapy strives to understand the client in the context of a system (Wheeler, 2014). IN terms of family therapy, clients have lived most of their lives growing up in a family and starting a new family.

    In group and family therapy, information revealed to the therapist as well as to other group members. Legal and ethical considerations differ from those of individual therapy. Therapists have the responsibility to inform all group participants of the need for confidentiality, potential consequences of breaching confidentiality, and that legal privilege does not apply to group discussions (Mclanahan, 2014).

    Confidentiality should be discussed with group members prior to entering the group therapy session. Potential group members should be informed that therapists may have a legal obligation to break confidentiality in certain circumstances such as a group member verbalizing intent to harm self or others. Therapists can assure confidentiality within the constraints of the law but, are unable to promise that other group members will maintain confidentiality (Mclanahan, 2014). Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples. In most states, privileged communication does not exist in group settings due to the third-party rule, which states that information revealed in front of a third party was not intended to be private and is not privileged (Mclanahan, 2014). So, group members can testify against other group members regarding information that was revealed in group. In order to help maintain confidentiality, group members must embrace the concept of confidentiality and trust that other members will not reveal information discussed within the constraints of the law. In my own practice in the future, I will educate all members of my psychotherapy groups that is essential to maintain confidentiality to promote trust within the group.

    References:

    Mclanahan, K., (2014). 
    Can confidentiality be maintained n group therapy?
     Retrieved from https://nationalpsychologist.com/2014/07/can-confidentiality-be-maintained-in-group-therapy/102566.html

    Wheeler, K. (Ed.). (2014). 
    Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice.
     New York, NY: Springer. Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples.

     

    Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples – 7

    Group Therapy Premise

    Group therapy is formulated under several historical assumptions of human behavior and relationship. Fehr & Gaska (2013), explains that psychological basis for group dynamic stems from earlier philosophies regarding the inner circle as in ancient Chinese philosophy, to Rudolph Dreikurs’ group benefit philosophy. The group therapy model harness tribal instincts that may perhaps illicit benefits to the entirety of a tribe, but also reap benefits for the individual.

    Besides the inherent differences, group therapy compared to individual therapy helps the individual’s identity and personality emerge. Individuals may exhibit personalities that are different given the social conditions or environment ( Fehr & Gaska, 2013). For example, in a group setting, there can be social requirements, whether explicit or not, in order to progress a given interaction. The group dynamic helps people understand how they may shape the environment, and the environment could influence them ( Fehr & Gaska, 2013). For the sake of practicality, a group therapy model provides a greater simulation of the real-world. As in individual psychotherapy, there are many modalities that have been described and developed. Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples.  However, not all are necessarily accepted by professionals.

    Legal and Ethical Implications

    Legal and ethical implications are especially concerning due to an increase in participating parties in group therapy. Unlike individual therapeutic relationships, where the client is reliant of the therapist for confidentiality, group dynamics require all participating members to adhere to ethical conducts. The Health Insurance Portability and Accountability Act (HIPPA), outlines the responsibilities of clients, and providers in order to maintain privacy. Only under the patient’s discretion, or extreme circumstances can health information be shared (U.S. Department of Health & Human Services, 2014). Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples. However, confidentiality under the third party rule may not legally bind other participants within the group to the same standards as between the therapist and his or her clients (McClanahan, 2014). Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples.

    Approaches to Group Therapy Implications

    The impact of these requirements require that the therapist take an active role in clearly establishing rules of conduct among group members. It may also be prudent to remove individuals when they are harmful to the standards of therapeutic relationships set forth. If members are known to be discussing the health and care of other members, while not illegal, it could be detrimental a trusting environment. Signed agreements can help hold members accountable, such that participants are given the rules beforehand and agree that they can be removed if they infringed on those prior agreements. Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples.

    Fehr, S. S., & Gaska, J. M. (2013). 
    Introduction to group therapy : a practical guide
    . New York, New York ; Oxfordshire, England : Routledge, 2013.

    McClanahan, K. K. (2014). 
    Can confidentiality be maintained in group therapy?
     Retrieved from http://nationalpsychologist.com/2014/07/can-confidentiality-be-maintained-in-group-therapy/102566.html

    U.S. Department of Health & Human Services. (2014). 
    HIPAA privacy rule and sharing information related to mental health.
     Retrieved from http://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/special/mhguidancepdf.pdf. Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Samples.

  • Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree

    Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree

    Assignment 1: Practicum: Decision Tree

    For this Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting symptoms of a mental health disorder.

    Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree Learning Objectives

    Students will:

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    Evaluate clients for treatment of mental health disorders

    Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders

    The Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree:

    Examine 
    Case 2
    : 
    You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.

    At each Decision Point, stop to complete the following:

    Decision #1: Differential Diagnosis

    Which Decision did you select?

    Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

    What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

    Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different? Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree.

    Decision #2: Treatment Plan for Psychotherapy

    Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

    What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

    Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?

    Decision #3: Treatment Plan for Psychopharmacology

    Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

    What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

    Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different? Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree.

    Also include how ethical considerations might impact your treatment plan and communication with clients and their families.

    Note:
     Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

     

    BACKGROUND

    Tyrel is an 8-year-old black male who is brought in by his mother for a variety of psychiatric complaints. Shaquana, Tyrel’s mother, reports that Tyrel has been exhibiting a lot of worry and “nervousness” over the past 2 months. She states that she notices that he has been quite “keyed up” and spends a great deal of time worrying about “germs.” She states that he is constantly washing his hands because he feels as though he is going to get sick like he did a few weeks ago, which kept him both out of school and off the playground. He was also not able to see his father for two weekends because of being sick. Shaquana explains that although she and her ex-husband Desmond divorced about 2 years ago, their divorce was amicable and they both endeavor to see that Tyrel is well cared for.

    Shaquana reports that Tyrel is irritable at times and has also had some sleep disturbances (which she reports as “trouble staying asleep”). She reports that he has been more and more difficult to get to school as he has become nervous around his classmates. He has missed about 8 days over the course of the last 3 weeks. He has also stopped playing with his best friend from across the street. Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree.

    His mother reports that she feels “responsible” for his current symptoms. She explains that after he was sick with strep throat a few weeks ago, she encouraged him to be more careful about washing his hands after playing with other children, handling things that did not belong to him, and especially before eating. Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree. She continues by saying “maybe if I didn’t make such a big deal about it, he would not be obsessed with germs.”

    Per Shaquana, her pregnancy with Tyrel was uncomplicated, and Tyrel has met all developmental milestones on time. He has had an uneventful medical history and is current on all immunizations.

    OBJECTIVE

    During your assessment of Tyrel, he seems cautious being around you. He warms a bit as you discuss school, his friends at school, and what he likes to do. He admits that he has been feeling “nervous” lately, but when you question him as to why, he simply shrugs his shoulders.

    When you discuss his handwashing with him, he tells you that “handwashing is the best way to keep from getting sick.” When you question him how many times a day he washes his hands, he again shrugs his shoulders. You can see that his bilateral hands are dry. Throughout your assessment, Tyrel reveals that he has been thinking of how dirty his hands are; and no matter how hard he tries to stop thinking about his “dirty” hands, he is unable to do so. He reports that he gets “really nervous” and “scared” that he will get sick, and that the only way to make himself feel better is to wash his hands. Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree. He reports that it does work for a while and that he feels “better” after he washes his hands, but then a little while later, he will begin thinking “did I wash my hands well enough? What if I missed an area?” He reports that he can feel himself getting more and more “scared” until he washes his hands again.

    MENTAL STATUS EXAM

    Tyrel is alert and oriented to all spheres. Eye contact varies throughout the clinical interview. He reports his mood as “good,” admits to anxiety. Affect consistent to self-reported mood. He denies visual/auditory hallucinations. No overt delusional or paranoid thought processes were apparent. He denies suicidal ideation.

    Lab studies obtained from Tyrel’s pediatric nurse practitioner were all within normal parameters. An antistreptolysin O antibody titer was obtained for reasons you are unclear of, and this titer was shown to be above normal parameters.

    Decision Point One

    BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PMHNP GIVE TO TYREL?

    In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.

    Generalized Anxiety Disorder (GAD)

    Obsessive Compulsive Disorder

    Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (“PANDAS”)

    Decision Point One

     
    Generalized Anxiety Disorder (GAD)

    Decision Point Two

    Begin Paxil 10 mg orally daily

    RESULTS OF DECISION POINT TWO

     Client returns to clinic in four weeks

     Upon return to the clinic, Tyrel’s mother reported that he has had some decrease in his symptoms. She notices that he is still handwashing frequently, but thinks that the frequency has decreased “a bit.” Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree. She also reports that Tyrel has not fully embraced returning to school, but that his attendance has improved.

    Decision Point Three

    Increase Paxil to 20 mg orally daily

    Guidance to Student

    While GAD was not the actual diagnosis in this case, the child’s OCD symptoms did decrease with Paxil. Although Paxil is not FDA-approved for treatment of OCD in children, it is an SSRI like Sertraline and Fluvoxamine, which are FDA-approved for the treatment of OCD. So if there are no objectionable side effects and the symptoms appear to be decreasing, there may be no need to change drugs, but optimizing the dose may be a better choice. Augmentation with psychotherapy may also be useful, but the current dose of Paxil is still somewhat low, so augmenting with psychotherapy would be a good idea, but in and of itself would not be sufficient to meet this child’s needs.

    Finally, while the PMHNP could consider changing to Fluvoxamine, the “controlled release” preparation is not FDA-approved for use in children with OCD (see “Special Populations: Children and Adolescents” in the Fluvoxamine monograph of Stahl’s 
    Prescriber’s Guide
     for further details). Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree. Fluvoxamine 100 mg orally daily may not be tolerated in the morning secondary to the drug’s sigma-1 antagonist properties, which can cause sedation. Dosing of Fluvoxamine should be such that the larger dose is given in the evening to minimize daytime sedation.

    Decision Point Two

     

    Begin Zoloft 50 mg orally daily

    RESULTS OF DECISION POINT TWO

     Client returns to clinic in four weeks

     Upon return to the clinic, Tyrel’s mother reported that he has had some decrease in his symptoms. She notices that he is still handwashing frequently, but thinks that the frequency has decreased “a bit.” Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree. She also reports that Tyrel has not fully embraced returning to school, but that his attendance has improved. Tyrel’s mom is concerned about the decrease in Tyrel’s appetite. She reports that he has been having some decreased appetite and has complained of feeling “sick to his stomach.”

    Decision Point Three

    Change to Fluvoxamine controlled release 100 mg orally every morning

    Guidance to Student

    In terms of an actual diagnosis, the child’s main symptoms are most consistent with obsessive-compulsive disorder. There may also be an element of social phobia developing, but at this point, the PMHNP has not assessed the nature of the school avoidance—that is, why is the child avoiding school. Notice that nothing in the scenario tells us that the PMHNP has assessed this.

    Although the child had OCD and not GAD, Zoloft is FDA-approved to treat OCD in children. The starting dose is 25 mg orally daily. However, it is important to increase from the starting dose to an appropriate therapeutic dose to effectively manage symptoms. Starting at too high a dose can result in unfavorable side effects (gastrointestinal side effects are notable in this drug), and we can see that Tyrel is experiencing nausea and decreased appetite. In this case, it is recommended to wait to see if the side effects dissipate. Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree. Decreasing the dose to 12.5 mg orally daily for about 3 or 4 days, then going back to 25 mg orally daily may help to overcome the unfavorable side effects. If side effects persist, the PMHNP may need to consider switching to a different medication.

    Fluvoxamine controlled release is not FDA-approved for use in children with OCD (see “Special Populations: Children and Adolescents” in the Fluvoxamine monograph of Stahl’s 
    Prescribers Guide
     for further details). Fluvoxamine 100 mg orally daily may not be tolerated in the morning secondary to the drug’s sigma-1 antagonist properties, which can cause sedation. Dosing of Fluvoxamine should be such that the larger dose is given in the evening to minimize daytime sedation. It is also worth noting that nothing in the scenario tells us that the Zoloft will not be effective.

    Cognitive behavioral therapy is the psychotherapy of choice for treating OCD. However, in this case, the PMHNP assumed he/she was working with GAD, which may have delayed some of the work of CBT—that is, the focus of the sessions would have focused on the obsessive thoughts/compulsive behaviors versus a generalized anxiety. Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree. However, in this case, the diagnostic challenge made it difficult.

    Decision Point One

     
    Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (“PANDAS”)

    Decision Point Two

    Refer client to a pediatric neurologist

    RESULTS OF DECISION POINT TWO

     Client returns to clinic in four weeks

     You learn that the pediatric neurologist completed a comprehensive assessment on Tyrel, and although symptoms of OCD seem to have occurred after he was sick, and although antistreptolysin O titers were elevated, there is insufficient evidence for the diagnosis of PANDAS.

    Decision Point Three

    Begin Risperdal 0.5 mg orally twice a day

    Guidance to Student

    If the PMHNP believes that PANDAS is the most likely diagnosis, he or she should consider the nature of the disorder and the extent of the management, which may include high doses of steroids, the potential for plasma exchange therapy, and possibly monoclonal antibody therapy. A scope of practice considerations should be undertaken—that is, does the PMHNP have the necessary knowledge, skills, and abilities to undertake the care of this client? The PMHNP should consider working in collaboration with the pediatric neurologist to optimize outcomes for this client and his family. Although antistreptolysin O and other titers indicate recent alpha streptococci infection, it should be noted that these titers can remain elevated for weeks after the infection and do not necessarily represent the development of negative sequelae such as PANDAS.

    In terms of an actual diagnosis, the child’s main symptoms are most consistent with obsessive-compulsive disorder. There may also be an element of social phobia developing, but at this point, the PMHNP has not assessed the nature of the school avoidance—that is, why is the child avoiding school. Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree. Notice that nothing in the scenario tells us that the PMHNP has assessed this.

    Zoloft is FDA-approved to treat OCD in children. The starting dose is 25 mg orally daily. However, it is important to increase from the starting dose to an appropriate therapeutic dose to effectively manage symptoms. In this scenario, Fluvoxamine (immediate release) 25 mg orally daily would be the most appropriate agent.

    Week 7: Learning and Motor Disorders in Childhood

    “I had a substitute teacher today, so it was not a good day. She thought I was goofing off, but I could not help myself. As much as I tried to hold back, knowing she would freak out, I felt like a volcano. I erupted with a sound, kinda like a bullfrog that lasted for almost 10 minutes. She kept telling me to quiet down, but I could not help myself. Then the physical stretching and flexing of my neck started. She was really mad. Finally, my friend told her about me. It was embarrassing.”

    Samuel, age 9

    Learning disorders represent a diagnostic challenge in that many of the features of learning disorders overlap with ADHD. Appropriate diagnosis is essential to proper treatment. Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree. Motor disorders can be a source of considerable distress for both the child and their parents. Appropriate diagnosis is required in order to initiate the most appropriate treatment to minimize the impact of these conditions on the child.

    This week, you work with your group again to develop a Parent Guide for an assigned learning or motor disorder. For your practicum, you examine the practice of voluntary and involuntary commitment of children and adolescents with mental health disorders.

    Photo Credit: PT Images

    Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree Learning Resources

    Note:
     To access this week’s required library resources, please click on the link to the Course Readings List, found in the 
    Course Materials
     section of your Syllabus.

    Required Readings

    American Nurses Association. (2014).
    Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.)
    . Washington, DC: Author.

    Standard 9 “Evidence-Based Practice and Research” (pages 71-72)

    Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).
    Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry
    (11th ed.). Philadelphia, PA: Wolters Kluwer.

    Chapter 4, “Theories of Personality and Psychopathology” (pp. 151–191)

    Chapter 31, “Child Psychiatry” (pp. 1181–1205)

    American Psychiatric Association. (2013).
    Diagnostic and statistical manual of mental disorders
    (5th ed.). Washington, DC: Author.

    “Neurodevelopmental Disorders”

    “Specific Learning Disorder”

    “Motor Disorders”

    Note:
    You will access this book from the Walden Library databases.

    Murphy, T. K., Lewin, A. B., Storch, E. A., Stock, S. (2013). Practice parameter for the assessment and treatment of children and adolescents with tic disorders.
    Journal of the American Academy of Child & Adolescent Psychiatry
    ,
    52
    (12), 1341–1359. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00695-3/pdf

    McGarvey, E. L., Leon-Verdin, M., Wancheck, T. N., & Bonnie, R. J. (2013). Decisions to initiate involuntary commitment: The role of intensive community services and other factors.
    Psychiatric Services
    ,
    64
    (2), 120–126.

    Note:
    You will access this article from the Walden Library databases.

    Kaltiala-Heino, R. (2010). Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree . Involuntary commitment and detainment in adolescent psychiatric inpatient care.
    Social Psychiatry and Psychiatric Epidemiology
    ,
    45
    (8),785–793. doi:10.1007/s00127-009-0116-3

    Note:
    You will access this article from the Walden Library databases.

    Lindsey, M. A., Joe, S., Muroff, J., & Ford, B. E. (2010). Social and clinical factors associated with psychiatric emergency service use and civil commitment among African-American youth.
    General Hospital Psychiatry
    ,
    32
    (3)
    ,
    300–309. doi:10.1016/j.genhosppsych.2010.01.007

    Note:
    You will access this article from the Walden Library databases.

    Stahl, S. M. (2014).
    Prescriber’s Guide: Stahl’s Essential Psychopharmacology
    (5th ed.). New York, NY: Cambridge University Press.

     

    Note:
    All Stahl resources can be accessed through the Walden Library using the link. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear.

     

    To access information on the following medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication. Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree.

    Review the following medications:

    Tourette syndrome

    Pervasive developmental disorders

    clonidine

    haloperidol

    pimozide

    guanfacine

    Note:
     Many of these medications are FDA approved for adults only. Some are FDA approved for disorders in children and adolescents. Many are used “off label” for the disorders examined in this week. As you read the Stahl drug monographs, focus your attention on FDA approvals for children/adolescents (including “ages” for which the medication is approved, if applicable) and further note which drugs are “off label.”

    Optional Resources

    Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015).
    Rutter’s child and adolescent psychiatry
    (6th ed.). Hoboken, NJ: Wiley Blackwell.

    Chapter 47, “Children With Specific Sensory Impairments” (pp. 612–622)

    Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree Discussion: Parent Guide

    Learning disorders and motor disorders can be difficult for parents to understand. They often have many questions that go unanswered and can create considerable misunderstanding. This misunderstanding can damage the child/parent relationship. The PMHNP can answer questions and provide guidance for the family in order to help reduce the uncertainty of the disorders.

    For the Discussion, you will work with your group again to develop a Parent Guide for your assigned disorder.

    Learning Objectives

    Students will:

    Analyze signs and symptoms of learning and motor disorders in childhood

    Analyze pathophysiology of learning and motor disorders in childhood

    Analyze diagnosis and treatment methods for learning and motor disorders in childhood

    Evaluate Parent Guides

    To Prepare for this Discussion:

    Your Instructor will assign you to a group and a disorder by Day 1 of Week 2.

    Review the resources concerning your assigned disorder.

    Use your group’s Discussion Board to design and develop the Parent Guide before posting to the group wiki. For further guidance, refer to the 
    Accessing Group Discussions
     instructions below. Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree.

    Using evidence-based research, design and develop a Parent Guide for your assigned disorder including:

    Signs and symptoms

    Pathophysiology

    How the disorder is diagnosed

    Treatment options

    Provide a minimum of three academic references.

    By Day 5

    One designated group member
     should post the completed Parent Guide to the Discussion.

    By Day 7

    Respond
     to at least 
    two
     other groups’ wikis by providing at least two contributions for improving or including in their Parent Guide and at least two things that you like about their guide. Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree.

    Submission and Grading Information

    Accessing Group Discussions and Wikis

    To access your group’s discussion
    , click on the 
    Parent Guide Groups
     link. Once you have clicked on the link, select your assigned team (e.g., Team A, Team B, Team C, etc.) to access your team’s home page. Select 
    Group Discussion Board
     under the Group Tools menu to work on your participate in your group’s discussion.

    To access your group’s wiki
    , click on the 
    Parent Guide Groups
     link. Once you have clicked on the link, select your assigned team (e.g., Team A, Team B, Team C, etc.) to access your team’s home page.

    Creating a Wiki Page

    Create the first wiki topic page by entering the group’s wiki area and selecting 
    Create Wiki Page
    . Use the group’s assigned disorder as the name of your wiki. Then add your Parent Guide in the Content text box. You can use the editor functions to format the text and include files, images, web links, multimedia, and mashups. Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree Select 
    Submit
     when you have completed the wiki page.

    Grading Criteria

    To access your rubric:

    Week 7 Parent Guide Discussion Rubric

    To access your group discussion / wiki:

    Parent Guide Groups

    Post to Discussion by Day 5 and Respond by Day 7

    To participate in this Discussion:

    Parent Guide Groups – Week 7

    Assignment 1: Practicum Journal: Voluntary and Involuntary Commitment

    PMHNPs may find themselves working in a wide variety of settings—each having their own unique challenges and inherent legal issues. For instance, what do you do in your state of practice when you are providing a therapy/treatment session and a client reports active suicidal ideation? What do you do if you are covering inpatient psychiatric consults and are called to see a patient in the ICU who overdosed on prescription medication requiring intubation? Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree What do you do if you are a PMHNP on an inpatient unit and a client who admitted themselves on a voluntary basis suddenly states that they have decided to sign themselves out of the hospital so that they can go home to kill themselves? These are just some of the legal questions that PMHNPs must know the answers to specific to their state of licensure/practice.

    In this Assignment, you investigate your state’s laws concerning voluntary and involuntary commitment. You also analyze a case to determine if the client is eligible for involuntary commitment.

    Scenario for Week 7 Case:

    You are a PMHNP working in a large intercity hospital. You receive a call from the answering service informing you that a “stat” consult has been ordered by one of the hospitalists in the ICU. Upon arriving in the ICU, you learn that your consult is a 14 year old male who overdosed on approximately 50 Benadryl (diphenhydramine hydrochloride) tablets in an apparent suicide attempt. At the scene, a suicide note was found indicating that he wanted to die because his girlfriend’s parents felt that their daughter was too young to be “dating.” The client stated in the suicide note that he could not “live without her” and decided to take his own life. Although he has been medically stabilized and admitted to the ICU, he has been refusing to talk with the doctors or nurses. The hospital staff was finally able to get in touch with the clients parents (using contact information retrieved from the 14 year old’s cell phone). Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree. Unbeknown to the hospital staff, the parents are divorced, and both showed up at the hospital at approximately the same time, each offering their own perspectives on what ought to be done. The client’s father is demanding that the client be hospitalized because of the suicide, but his mother points out that he does not have “physical custody” of the child. The client’s mother demands that the client be discharged to home with her stating that her son’s actions were nothing more than a “stunt” and “an attempt at manipulating the situation that he didn’t like.” The client’s mother then becomes “nasty” and informs you that she works as a member of the clerical staff for the state board of nursing, and if you fail to discharge her child “right now” she will make you “sorry.” How would you proceed?

    Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree Learning Objectives

    Students will:

    Evaluate clients for voluntary commitment

    Evaluate clients for involuntary commitment based on state laws

    Recommend actions for supporting parents of clients not eligible for involuntary commitment

    Recommend actions for treating clients not eligible for involuntary commitment

    To Prepare for this Practicum:

    Review the Learning Resources concerning voluntary and involuntary commitment.

    Read the Week 7 Scenario in your Learning Resources.

    Research your state’s laws concerning voluntary and involuntary commitment.

    The Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree (2–3 pages):

    Based on the scenario, would you recommend that the client be voluntarily committed? Why or why not?

    Based on the laws in your state, would the client be eligible for involuntary commitment? Explain why or why not.

    Did understanding the state laws confirm or challenge your initial recommendation regarding involuntarily committing the client? Explain.

    If the client were not eligible for involuntary commitment, explain what actions you may be able to take to support the parents for or against voluntary commitment.

    If the client were not eligible for involuntary commitment, explain what initial actions you may be able to take to begin treating the client.

    By Day 7

    Submit 
    your Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree Assignment.

    Submission and Grading Information

    To submit your completed Assignment for review and grading, do the following:

    Please save your Assignment using the naming convention “WK7Assgn1+last name+first initial.(extension)” as the name.

    Click the 
    Week 7 Assignment 1 Rubric 
    to review the Grading Criteria for the Assignment.

    Click the 
    Week 7 Assignment 1 
    link. You will also be able to “View Rubric” for grading criteria from this area.

    Next, from the Attach File area, click on the 
    Browse My Computer
     button. Find the document you saved as “WK7Assgn1+last name+first initial.(extension)” and click 
    Open
    . Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree.

    If applicable: From the Plagiarism Tools area, click the checkbox for 
    I agree to submit my paper(s) to the Global Reference Database
    .

    Click on the 
    Submit
     button to complete your submission.

    Grading Criteria

    To access your rubric:

    Week 7 Assignment 1 Rubric

    Check Your Assignment Draft for Authenticity

    To check your Assignment draft for authenticity:

    Submit your Week 7 Assignment 1 draft and review the originality report.

    Submit Your Assignment by Day 7

    To submit your Assignment:

    Week 7 Assignment 1

    Assignment 2: Practicum: Week 5 Decision Tree

    By Day 7

    Submit 
    your Assignment. Refer to Week 5 for additional guidance.

    Submission and Grading Information

    To submit your completed Assignment for review and grading, do the following:

    Please save your Assignment using the naming convention “WK7Assgn2+last name+first initial.(extension)” as the name.

    Click the 
    Week 7 Assignment 2 Rubric 
    to review the Grading Criteria for the Assignment.

    Click the 
    Week 7 Assignment 2 
    link. You will also be able to “View Rubric” for grading criteria from this area.

    Next, from the Attach File area, click on the 
    Browse My Computer
     button. Find the document you saved as “WK7Assgn2+last name+first initial.(extension)” and click 
    Open
    . Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree.

    If applicable: From the Plagiarism Tools area, click the checkbox for 
    I agree to submit my paper(s) to the Global Reference Database
    .

    Click on the 
    Submit
     button to complete your submission.

    Grading Criteria

    To access your rubric:

    Week 7 Assignment 2 Rubric

    Check Your Assignment Draft for Authenticity

    To check your Assignment draft for authenticity:

    Submit your Week 7 Assignment 2 draft and review the originality report.

    Submit Your Assignment by Day 7

    To submit your Assignment:

    Week 7 Assignment 2

    Assignment 3: Board Vitals

    This week you will be responding to twenty Board Vitals questions that cover a broad review of your Nurse Practitioner program courses up to this point.

    These review questions will provide practice that is critical in your preparation for the national certification exam that’s required to certify you to practice as a nurse practitioner. Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree. These customized test questions are designed to help you prepare for your Nurse Practitioner certification exam. It is in your best interest to take your time, do your best, and answer each question to the best of your ability.

    You can access Board Vitals through the link sent to you in email or by following the link below:

    https://www.boardvitals.com/

    By Day 7

    Complete the Board Vitals questions.

    Practicum Reminder

    Time Logs

    You are required to keep a log of the time you spend related to your practicum experience 
    and enter every patient you see each day
    . You can access your time log from the Welcome Page in your Meditrek account. You track time individually for each patient you work with. Please make sure to continuously input your hours throughout the term.

    Making Connections

    This week, you worked with your group to develop a Parent Guide for an assigned learning or motor disorder. For your practicum, you examined the practice of voluntary and involuntary commitment of children and adolescents with mental health disorders.

    Anxiety disorder, OCD – Tyrel Essay Assignment Decision Tree Next week, you will debate the theory that bipolar depression can or cannot be diagnosed in children and adolescents.

  • PICO Analysis of Delirium Sample Essay

    PICO Analysis of Delirium Sample Essay

    With the aging of our population, cognitive aging has emerged as a leading public health concern. In a 2014 AARP survey, 93% of respondents identified maintaining brain health as a top priority (Inouye, 2015). Yet a substantial void exists in the fundamental understanding of the cognitive aging process and its distinction from cognitive impairments such as delirium and dementia-related conditions. Nearly one third of the older population in the United States is hospitalized each year in relation to acute illness or surgery, and delirium is the most common complication of hospitalization in older persons, and it occurs in an estimated 2.6 million of older adults each year. Delirium has been identified as a leading contributor to short and long term cognitive decline after hospitalization, and at least 40% of these cases are preventable when identified. PICO Analysis of Delirium Sample Essay. The purpose of this analysis is to ascertain a PICO question related to delirium, identify resources used to find supportive literature, review the supportive information, and create an evidence-based table summarizing the data to determine the best delirium screening options.

    ORDER A PLAGIARISM-FREE PAPER HERE

    PICO Question

    In older adult patients with delirium (P), what are the best delirium screening tools (I) compared to the Diagnostic and Statistical Manual or International Classification of Diseases used in defining the diagnosis of delirium (C) to improve early detection and management in older adult patients with delirium (O)?

    Search Strategy

    To find research to support the chosen PICO question, electronic databases such as CINAHL, Google Scholar, PubMed, PsychInfo, and Medline were used. The Hartford Institute for Geriatric Nursing, the American Geriatrics Society as well as the book
    Evidence-Based Geriatric Medicine
    were also used as resources. PICO Analysis of Delirium Sample Essay. The following keywords and phrases were used to search: delirium screening tools, aging, older adults, geriatric, and primary care setting. Articles that were older than five years old as well as secondary sources were excluded.  Articles that applied to the geriatric population, and analyzed the various delirium screening tools and met the criteria were included. The following Boolean search strings were used: delirium screening tools systematic review, and delirium and aging.

     

    Analysis of Literature

    Evidence Table

    Citation

    Conceptual Framework

    Finding

    Research Method

    Implications of Literature Review

    Level of Evidence

    O’Sullivan, D., O’Regan, N. A., & Timmons, S. (2016). Validity and Reliability of the 6-Item Cognitive Impairment Test for Screening Cognitive Impairment: A Review. 
    Dementia and Geriatric Cognitive Disorders
    , 
    42
    (1-2), 42-49. doi:10.1159/000448241. PICO Analysis of Delirium Sample Essay.

     

    Descriptive Theory

    The
    Six-Item Cognitive Impairment Test (6-CIT)
    has been suggested as a useful dementia screening instrument in primary care. The studies on the 6-CIT in primary care present conflicting results and all 3 have significant variations in their selection of cases/reference standards used.

    Systematic Review of Literature

     Although researchers have investigated its accuracy in diagnosing cognitive impairment in primary and secondary care settings, its validity in primary care use has been questioned and there are limited validation studies on its use in secondary care. In addition, the cut-offs used in 2 of the studies favored specificity over sensitivity, which is not desirable for a screening test. The authors recommend that larger studies, which test the psychometric properties of the 6-CIT in primary and acute care settings, are conducted to establish recommendations for routine screening use.

    Level I

    De, J. & Wand, A. (2015). Delirium Screening: A Systematic Review of Delirium Screening Tools in Hospitalized Patients,
    The Gerontologist
    , 55(6), 1079–1099. Retrieved from https://doi.org/10.1093/geront/gnv100. PICO Analysis of Delirium Sample Essay

    Descriptive Theory

    Thirty-one studies describing 21 delirium screening tools were included in the systematic review. Most studies were conducted across a broad range of inpatient settings internationally in elderly inpatients, including patients with dementia but most excluded nonnative language speakers.

    Systematic Review of Literature

    The Confusion Assessment Method was the most widely used instrument to identify delirium, however, specific training is required to ensure optimum performance. The Delirium Rating Scale and its revised version performed best in the psychogeriatric population but requires an operator with psychiatric training. The Nurses’ Delirium Screening Checklist appears best suited to the surgical and recovery room setting. The Single Question in Delirium shows promise in oncology patients. The Memorial Delirium Assessment Scale, while demonstrating good measures of validity in the surgical and palliative care setting, may be better used a measure of delirium severity. The 4As Test performed well when delirium was superimposed on dementia, but it requires further study.

    Level I

    PICO Analysis of Delirium Sample Essay

    Iatraki, E. et al. (2017). Cognitive screening tools for primary care settings: examining the ‘Test Your Memory’ and ‘General Practitioner assessment of Cognition’ tools in a rural aging population in Greece.
    European Journal of General Practice
    , 23(1), 171-178. Retrieved from http://dx.doi.org/10.1080/13814788.2017.1324845

    Predictive Theory

    The ‘
    Test Your Memory’ (TYM)
    and
    ‘General Practitioner assessment of Cognition’ (GPCog)
    instruments appear to be suitable for routine use in the primary care setting as tools for cognitive impairment risk detection in elderly rural populations.

     

    Randomized Control Trials (RCT)

    PICO Analysis of Delirium Sample Essay

    The clinical validity of TYM/GPCog was assessed through comparison with a screening test that was used to establish risk for cognitive impairment instead of clinical diagnosis of dementia. Although, MMSE is widely used and considered by many as the gold-standard instrument for dementia screening, it has far from perfect sensitivity or specificity. The limited gender and education-level susceptibility of GPCog render it preferable over TYM for routine use in primary care settings in accordance with a growing number of studies in other cultures.

    Level II

    Bellelli, G., Morandi, A., Davis, D. H. J., Mazzola, P., Turco, R., Gentile, S., … MacLullich, A. M. J. (2014). Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people. Age and Ageing, 43(4), 496–502. http://doi.org/10.1093/ageing/afu021. PICO Analysis of Delirium Sample Essay

    Prospective Study

    The
    4AT
    screening tool is a sensitive and specific method of screening for delirium in older people. Its brevity and simplicity support its use in routine clinical practice.

    Cross-Sectional Observation Study

    A strength of this study is the provision of a clear description of exactly how the delirium diagnosis was obtained, detailing the procedure which informed scoring by DSM-IV-TR criteria. Some limitations of this study must be acknowledged. The 4AT assessments were performed by experienced physicians, though no specific training in the 4AT was given. Further research is needed to assess the ease of use of 4AT among other professional groups of varying levels of seniority. The clinical outcomes in relation to ‘possible delirium’ as assessed by the 4AT was not studied.

     

    Level II. PICO Analysis of Delirium Sample Essay

    Fick, D. & Mion, L. (2013). Assessing and Managing Delirium in Older Adults with Dementia. Retrieved from https://consultgeri.org/try-this/dementia/issue-d8.pdf

     

    Geriatric Models of Care

    The Hartford Institute states that the best tools for delirium screening in the older adult population are the
    Confusion Assessment Method (CAM)
    algorithm, which relies on the presence of acute onset of symptoms and a fluctuating course, inattention, and either disorganized thinking or an altered level of consciousness; and the
    Delirium Superimposed on Dementia Algorithm (DSDA)
    is recommended for delirium for people with a pre-existing dementia (Fick and Mion, 2013).

    Evidence-Based Practice Guidelines (systematic reviews, RCTs, Cohorts)

    PICO Analysis of Delirium Sample Essay

    While the CAM is a useful tool, the Delirium Superimposed on Dementia Algorithm recognizes that the patient’s baseline mental status is a critical parameter for assessing and treating delirium. The algorithm presents practical ways for bedside nurses to assess delirium and CAM features such as poor attention and fluctuation. The algorithm can be used with patients with dementia who present to the hospital without previous medical evaluation, and/or family members who cannot describe the patient’s mental status pre-hospitalization, who are at increased risk for undetected delirium. The algorithm helps address ageism, a significant barrier to detecting the presence of delirium, wherein clinicians attribute further cognitive loss or lethargy in a person with dementia as an inevitable fact of life for older adults.

    Level I

     

    Purpose of Research Paper

    Delirium is a common, often underdiagnosed, geriatric syndrome characterized by an acute change in attention and consciousness. The elderly population, especially those who are age 70 and older are particularly vulnerable to delirium than those younger due to changes in brain function, multiple general medical problems, polypharmacy, reduced hepatic metabolism of medications, multisensory declines, and brain disorders such as dementia. Polypharmacy is very common in the elderly, and the possibility of drug-drug interactions must be considered as a cause of agitation. PICO Analysis of Delirium Sample Essay. According to Rosen et al (2015), Delirium is frequently seen in older patients in the emergency department (ED), is under-recognized, and has potentially serious consequences. About 7–17% of older adults who present to the ED suffer from delirium (Rosen, 2015). Delirium is a medical emergency with significant associated morbidity and mortality requiring rapid diagnosis and management. Delirium has been identified as a leading contributor to short and long term cognitive decline after hospitalization, and at least 40% of these cases are preventable. As a neuropsychiatric disorder with an underlying organic cause, delirium is known to occur as both an acute and subacute condition that carries significant morbidity and mortality. Combined with its association with dementia and aging, this makes delirium an important topic for primary care providers to become more familiar with as they are tasked with caring for an aging population (Setters and Solberg, 2017).

    Gaps in Existing Literature

    Presently, there are very few RCTs and studies assessing the effectiveness of delirium screening tools in older adults with delirium in primary care settings. Most of the research focused mostly in acute care/hospital settings. A role for routine delirium screening can be clarified through a well-designed delirium screening trial investigating the benefits of delirium screening, coupled with a multicomponent intervention versus usual care.  PICO Analysis of Delirium Sample Essay. It could be challenging to measure emotions and cognitive improvement in a consistent manner across patients. Studies are needed to rigorously evaluate the benefits and potential harms of screening in relation to multiple outcomes such as medical intervention requirements, preventive strategies, delirium reversibility, care needs and economic burden.

    Conclusion

    Despite the limitations on the available research, most data show that the Confusion Assessment Method is widely used, and can used in any clinical setting. And for the patients with underlying dementia conditions, then, the Delirium Superimposed on Dementia Algorithm is recommended per evidence-based practice guidelines. Poor attention is a key marker in delirium and delirium superimposed on dementia patients. In addition, evaluations of the elderly should include a comprehensive review of all drugs being taken, including those that are prescribed, and those taken OTC and herbals. Delirium is often multifactorial and requires an immediate medical attention. Health practitioners should make it a habit to evaluate elderly patients for signs of delirium in every clinical setting especially in primary care settings as it often overlooked. PICO Analysis of Delirium Sample Essay.

     

    References

    Alaglakrishnan, K. (2017). Delirium. Retrieved from

    http://emedicine.medscape.com/article/288890-overview

    Arcangelo, V. P., & Peterson, A. M. (2013). 
    Pharmacotherapeutics for advanced

    practice: A practical approach
     (3rd ed.). Philadelphia, PA: Lippincott Williams & Wilkins
    .

    Bellelli, G., Morandi, A., Davis, D. H. J., Mazzola, P., Turco, R., Gentile, S., … MacLullich, A. M. J. (2014). Validation of the 4AT, a

    new instrument for rapid delirium screening: a study in 234 hospitalised older people. Age and Ageing, 43(4), 496–502. http://doi.org/10.1093/ageing/afu021

    De, J. & Wand, A. (2015). Delirium Screening: A Systematic Review of Delirium Screening Tools in Hospitalized Patients,
    The

    Gerontologist
    , 55(6), 1079–1099. Retrieved from https://doi.org/10.1093/geront/gnv100

    Fick, D. & Mion, L. (2013). Assessing and Managing Delirium in Older Adults with Dementia. PICO Analysis of Delirium Sample Essay. Retrieved from https://consultgeri.org/try-this/dementia/issue-d8.pdf

    Fong, T. G., Tulebaev, S. R., & Inouye, S. K. (2009). Delirium in elderly adults: diagnosis,

    prevention and treatment. Nature Reviews. Neurology, 5(4), 210–220. http://doi.org/10.1038/nrneurol.2009.24

    Iatraki, E. et al. (2017). Cognitive screening tools for primary care settings: examining the ‘Test Your Memory’ and ‘General

    Practitioner assessment of Cognition’ tools in a rural aging population in Greece.
    European Journal of General Practice
    , 23(1), 171-178. Retrieved from http://dx.doi.org/10.1080/13814788.2017.1324845. PICO Analysis of Delirium Sample Essay.

    Inouye, S. K. (2015). Enhancing cognitive aging: clinical highlights of a report from the Institute of Medicine. 
    Annals Of Internal

    Medicine
    , 
    163
    (4), 307-310. doi:10.7326/M15-1228

    National Institute on Aging (2013). The Dementias: Hope through Research. Retrieved from https://www.nia.nih.gov/alzheimers/publication/dementias/treatment

    O’Sullivan, D., O’Regan, N. A., & Timmons, S. (2016). Validity and Reliability of the 6-Item Cognitive Impairment Test for Screening

    Cognitive Impairment: A Review. 
    Dementia and Geriatric Cognitive Disorders
    , 
    42
    (1-2), 42-49. doi:10.1159/000448241

    Rosen, T., Connors, S., Clark, S., Halpern, A., Stern, M. E., DeWald, J., & Flomenbaum, N. PICO Analysis of Delirium Sample Essay.  (2015). Assessment and Management of Delirium in Older Adults in the Emergency Department: Literature Review to Inform Development of a Novel Clinical Protocol. Advanced Emergency Nursing Journal, 37(3), 183–E3. http://doi.org/10.1097/TME.0000000000000066

    Setters, B., & Solberg, L. M. (2017). Delirium. 
    Primary Care
    , 
    44
    (3), 541-559. doi:10.1016/j.pop.2017.04.010. PICO Analysis of Delirium Sample Essay.

  • Cyclothymic Disorder Decision Tree Case Study Essay Assignment Example

    Cyclothymic Disorder Decision Tree Case Study Essay Assignment Example

    Assignment : Cyclothymic Disorder

    For this Cyclothymic Disorder decision tree case study essay assignment example, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat adult and older adult clients presenting symptoms of a mental health disorder.

    Learning Objectives

    Students will:

    Evaluate clients for treatment of mental health disorders

    Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders

    THE CASE STUDY

    Cyclothymic Disorder

    BACKGROUND

    SUBJECTIVE

    Stefanie is a 32-year-old female from Puerto Rico who presents to your office today with complaints of difficulty sleeping. You learn that Stefanie can go for a few days with minimal sleep (about 3 hours/night), but does not seem to be fatigued the next day. Stefanie explains that after 3 days with minimal sleep, she “crashes” and has a good night’s sleep. She states that sleep will be “alright” for a few days, even a few weeks, and then she will have a similar issue with sleep.

    You learn throughout the assessment process that Stefanie has had this problem for years. She noticed that it began in college and thought it was just because of the workload and academic demands. However, she found that it persisted after college. She also notices that she has periods where she will engage in increased amounts of goal-directed activity. She states that things will just “pile up” at work and she gets this burst of energy to “make everything right.” She states that these bursts will last most of the day. She states that these periods show up probably every 2 to 3 weeks. Cyclothymic Disorder decision tree case study essay assignment example.

    Stefanie also confesses to problems with being “down in the dumps.” She states that when she has her episodes in which she endeavors to “make everything right,” she feels fantastic and on top of the world. Cyclothymic Disorder decision tree case study essay assignment example. However, when these periods of energy end, she reports that she feels “depressed”—but then states: “well, maybe not depressed, but I definitely feel sad and empty.” She also endorses feelings of fatigue and a decreased ability to concentrate when she is feeling sad. She finally tells you: “I have lived with this for so long, I have to admit that it is finally a relief to tell someone how I feel!”

    OBJECTIVE

    Stefanie is dressed appropriately to the weather. She has no gait abnormalities. Physical assessment is unremarkable. Gross neurological assessment is within normal limits.

    MENTAL STATUS EXAM

    Stefanie is alert and oriented × 4 spheres. Her speech is clear, coherent, goal directed, and spontaneous. Self-reported mood is “sad.” Affect does appear consistent with dysphoria. Eye contact is normal. Speech is clear, coherent, and goal directed. She denies visual or auditory hallucinations. No overt evidence of paranoid or delusional thought processes noted. She denies suicidal or homicidal ideation and is future oriented. Cyclothymic Disorder decision tree case study essay assignment example.

    At this point, please discuss any additional diagnostic tests you would perform on Stefanie.

    1.Decision Point One

    Diagnosis: Cyclothymic disorder

    2.Decision Point Two: Begin Abilify 10mg orally daily

    RESULTS OF DECISION POINT TWO

    – Client returns to clinic in four weeks

    -Stefanie reports that her mood seems a bit more “stable.” She states that she notices that she has not been as “sad” since she started taking the medication. She does report that for the first 2 weeks, she noticed that whenever she went from a lying or sitting to a standing position, she felt “lightheaded.” Cyclothymic Disorder decision tree case study essay assignment example.

    -She does report that the side effect was quite concerning at times. However, she reports that this is no longer happening.

    3.Decision Point Three: Maintain current dose of Abilify

    Guidance to Student

    In order to meet the criteria for a major depressive episode, the client needs to have five or more symptoms (refer to DSM–5 major depressive episode criteria). She only demonstrates criteria # 1: depressed mood most of the day, nearly every day, as indicated by either subjective reports (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful); criteria # 6: “fatigue or loss of energy nearly every day”; and criteria # 8: “diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).” Thus, Stefanie does not meet the criteria for a major depressive episode as she only has three out of the needed five criteria for the diagnosis of a major depressive episode.

    In order to meet criteria for a hypomanic episode, the client needs to have a period of abnormally and persistently elevated, expansive, or irritable mood, and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day. Stefanie’s symptoms last 3 days. Additionally, during the period of mood disturbance, the person must have three or more of the qualifying symptoms. Cyclothymic Disorder decision tree case study essay assignment example. Stefanie only has an increase in goal-directed activity and distractibility. Thus, Stefanie does not meet criteria for a hypomanic episode as she only has a decreased need for sleep and an increase in goal-directed activity.

    Since Stefanie has symptoms of both hypomania and depression (but does not meet the criteria for a major depressive or hypomanic episode), and since these behaviors do not occur in the context of a drug/substance or medical condition, Stefanie meets the diagnostic criteria for cyclothymic disorder. Cyclothymic Disorder decision tree case study essay assignment example.

    Some providers will treat cyclothymic disorder with pharmacologic agents used to treat bipolar disorder because individuals with cyclothymic disorder have a higher risk of progression to bipolar disorder. However, there is no consensus in the literature as to the optimal treatment, or if prophylactic psychopharmacologic treatment is beneficial in consideration of the side effects associated with antipsychotics and mood stabilizers.

    Stefanie’s symptoms are most consistent with orthostatic hypotension, which is not uncommon when initiating Abilify. At this point, it sounds as if the side effects have subsided. There is nothing to tell us that we should increase the dose. Similarly, there is nothing in the case to tell us that we should discontinue the Abilify. Instead, routine monitoring should occur.

    The Assignment:

    .

    At each Decision Point, stop to complete the following:

    Decision #1: Cyclothymic disorder

    Which Decision did you select?

    o Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

    o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

    o Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?

    Decision #2: Treatment Plan for Psychotherapy

    o Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

    o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. Cyclothymic Disorder decision tree case study essay assignment example.

    o Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?

    Decision #3: Treatment Plan for Psychopharmacology

    o Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

    o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

    o Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different? Cyclothymic Disorder decision tree case study essay assignment example.

    Also include how ethical considerations might impact your treatment plan and communication with clients and their family.

     

    Psychiatric Mental Health Nurse Practitioner Role I1: Adult – NURS 6670 – Cyclothymic Disorder decision tree case study essay assignment example

     

                                         Decision #1: Differential Diagnosis

                                                     Cyclothymic disorder

                                                     Reason for this Decision

    Cyclothymic disorder is a mild form of bipolar disorder in which a patient has mood swings throughout two years. The patient has a fluctuating mood swing between depression and hypomania with irritability and a short period of regular activity in between. The patient may sometimes deny that a problem exists. The Cyclothymic disorder starts in adolescence with 15 to 50 percent possibility of developing bipolar type 1 (Tracy, 2012). Patient with this disorder is known to abuse alcohol and other substance abuse. The patient also has a history of multiple religious cults and dilettantism (Saddock, Sadock & Pedro, 2014).   Cyclothymic Disorder decision tree case study essay assignment example.

                What was Hoping to Achieve by Making this Decision

    The patient (Stephanie) is a 32-year-old Hispanic female from Puerto Rican. She is well dressed for the weather. Stephanie is alert oriented x 4. Her speech is clear, spontaneous, goal-directed and coherent. Her gross neurological assessment is within reasonable limits with a steady gait. She denies any homicidal or suicidal ideation. No auditory or visual hallucinations reported (Laureate Education, 2017d).

    Patient Stephanie has been having the following issues for the past two years. She complains of sleeping about 3 hours for few days without being tired and other days have a good night sleep. She experiences period depression now and then, hypomanic phases with enhanced energy, fatigue, sad when unable to concentrate or think good. Cyclothymic Disorder decision tree case study essay assignment example. She had distractibility and enhanced goal-directed activity. Patient symptoms are indicative of cyclothymic disorder (Laureate Education, 2017d).

    Difference between Expected outcome and Achieve outcome with Decision #1

    There is no difference between the expected outcome and the achieve an outcome. The Patient symptoms of mood swings between hypomania and depression, fatigue, high energy, distractibility, decrease the need for sleep and enhanced goal-directed activity are indicative of Cyclothymic disorder
    .

                                     Decision #2: Treatment Plan for Psychotherapy

    Begin Abilify 10mg orally daily

                                                    Reason for this Decision

    Abilify is known to be effective with improving psychotic and manic symptoms within a week but take several weeks for full effect on behavior, cognition and affective stabilization. It increases dopamine output when the concentrations are low, consequently enhancing cognitive, behavioral and affective symptoms. It also reduces dopamine output when the concentrations are high, therefore improving mediating antipsychotic actions and positive symptoms (Stahl, 2014). Cyclothymic Disorder decision tree case study essay assignment example.

    The efficacy of the medication shows between 4–6 weeks for some patient but takes up to 16–20 weeks to show the effect on cognitive symptoms. Educating the patient about the side effect of the medication is crucial. Cyclothymic Disorder decision tree case study essay assignment example. The following baseline of blood pressure, weight, fasting plasma glucose, and fasting lipid profile must be taken and check within three months after starting the medication (Stahl, 2014).The patient is educated about the medication and the side effects (dizziness, hypotension, sedation, nausea, vomiting, headache.

    The patient will be informed to go for psychotherapy because it increased patient awareness of their diagnosis and helped cope with their mood swings. Cyclothymic Disorder decision tree case study essay assignment example. It also helps to prevent full-blown manic attacks from happening (Saddock, Sadock & Ruiz, 2014).

                What was Hoping to Achieve by Making this Decision?

    The aim of giving the patient Abilify is to help stabilize her mood and ability to think well and prevent a full-blown manic attack from happening. When the patient returns for follow up, she will express feeling a little better.

    The Difference between what is Expected and the Achieve outcome with Decision #2

    The expected outcome and achieved outcome are the same. The medication was reduced the symptoms of cyclothymic disorder and the side effect was expected. The patient returned to the clinic for follow-up after four weeks and reported that the medication had helped her not feel sad, but she noted some dizziness which had subsided.

    Decision #3: Treatment Plan for Psychopharmacology

                                                Decision Point Three

                                         Maintain current dose of Abilify

    Reason for Decision

    It is crucial to continue with the same dosage of medication because the patient is doing fine, and the side effect of drugs had disappeared. Increasing the medication or have the patient halting the medication will not able at an advantage to the patient. It is vital to continue to monitor patient progress. Cyclothymic Disorder decision tree case study essay assignment example.

                       What was Hoping to Achieve by Making this Decision?

    The expectation is to achieve significant decreased in patient’s symptoms and to halt relapse of cyclothymic symptoms.

    Expected Result with this Decision.

    The expected result is that the patient will continue to do well with the medication with little or no side effect and prevent relapse. The patient is expected to be doing well with psychotherapy to help with behavioral symptoms.

          Difference between Expected Result and the Achieved Result with Decision

    The expected result and achieved result are the same. Ms. Stephanie returned to the clinic showing decreases symptoms of swing mood and no report of sadness or any issues.

    Ethical Considerations

    It is crucial to consider the following ethical issue while providing care for this patient which beneficence, autonomy, and nonmaleficence. It is significant to assess the patient thoroughly and provided the best treatment without any harm. It is imperative to consider and respect a patient autonomy when providing care. Cyclothymic Disorder decision tree case study essay assignment example.

     

        
                                                  References

    American Psychiatric Association. (2013).
    Diagnostic and statistical manual of mental disorders 
    (5th ed.). Washington, DC: Author.

    Laureate Education (Producer). (2017d).
    A young woman with depression
    [Multimedia file] 
    Baltimore, MD: Author.

    Perugi, G., Hantouche, E., & Vannucchi, G. (2017). Diagnosis and Treatment of Cyclothymia: The “Primacy” of Temperament.
    Current Neuropharmacology
    ,
    15
    (3), 372–379.
     https://doi-
    org.ezp.waldenulibrary.org/10.2174/1570159X14666160616120157

    Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).
    Kaplan & Sadock’s synopsis of psychiatry:
    Behavioral sciences/clinical psychiatry
    (11th ed.). Philadelphia, PA: Wolters Kluwer. Cyclothymic Disorder decision tree case study essay assignment example.

    Stahl, S. M. (2014).
    Prescriber’s Guide: Stahl’s Essential Psychopharmacology
    (5th ed.).   
    New York, NY: Cambridge University Press.

    Tracy, N. (2012). Bipolar Spectrum Disorders – What is Cyclothymia?.  Retrieved from 

    Bipolar Spectrum Disorders – What is Cyclothymia?

    Van Meter, A., Youngstrom, E., Freeman, A., Feeny, N., Youngstrom, J. K., & Findling, R. L. (2016). Impact of Irritability and Impulsive Aggressive Behavior on Impairment and Social Functioning in Youth with Cyclothymic Disorder.
    Journal Of Child And 
     Adolescent Psychopharmacology
    ,
    26
    (1), 26–37.
    https://doi-rg.ezp.waldenulibrary.org 
     /10.1089/cap.2015.0111. Cyclothymic Disorder decision tree case study essay assignment example.

  • The Buzzard, The Bat & The Bumblebee

    The Buzzard, The Bat & The Bumblebee

    THE BUZZARD:

    If you put a buzzard in a pen that is 6 feet by 8 feet but that is entirely open at the top, the bird, in spite of its ability to fly, will be an absolute prisoner. The reason is that a buzzard always begins a flight from the ground with a run of 10 to 12 feet. Without space to run, as is its habit, it will not even attempt to fly, but will remain a prisoner for life in a small jail with no top.

    THE BAT:

    The ordinary bat that flies around at night, a remarkably nimble creature in the air, cannot take off from a level place. If it is placed on the floor or flat ground, all it can do is shuffle about helplessly and, no doubt, painfully, until it reaches some slight elevation from which it can throw itself into the air. Then, at once, it takes off like a flash. The Buzzard, The Bat & The Bumblebee.

    THE BUMBLEBEE:

    A bumblebee, if dropped into an open tumbler, will be there until it dies, unless it is taken out. It never sees the means of escape at the top, but persists in trying to find some way out through the sides near the bottom. It will seek a way where none exists, until it completely destroys itself.

    PEOPLE:

    In many ways, we are like the buzzard, the bat, and the bumblebee. We struggle about with all our problems and frustrations, never realizing that all we have to do is look up!

    That’s the answer, the escape route and the solution to any problem! Just look up.

    Sorrow looks back, Worry looks around, but faith looks up!

    Live simply, love generously, care deeply, speak kindly. The Buzzard, The Bat & The Bumblebee.

  • Juvenile Diabetes and Drug Treatments Essay Assignment – Zocor, Micronase, Glucophage

    Juvenile Diabetes and Drug Treatments Essay Assignment – Zocor, Micronase, Glucophage

    Diabetes and Drug Treatments

    Diabetes is an endocrine system disorder that affects millions of children and adults (ADA, 2011). If left untreated, diabetic patients are at risk for several alterations including heart disease, stroke, kidney failure, neuropathy, and blindness. There are various methods for treating diabetes, many of which include some form of drug therapy. The type of diabetes as well as the patient’s behavior factors will impact treatment recommendations. In this Assignment, you compare types of diabetes including drug treatments for type 1, type 2, gestational, and juvenile diabetes.

    ORDER A CUSTOM-WRITTEN PAPER NOW

    To prepare:

    Review this week’s media presentation on the endocrine system and diabetes, as well as Chapter 46 of the Arcangelo and Peterson text and the Peterson et al. article in the Learning Resources. Juvenile Diabetes and Drug Treatments Essay Assignment – Zocor, Micronase, Glucophage.

    Reflect on differences between types of diabetes including type 1, type 2, gestational, and juvenile diabetes.

    Select one type of diabetes.

    Consider one type of drug used to treat the type of diabetes you selected including proper preparation and administration of this drug. Then, reflect on dietary considerations related to treatment.

    Think about the short-term and long-term impact of the diabetes you selected on patients including effects of drug treatments.

    By Day 7

    Write a 2- to 3- page Juvenile Diabetes and Drug Treatments Essay Assignment – Zocor, Micronase, Glucophage paper that addresses the following:

    Explain the differences between types of diabetes including type 1, type 2, gestational, and juvenile diabetes.

    Describe one type of drug used to treat the type of diabetes you selected including proper preparation and administration of this drug. Include dietary considerations related to treatment.

    Explain the short-term and long-term impact of this diabetes on patients including effects of drugs treatments.

    View options

    Course

    Institution

    Announcements

    Reflection: The buzzard, the bat and the bumblebee

    Posted on: Tuesday, January 1, 2019 2:56:31 PM EST

    Dear Class,

    I was in a meeting the other day and this reflection was read to remind us about the many lessons of life. Juvenile Diabetes and Drug Treatments Essay Assignment – Zocor, Micronase, Glucophage.

    Best wishes for a great week!

    Sincerely,

    Dr. Anderson

    The Buzzard, The Bat & The Bumblebee (Author Unknown)

    THE BUZZARD:

    If you put a buzzard in a pen that is 6 feet by 8 feet but that is entirely open at the top, the bird, in spite of its ability to fly, will be an absolute prisoner. The reason is that a buzzard always begins a flight from the ground with a run of 10 to 12 feet. Without space to run, as is its habit, it will not even attempt to fly, but will remain a prisoner for life in a small jail with no top.

    THE BAT:

    The ordinary bat that flies around at night, a remarkably nimble creature in the air, cannot take off from a level place. If it is placed on the floor or flat ground, all it can do is shuffle about helplessly and, no doubt, painfully, until it reaches some slight elevation from which it can throw itself into the air. Then, at once, it takes off like a flash. Juvenile Diabetes and Drug Treatments Essay Assignment – Zocor, Micronase, Glucophage.

    THE BUMBLEBEE:

    A bumblebee, if dropped into an open tumbler, will be there until it dies, unless it is taken out. It never sees the means of escape at the top, but persists in trying to find some way out through the sides near the bottom. It will seek a way where none exists, until it completely destroys itself.

    PEOPLE:

    In many ways, we are like the buzzard, the bat, and the bumblebee. We struggle about with all our problems and frustrations, never realizing that all we have to do is look up!

    That’s the answer, the escape route and the solution to any problem! Just look up.

    Sorrow looks back, Worry looks around, but faith looks up!

    Live simply, love generously, care deeply, speak kindly.

    Posted by: Holly Anderson

    Posted to: NURS-6521N-28,Advanced Pharmacology.2018 Winter Qtr 11/26-02/17-PT27

    Week 6 formal paper-helpful hints

    Posted on: Monday, December 31, 2018 9:49:22 PM EST

    Dear Class,

    Welcome to Week 6! There is a formal paper due this week. Here is some information that you might find helpful for the upcoming Week 6 formal paper. Juvenile Diabetes and Drug Treatments Essay Assignment – Zocor, Micronase, Glucophage.

    Sincerely,

    Dr. Anderson

    **This is important for the Week 6 writing assignment**

    In referencing type 1 and type 2 diabetes, Arabic numerals are used. This nomenclature changed from using Roman numerals (type I and type II) in 1995. Please refer to textbook (Arcangelo & Peterson) chapter 45 (third edition) and chapter 46 (fourth edition) to view the use of the terms type 1 diabetes and type 2 diabetes within the chapter.

    Clinical Pearls:

    Due to the number of insulin preparations on the market, it is essential to identify/clarify the type of insulin used by your patient. (Recommendation of the Institute for Safe Medication Practices [ISMP]).

    Clinical Pearl #2 (this is information I included from an earlier posting):

    The assignment asks to explain “juvenile diabetes”. The term ”juvenile diabetes” is now confusing as children could be diagnosed with type 2 diabetes or type 1 diabetes (Please take note of the nomenclature for type 1 and type 2 diabetes…Roman numerals II or I are no longer utilized.) Juvenile Diabetes and Drug Treatments Essay Assignment – Zocor, Micronase, Glucophage.

    The way you might want to approach this part of the writing assignment, is to include a one or two line statement in the opening paragraph or paragraph number 2, about JDRF (formerly known as the Juvenile Diabetes Research Foundation…now known as JDRF) and/or the National Diabetes Association (NDA) position on the terminology of ”juvenile diabetes”. The healthcare community (or community standard as it might be called) no longer uses the phrase ”juvenile diabetes”.

    Some of the points to include in the Week 6 writing assignment:

    a. Select one type of diabetes

    b. Mention one drug class with a specific drug from that classification with dosing information (HINT: Think about starting doses, maximum dosages, any US Boxed Warnings, common side effects that a patient might experience and any common drug interactions.)

    c. As a friendly reminder, include the short-term and long-term impact of your selected type of diabetes on the patient including effects of drug treatments. For short-term impact of your selected diabetes drug, think about some possible side effects of the drug. For the long-term impact, think about how high blood glucose affects the body over long periods of time (**HINT: neuropathy, retinopathy and nephropathy**). Juvenile Diabetes and Drug Treatments Essay Assignment – Zocor, Micronase, Glucophage.

    When generic drug names or drug categories are in the middle of a sentence, it is not necessary to capitalize the first letter (example: simvastatin, cephalosporins, metformin). If the drug name was a brand name product, then the first letter of the word would be capitalized regardless of where the name appears in a sentence (example: Zocor, Micronase, Glucophage).

    In the writing of formal papers, Latin medical abbreviations are not used. The reader of the paper may have little or no knowledge of the subject matter. The information would be written out fully, such as:

    Start the dose at 500mg orally twice a day before breakfast and dinner (not 500mg po bid before breakfast and dinner).

    Abbreviations need to be written out in full the first time they are used in a formal paper. After the first use, then the abbreviation can be used in the formal paper. Juvenile Diabetes and Drug Treatments Essay Assignment – Zocor, Micronase, Glucophage.

    Example: American Diabetes Association (ADA)

    American with Disabilities Act (ADA)

    Assistant District Attorney (ADA)

    American Dental Association (ADA)

    **This is important for the Week 6 writing assignment**

    In referencing type 1 and type 2 diabetes, Arabic numerals are used. This nomenclature changed from using Roman numerals (type I and type II) in 1995. Please refer to textbook (Arcangelo & Peterson) chapter 45 (third edition) and chapter 46 (fourth edition) to view the use of the terms type 1 diabetes and type 2 diabetes within the chapter. Juvenile Diabetes and Drug Treatments Essay Assignment – Zocor, Micronase, Glucophage.