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Assessing and Treating Clients with Dementia case study decision tree example

Assessing and Treating Clients with Dementia

The Alzheimer’s Association defines dementia as “a general term for a decline in mental ability severe enough to interfere with daily life” (Alzheimer’s Association, 2016). This term encompasses dozens of cognitive disorders of impaired memory formation, recall, and communication. The care and treatment of clients with dementia is dependent on multiple factors, including the stage of dementia, comorbidities, family support, and even the care setting. In your role, as the psychiatric mental health nurse practitioner, you must be prepared to not only treat clients with these various cognitive disorders, but also the multiple behavioral issues that often accompany them. For this Assessing and Treating Clients with Dementia case study decision tree example Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with dementia.

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Examine Case Study: An Elderly Iranian Man w/ Alzheimer’s Disease

You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point there will be three decisions. I will choose one out of the three and give the outcome. At each decision point these are the thoughts to ponder:

Decision #1

Which decision did you select?

Why did you select this decision? Support your response with evidence and references to the Learning Resources. Assessing and Treating Clients with Dementia case study decision tree example.

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?

Decision #2

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. Assessing and Treating Clients with Dementia case study decision tree example.

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

Decision #3

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? Assessing and Treating Clients with Dementia case study decision tree example.

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

NB:  Write paper addressing all section listed based on the decision tree.

 

Case Study: An Elderly Iranian Man with Alzheimer’s Disease

BACKGROUND

Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CT-scan of the head) were normal.

According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. Assessing and Treating Clients with Dementia case study decision tree example. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.”

Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficult “finding the right words” in a conversation and then will shift to an entirely different line of conversation.

SUBJECTIVE

During the clinical interview, Mr. Akkad is pleasant, cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so the PMHNP performs a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia.

MENTAL STATUS EXAM

Mr. Akkad is 76 year old Iranian male who is cooperative with today’s clinical interview. His eye contact is poor. Speech is clear, coherent, but tangential at times. He makes no unusual motor movements and demonstrates no tic. Self-reported mood is euthymic. Affect however is restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. He is alert and oriented to person, partially oriented to place, but is disoriented to time and event [he reports that he thought he was coming to lunch but “wound up here”- referring to your office, at which point he begins to laugh]. Insight and judgment are impaired. Impulse control is also impaired as evidenced by Mr. Akkad’s standing up during the clinical interview and walking towards the door. When the PMHNP asked where he was going, he stated that he did not know. Mr. Akkad denies suicidal or homicidal ideation. Assessing and Treating Clients with Dementia case study decision tree example.

Diagnosis:
 
Major neurocognitive disorder due to Alzheimer’s disease (presumptive)

 

Decisions Made and Outcomes (Needed to formulate the paper) (Must use and formulate paper based off of the chosen decision. Then tell why the other two decision were not a good choice with in-text citations noted for each.)

 

Choices for Decision 1: Select what the PMHNP should do:

Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks

Begin Aricept (donepezil) 5 mg orally at BEDTIME

Begin Razadyne (galantamine) 4 mg orally BID

 

Decision Choice Chosen:
 Begin Aricept (donepezil) 5 mg orally at BEDTIME

***Explain why other two choice were rejected (not adequate choices)***

Outcome: RESULTS OF DECISION POINT ONE
:

Client returns to clinic in four weeks

The client is accompanied by his son who reports that his father is “no better” from this medication

He reports that his father is still disinterested in attending religious services/activities, and continues to exhibit disinhibited behaviors

You continue to note confabulation and decide to administer the MMSE again. Mr. Akkad again scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall Assessing and Treating Clients with Dementia case study decision tree example

 

Choices for Decision 2: Select what the PMHNP should do:

Increase Aricept to 10 mg orally at BEDTIME

Discontinue Aricept and begin Razadyne (galantamine) extended release 24 mg orally daily

Discontinue Aricept and begin Namenda (memantine) extended release, 28 mg orally daily

 

Decision Choice Chosen:
 Increase Aricept to 10 mg orally at BEDTIME

***Explain why other two choice were rejected (not adequate choices)***

Outcome: RESULTS OF DECISION POINT TWO:

Client returns to clinic in four weeks

Client’s son reports that the client is tolerating the medication well, but is still concerned that his father is no better Assessing and Treating Clients with Dementia case study decision tree example.

He states that his father is attending religious services with the family, which the son and the rest of the family is happy about. He reports that his father is still easily amused by things he once found serious

Choices for Decision 3: Decision Point Three Select what the PMHNP should do next:

Continue Aricept 10 mg orally at BEDTIME

Increase Aricept to 15 mg orally at BEDTIME x 6 weeks, then increase to 20 mg orally at BEDTIME

Discontinue Aricept and begin Namenda 5 mg orally daily

 

Decision Choice Chosen:
 Continue Aricept 10 mg orally at BEDTIME

***Explain why other two choice were rejected (not adequate choices)***

Outcome: Guidance to Student

RESULT FROM CHOOSING TO MAINTAIN CURRENT DOSE OF ARICEPT 10 mg ORALLY AT BEDTIME

Guidance to Student

At this point, it would be prudent for the PMHNP to continue Aricept at 10 mg orally at bedtime. Recall that this medication can take several months before stabilization of deterioration is noted. At this point, the client is attending religious services with the family, which has made the family happy Assessing and Treating Clients with Dementia case study decision tree example. Disinhibition may improve in a few weeks, or it may not improve at all. This is a counseling point that the PMHNP should review with the son.

There is no evidence that Aricept given at doses greater than 10 mg per day has any therapeutic benefit. It can, however, cause side effects. Increasing to 15 and 20 mg per day would not be appropriate.

There is nothing in the clinical presentation to suggest that the Aricept should be discontinued. Whereas it may be appropriate to add Namenda to the current drug profile, there is no need to discontinue Aricept. In fact, NMDA receptor antagonist therapy is often used with cholinesterase inhibitors in combination therapy to treat Alzheimer’s disease. The key to using both medications is slow titration upward toward therapeutic doses to minimize negative side effects.

Finally, it is important to note that changes in the MMSE should be evaluated over the course of months, not weeks. The absence of change in the MMSE after 4 weeks of treatment should not be a source of concern. Assessing and Treating Clients with Dementia case study decision tree example.

 

***Write on each decision. Make sure that in each decision choice that you explain why the other two decisions were not good choices. Use cited sources to validate points. Make sure that this paper has at least 
7 References
. 
Please use in-text citations for each section of each decision.
 Don’t forget the ethical considerations for this assignment. Make it a section by itself.***

***

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

 

 
Please use the following format when formulating the paragraphs for each section. Don’t forget the intext citations. Remember to use at least 6 references.

Introduction

Decision #1

Reasons for Choosing the Decision (Why is it the best choice out of the 3 choices)

Anticipated Results (of Chosen Decision)

Difference in Results (Anticipated VS Actual)

Decision #2

Reasons for Choosing the Decision (Why is it the best choice out of the 3 choices)

Anticipated Results (of Chosen Decision)

Difference in Results (Anticipated VS Actual)

Decision #3

Reasons for Choosing the Decision (Why is it the best choice out of the 3 choices)

Anticipated Results (of Chosen Decision)

Difference in Results (Anticipated VS Actual)

Ethical Considerations

References

Assessing and Treating Dementia

Dementia is one of the most chronic ailments that affect human beings. It is typically defined as a clinical syndrome of decline in cognitive functionalities. Basically, victims suffering from the disease experience memory loss. Dementia effects lead to substantial interferences with a victim’s occupational and social functionality. Regular clinical inferences state that dementia is accompanied with personality and diverse behavioral alterations. In fact, the sickness has been linked to cause Alzheimer’s disease in later stages of development. Despite these important scientific deliberations Chertkow, Feldman, Jacova and Massoud (2013) posit that dementia remains a mere clinical diagnosis. Precisely, researchers are yet to offer concrete and clinically proven diagnostic frameworks for the disease. Based on this aspect, dementia does not have an elaborate treatment scientifically proven. Despite these setbacks, clinical professionals have made considerable strides in deriving dependable medications that can help alleviate dementia, based on a keen assessment of the patient’s conditions.

Case Study Overview

Mr. Akkad is a 76-year old Iranian with normal CT-scans from the family physician. However, his elder son reports that Akkad exhibits abnormal behaviors. Particularly, he experience strange thoughts, with his personality getting worse each year. He loses interest in religious matters and criticizes all members of his family. Notably, he ridicules aspects he deemed important in his life when he was healthy. Assessing and Treating Clients with Dementia case study decision tree example. Besides, he is forgetful and finds difficulties talking the right words during conversations.

On conduction of a clinical interview, Akkad is cooperative and speaks pleasantly. However, he exhibits hitches with his mental ability, and performs fair in a Mini-mental exam administered by the Psychiatric Mental Health Nurse Practitioner (PMHNP). The scores suggest moderate dementia. Akkad displays a clear speech but poor eye contact in the next clinical visit. Besides, he exhibits unusual motor movements and denies auditory hallucinations. Akkad’s mood is euthymic and is not delusional. However, he is disoriented at times and exhibits poor judgment. Akkad is presumptively diagnosed with a neurocognitive condition associated with Alzheimer’s disease.

Decision One

Akkad displayed various symptoms that depicted a person suffering from a psychological ailment. Notably, Chertkow et al. (2013) state defections in motor skills and problems with speech may be a sign of a neurologic disorder. However, it is imperative to ascertain the exact ailment to warrant precise medication.  In the light of this aspect, administration of Aricept (donepezil) 5 mg tablets to be taken orally during bed time would be the best option for Akkad.

Notably, dementia is a disease that entails impairment of memory functionality and attention deficits amongst the victims. The aspect arises due to diminished levels of the compound acetylcholine. In fact, the acetylcholine is broken down by butyryl-cholinesterase and acetyl-cholinesterase enzymes, leading to reduced memory functionality. Based on this factor, administration of donepezil would be the best option. Donepezil inhibits the actions and viability of acetyl-cholinesterase enzyme. Assessing and Treating Clients with Dementia case study decision tree example In the long run, Kalisch Ellett, Pratt, Ramsay,Barratt and Roughead (2014) postulate that it minimizes the breakdown of the compound acetylcholine in the brain, leading to mental stability. Albeit there are various options for antipsychotic drugs, donepezil is easily tolerated in the victim’s body, warranting speedy recovery.

Administration of galantamie would not be effective since it causes complications with victims suffering from renal predicaments. According to Coresh et al., (2014), older people are susceptible to urinary problems and problems related to kidneys. Since Akkad was 76 years, administration of galantamine would cause further complications, derailing the recovery process. Besides, administration of Exelon (rivastigmine) would cause adverse side effects which include nausea and diarrhea (Birks, Chong and Grimley Evans, 2015). The symptoms would affect the ability of the patient to respond positively to the medication.

Decision Two

Upon returning for the second visit, the client was reportedly unresponsive to Donepezil. In fact, his son explained that Akkad retained his disinhibited behaviors. At this point, continuation of an increased dose of donepezil orally after bedtime was the best option. Notably, Tan et al., (2014) state that donepezil acts optimally when taken after meals. Besides, it is imperative to note that the dementia victims and their families ought to maintain patience in terms of achieving full recovery. Tan et al., (2014) underscore the fact that donepezil treatment results are achieved after 6-9 months, and in some cases, 1-3 years. Additionally, discontinuing administration of donepezil would lead to dissipation of its clinical effects after only 6 weeks. Based on this factor, it would not be a precise clinical decision to administer Razadyne (galantamine) and Exelon (rivastigmine). Further, the PMHNP ought to increase the quantity of Aricept (donepezil) from 5mg to 10 mg, to be taken orally after meals. The aspect would warrant further inhibition of enzyme acetyl-cholinesterase from breaking down, an aspect that would warrant better cognition of Akkad. Assessing and Treating Clients with Dementia case study decision tree example.

Decision Three

Akkad displayed impressive signs on the following visit. Particularly, he was positively responding to medication and he had started attending religious events. The aspect made his family happy. However, he still found amusement in serious matters. Based on these deliberations, it is evident that donepezil was functioning effectively. In fact, it had reduced the comorbidity of the enzymes butyryl-cholinesterase and acetyl-cholinesterase in breaking down the acetyl-cholinesterase compound in the brain. Based on this fact, continuation of Aricept 10 mg to be taken orally would be the best option. Since the results after the previous dosage were impressive, the clinician has no reason to titrate Aricept 10 mg in an upward manner. In fact, Torniainen et al. (2014) state that excessive administration of antipsychotics may cause detrimental effects to the neurotransmission system of a victim, derailing the recovery process. Besides, it would not be effective to administer Namenda (memantine), since it is most effective when ingested with other anti-psychotics especially donepezil, and therefore would not act meritoriously. In fact, Ellison states that memantine is used to taper cholinesterase inhibitors when attempting to stop administration of particular anti-psychotics. Besides, Exelon (rivastigmine) would not be relevant at this stage, since the clinical effects of donepezil were already dominant.

Conclusion

Dementia is one of the most chronic mental ailments, without a precise known cure. However, administration of relevant anti-psychotics helps alleviate a patient’s situation. Akkad is a 76-year-old Iranian who displayed cognitive and motor-deficiencies. He was prescribed of donepezil, 5 mg to be ingested during bed time. PMHNPs increased the medication to 10mg after the second visit, an aspect that led to impressive results. During the third visit, it was recommended for him to continue with the same dosage to warrant impressive results. Assessing and Treating Clients with Dementia case study decision tree example.

References

Birks, J. S., Chong, L. Y., & Grimley Evans, J. (2015). Rivastigmine for Alzheimer’s disease.
The Cochrane Library
.

Chertkow, H., Feldman, H. H., Jacova, C., & Massoud, F. (2013). Definitions of dementia and predementia states in Alzheimer’s disease and vascular cognitive impairment: consensus from the Canadian conference on diagnosis of dementia.
Alzheimer’s research & therapy
,
5
(1), S2. https://doi.org/10.1186/alzrt198

Coresh, J., Turin, T. C., Matsushita, K., Sang, Y., Ballew, S. H., Appel, L. J., … & Green, J. A. (2014). Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality.
Jama
,
311
(24), 2518-2531. doi:10.1001/jama.2014.6634

Ellison, M,J. Do Alzheimer’s Medications Really Help?
Bright Focus Foundation
. Retrieved from https://www.brightfocus.org/alzheimers/article/do-alzheimers-medications-really-help Assessing and Treating Clients with Dementia case study decision tree example.

Kalisch Ellett, L. M., Pratt, N. L., Ramsay, E. N., Barratt, J. D., & Roughead, E. E. (2014). Multiple anticholinergic medication use and risk of hospital admission for confusion or dementia.
Journal of the American Geriatrics Society
,
62
(10), 1916-1922. https://doi.org/10.1111/jgs.13054 Assessing and Treating Clients with Dementia case study decision tree example.

Tan, C. C., Yu, J. T., Wang, H. F., Tan, M. S., Meng, X. F., Wang, C., … & Tan, L. (2014). Efficacy and safety of donepezil, galantamine, rivastigmine, and memantine for the treatment of Alzheimer’s disease: a systematic review and meta-analysis.
Journal of Alzheimer’s Disease
,
41
(2), 615-631. doi: 10.3233/JAD-132690

Torniainen, M., Mittendorfer-Rutz, E., Tanskanen, A., Björkenstam, C., Suvisaari, J., Alexanderson, K., & Tiihonen, J. (2014). Antipsychotic treatment and mortality in schizophrenia.
Schizophrenia bulletin
,
41
(3), 656-663. https://doi.org/10.1093/schbul/sbv181 Assessing and Treating Clients with Dementia case study decision tree example.

Assignment: Assessing and Treating Clients With Dementia

The Alzheimer’s Association defines dementia as “a general term for a decline in mental ability severe enough to interfere with daily life” (Alzheimer’s Association, 2016). This term encompasses dozens of cognitive disorders of impaired memory formation, recall, and communication. The care and treatment of clients with dementia is dependent on multiple factors, including the stage of dementia, comorbidities, family support, and even the care setting. In your role, as the psychiatric mental health nurse practitioner, you must be prepared to not only treat clients with these various cognitive disorders, but also the multiple behavioral issues that often accompany them. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with dementia. Assessing and Treating Clients with Dementia case study decision tree example.

Reference: Alzheimer’s Association. (2016). What is dementia? Retrieved from http://www.alz.org/what-is-dementia.asp

To prepare for this Assignment:

· Review this week’s Learning Resources. Consider how to assess and treat clients requiring therapy for dementia.

The Assignment

Examine Case Study: An Elderly Iranian Man With Alzheimer’s Disease. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. At each decision point stop to complete the following:

Introduction regarding disease state

High-level summary of patient case

Purpose of the essay statement

Decision #1

What options were listed?

Which decision did you select?

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

Why didn’t you select the other two options?

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?

Decision #2

What options were listed?

What option did you choose?

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

Why didn’t you select the other two options?

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

What options were listed?

What option did you choose?

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

Why didn’t you select the other two options?

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?

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

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.

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.

References

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press. Assessing and Treating Clients with Dementia case study decision tree example.

To access the following chapter, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

· Chapter 13, “Dementia and Its Treatment”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

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.

Review the following medications:

For insomnia

· donepezil

· galantamine

· memantine

· rivastigmine

Bui, Q. (2012). Antidepressants for agitation and psychosis in patients with dementia. American Family Physician, 85(1), 20–22. Retrieved from http://www.aafp.org/journals/afp.html

Note: Retrieved from from the Walden Library databases. Assessing and Treating Clients with Dementia case study decision tree example.

Meltzer, H. Y., Mills, R., Revell, S., Williams, H., Johnson, A., Bahr, D., & Friedman, J. H. (2010). Pimavanserin, a serotonin receptor inverse agonist for the treatment of Parkinson’s disease psychosis. Neuropsychopharmacology, 35, 881–891. Retrieved from http://www.nature.com/npp/journal/v35/n4/pdf/npp2009176a.pdf

Required Media

Laureate Education. (2016h). Case study: An elderly Iranian man with Alzheimer’s disease [Interactive media file]. Baltimore, MD: Author.

BACKGROUND

Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CT-scan of the head) were normal.

According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.”

Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficult “finding the right words” in a conversation and then will shift to an entirely different line of conversation. Assessing and Treating Clients with Dementia case study decision tree example.

SUBJECTIVE

During the clinical interview, Mr. Akkad is pleasant, cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so the PMHNP performs a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia.

MENTAL STATUS EXAM

Mr. Akkad is 76 year old Iranian male who is cooperative with today’s clinical interview. His eye contact is poor. Speech is clear, coherent, but tangential at times. He makes no unusual motor movements and demonstrates no tic. Self-reported mood is euthymic. Affect however is restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. He is alert and oriented to person, partially oriented to place, but is disoriented to time and event [he reports that he thought he was coming to lunch but “wound up here”- referring to your office, at which point he begins to laugh]. Insight and judgment are impaired. Impulse control is also impaired as evidenced by Mr. Akkad’s standing up during the clinical interview and walking towards the door. When the PMHNP asked where he was going, he stated that he did not know. Mr. Akkad denies suicidal or homicidal ideation.

Diagnosis: Major neurocognitive disorder due to Alzheimer’s disease (presumptive)

RESOURCES

§ Folstein, M. F., Folstein, S. E., & McHugh, P. R. (2002). Mini-Mental State Examination (MMSE). Lutz, FL: Psychological Assessment Resources.

Decision Point One

Select what the PMHNP should do:

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/10/mm/alzheimers_disease/img/pill-red.pngBegin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/10/mm/alzheimers_disease/img/pill-blue.png Begin Aricept (donepezil) 5 mg orally at BEDTIME

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/10/mm/alzheimers_disease/img/pill-yellow.pngBegin Razadyne (galantamine) 4 mg orally BID Assessing and Treating Clients with Dementia case study decision tree example

Decision Point One

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/10/mm/alzheimers_disease/img/pill-blue.pngBegin Aricept (donepezil) 5 mg orally at BEDTIME

RESULTS OF DECISION POINT ONE

· Client returns to clinic in four weeks

· The client is accompanied by his son who reports that his father is “no better” from this medication

· He reports that his father is still disinterested in attending religious services/activities, and continues to exhibit disinhibited behaviors. Assessing and Treating Clients with Dementia case study decision tree example.

· You continue to note confabulation and decide to administer the MMSE again. Mr. Akkad again scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall

Decision Point Two

Select what the PMHNP should do next:

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/10/mm/alzheimers_disease/img/pill-red.pngIncrease Aricept to 10 mg orally at BEDTIME

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/10/mm/alzheimers_disease/img/pill-blue.pngDiscontinue Aricept and begin Razadyne (galantamine) extended release 24 mg orally daily

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/10/mm/alzheimers_disease/img/pill-yellow.pngDiscontinue Aricept and begin Namenda (memantine) extended release, 28 mg orally daily

Decision Point Two https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/10/mm/alzheimers_disease/img/pill-red.pngIncrease Aricept to 10 mg orally at BEDTIME

RESULTS OF DECISION POINT TWO

· Client returns to clinic in four weeks

· Client’s son reports that the client is tolerating the medication well, but is still concerned that his father is no better

· He states that his father is attending religious services with the family, which the son and the rest of the family is happy about. He reports that his father is still easily amused by things he once found serious

Decision Point Three

Select what the PMHNP should do next:

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/10/mm/alzheimers_disease/img/pill-red.pngContinue Aricept 10 mg orally at BEDTIME

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/10/mm/alzheimers_disease/img/pill-blue.pngIncrease Aricept to 15 mg orally at BEDTIME x 6 weeks, then increase to 20 mg orally at BEDTIME

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/10/mm/alzheimers_disease/img/pill-yellow.pngDiscontinue Aricept and begin Namenda 5 mg orally daily

Decision Point Three

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/10/mm/alzheimers_disease/img/pill-red.pngContinue Aricept 10 mg orally at BEDTIME Assessing and Treating Clients with Dementia case study decision tree example

Guidance to Student

At this point, it would be prudent for the PMHNP to continue Aricept at 10 mg orally at bedtime. Recall that this medication can take several months before stabilization of deterioration is noted. At this point, the client is attending religious services with the family, which has made the family happy. Disinhibition may improve in a few weeks, or it may not improve at all. This is a counseling point that the PMHNP should review with the son.

There is no evidence that Aricept given at doses greater than 10 mg per day has any therapeutic benefit. It can, however, cause side effects. Increasing to 15 and 20 mg per day would not be appropriate.

There is nothing in the clinical presentation to suggest that the Aricept should be discontinued. Whereas it may be appropriate to add Namenda to the current drug profile, there is no need to discontinue Aricept. In fact, NMDA receptor antagonist therapy is often used with cholinesterase inhibitors in combination therapy to treat Alzheimer’s disease. The key to using both medications is slow titration upward toward therapeutic doses to minimize negative side effects.

Finally, it is important to note that changes in the MMSE should be evaluated over the course of months, not weeks. The absence of change in the MMSE after 4 weeks of treatment should not be a source of concern. Assessing and Treating Clients with Dementia case study decision tree example.

Assessing and Treating Adult and Geriatric Clients With Mood Disorders Decision Tree Case Study Essay Assignment Example – Geriatric Depression Therapy

NURS 6630 Week 3 Assignment: Assessing and Treating Adult and Geriatric Clients With Mood Disorders

Advances in genetics and epigenetics have changed the traditional understanding of mood disorders, resulting in new evidence-based practices. In your role as a psychiatric mental health nurse practitioner, it is essential for you to continually educate yourself on new findings and best practices in the field. For this Assignment, you consider best practices for assessing and treating adult and geriatric clients presenting with mood disorders.

Learning Objectives

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Students will:

Assess client factors and history to develop personalized plans of antidepressant therapy for adult and geriatric clients

Analyze factors that influence pharmacokinetic and pharmacodynamic processes in adult and geriatric clients requiring antidepressant therapy.Assessing and Treating Adult and Geriatric Clients With Mood Disorders Decision Tree Case Study Essay Assignment Example – Geriatric Depression Therapy.

Evaluate efficacy of treatment plans

Analyze ethical and legal implications related to prescribing antidepressant therapy to adult and geriatric clients

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

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

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 6, “Mood Disorders”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

amitriptyline

bupropion

citalopram

clomipramine

desipramine

desvenlafaxine

doxepin

duloxetine

escitalopram

fluoxetine

fluvoxamine

imipramine

ketamine

mirtazapine

nortriptyline

paroxetine

selegiline

sertraline

trazodone

venlafaxine

vilazodone

vortioxetine

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

Note: Retrieved from Walden Library databases.

Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389. Retrieved from https://www.researchgate.net/profile/Marie_Asberg/publication/22697065_A_New_Depression_Scale_Designed_to_be_Sensitive_to_Change/links/09e41513f85c708fee000000.pdf Assessing and Treating Adult and Geriatric Clients With Mood Disorders Decision Tree Case Study Essay Assignment Example – Geriatric Depression Therapy

Required Media

Laureate Education. (2016g). Case study: An elderly Hispanic man with major depressive disorder [Interactive media file]. Baltimore, MD: Author.

Note: This case study will serve as the foundation for this week’s Assignment.

To prepare for this Assignment:

Review this week’s Learning Resources. Consider how to assess and treat adult and geriatric clients requiring antidepressant therapy.

The Assignment

Examine Case Study: An Elderly Hispanic Man With Major Depressive Disorder. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

Decision #1

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?

Decision #2

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. Assessing and Treating Adult and Geriatric Clients With Mood Disorders Decision Tree Case Study Essay Assignment Example – Geriatric Depression Therapy.

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

Decision #3

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?

Also include how ethical considerations might impact your treatment plan and communication with clients. Assessing and Treating Adult and Geriatric Clients With Mood Disorders Decision Tree Case Study Essay Assignment Example – Geriatric Depression Therapy.

NURS 6630 Week 3 Discussion

Discussion: The Impact of Ethnicity on Antidepressant Therapy

Major depressive disorder is one of the most prevalent disorders you will see in clinical practice. Treatment for this disorder, however, can vary greatly depending on client factors, such as ethnicity and culture. As a psychiatric mental health professional, you must understand the influence of these factors to select appropriate psychopharmacologic interventions. For this Discussion, consider how you might assess and treat the individuals in the case studies based on the provided client factors, including ethnicity and culture.

Required Readings

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

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 7, “Antidepressants”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

amitriptyline

bupropion

citalopram

clomipramine

desipramine

To prepare for this Discussion:

Note: By Day 1 of this week, your Instructor will have assigned you to one of the following case studies to review for this Discussion. To access the following case studies, click on the Case Studies tab on the Stahl Online website and select the appropriate volume and case number.

Case 1: Volume 1, Case #1: The man whose antidepressants stopped working

Case 2: Volume 1, Case #7: The case of physician do not heal thyself

Case 3: Volume 1, Case #29: The depressed man who thought he was out of options

Review this week’s Learning Resources and reflect on the insights they provide.

Go to the Stahl Online website and examine the case study you were assigned.

Take the pretest for the case study.

Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.

Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).

Consider whether any additional physical exams or diagnostic testing may be necessary for the patient. Assessing and Treating Adult and Geriatric Clients With Mood Disorders Decision Tree Case Study Essay Assignment Example – Geriatric Depression Therapy.

Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.

Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.

Review the posttest for the case study.

SAMPLE APPROACH

NURS 6630 Week 3 Assignment: Assessing and Treating Adult and Geriatric Clients With Mood Disorders

Introduction

Depression in the elderly altogether influences patients, families, and groups. Familiarity with inclining and hastening variables can help recognize patients needing screening with instruments, for example, the Geriatric Depression Scale (American Psychiatric Association, 2013). After analysis, consistent development and dynamic drug administration are essential to augment treatment and reduction. Determination of a stimulant solution ought to be founded on the best reaction profile and the most reduced danger of medication collaboration. On the off chance that abatement is not accomplished, then extra medicines, including different medications and psychotherapy, might be considered (Flint & Rifat, 2013). In instances of serious, insane, or recalcitrant depression in the elderly, electroconvulsive treatment is prescribed. This paper considers a case of a 31-year-old Hispanic man with severe depression and the treatment options available. The treatment decisions made are evaluated and the outcomes compared to facilitate greater understanding of geriatric depression therapy.

Decision Point One

Selected Decision

Begin Zoloft 25 mg orally daily

Reason for Selection

Zoloft is one of the most effective drugs for treatment of severe depression in adults. The patient had a score of 51 when the PMHNP administered MADRS, this is an indication of severe depression. Considering the available antidepressants in this case, phenelzine is recommended for use in areas where other drugs have failed (Stahl, 2014b). Effexor XL on the other hand can be used but has many potential side effects considering the patients history and lifestyle. Thus, Zoloft emerges as the best option.

Expected Results

The action of Zoloft should be evident within the first two weeks as this is the pharmaceutical expectation from the experiments completed with the drug. By the time the patient comes for checkup after two weeks, he should report ability to sleep at night. The level of concentration should also undergo a boost on administering this drug (Liu, Anderson, Mittmann, Axcell & Shear, 2015). It is also expected that the patient will be motivated to the normal activities and even relate well with people. The patient’s feeling of being an outsider due to the past treatment should start waning off. Assessing and Treating Adult and Geriatric Clients With Mood Disorders Decision Tree Case Study Essay Assignment Example – Geriatric Depression Therapy.

Differences between Expected Results and Actual Results

When the patient revisited after four weeks and reported a decrease of 25% in the symptoms. This is in the direction of the expectations. However, another outcome was not anticipated, the patient was experiencing erectile dysfunction (Gaboda, Lucas, Siegel, Kalay & Crystal, 2014). This is a side effect of the drug that was not expected when the treatment plan was made. Zoloft has a number of potential side effects and erectile dysfunction is one of them though not very common. The rest of the outcomes reflected the expected trend even though the rate was a bit lower than anticipated.

NURS 6630 Week 3 Assignment Decision Point Two

Selected Decision

Add augmenting agent such as Wellbutrin IR 150 mg in morning

Reason for Selection

The client was experiencing a decrease in the depression symptoms because of administering Zoloft but the same drug had led to erectile dysfunction. It is a good idea to maintain Zoloft for reducing depression and combine it with another antidepressant with abilities to abate erectile dysfunction. Wellbutrin is such an antidepressant that can be used to help the patient’s erection function normally while on depression therapy (Flint & Rifat, 2013). In this case, the focus is not to treat the side effect of Zoloft as this is not advisable, but it is to introduce an antidepressant and slowly withdraw Zoloft and thereby correcting erectile dysfunction.

Expected Results

When Wellbutrin is introduced as augmenting agent, the patient should experience much reduced symptoms. This is because both Zoloft and Wellbutrin will be working to reduce depression and thus the combined effect should be bigger (Flint & Rifat, 2013). In addition, the patient should start having normal erection as a result of the working of Wellbutrin. This should even make the patient better and more motivated. Assessing and Treating Adult and Geriatric Clients With Mood Disorders Decision Tree Case Study Essay Assignment Example – Geriatric Depression Therapy.

Differences between Expected Results and Actual Results

The patient visited again after four weeks and he stated that the depressive symptoms had even reduced further. He also informed that the erection dysfunction had been abated. These two outcomes were expected as the therapy was being administered. Nevertheless, different other outcomes from the ones anticipated arose (Gaboda, Lucas, Siegel, Kalay & Crystal, 2014). The patient was feeling jittery and nervous. Either of the two drugs could influence this; Zoloft and Wellbutrin as both are known to cause feelings of anxiety in some cases. Sometimes the feeling of jittery is caused by the kind of dosage of the two drugs.

Decision Point Three

Selected Decision

Change Wellbutrin to XL 150 mg orally in AM

Reason for Selection

The patient is experiencing jitteriness as the only problem with the current therapy. The effect of medication is as intended and so it is not proper to change just because of the side effect. Jitteriness may be caused by the immediate release of Wellbutrin. Trying to change the administration of Wellbutrin may be the solution to jitteriness. Administering Wellbutrin in its extended release form can help to reduce depression and remove jitteriness. It is not proper to introduce a new drug to treat the side effects of another before trying to modify the dosage of the original drug. Assessing and Treating Adult and Geriatric Clients With Mood Disorders Decision Tree Case Study Essay Assignment Example – Geriatric Depression Therapy.

Expected Results

Administration Wellbutrin in its extended release form is anticipated to treat jitteriness if in fact the problem is the immediate release of Wellbutrin. It is also expected that the patient will continue experiencing an improved rate of depression reduction (Liu, Anderson, Mittmann, Axcell & Shear, 2015). The ceasing of jitteriness should allow the patient to have confidence in the therapy and are motivated to continue using the medication. The concentration ability of the patient should increase tremendously. The patient should also not have problems with sleeping at night.

Differences between Expected Results and Actual Results

The decision seems to be in agreement with the standard way of dealing with side effects of therapy administered to a patient (Laureate Education, 2016g). It was recommended that a drug can be modified in the way it is administered in an attempt to handle the side effects rather than introduce another drug to treat the side effect (Liu, Anderson, Mittmann, Axcell & Shear, 2015). This is because every drug has side effects and so treating one may be just as good as introducing another.

Impact of Ethical Considerations on Treatment Plan

Ant-depression therapy in adults has many complications that accompany any medication plan adopted. It involves taking risks, as there are many side effects of the drugs used in this therapy. Some drugs cause patients to have suicidal tendencies (Flint, 2012). Based on the doctor’s evaluation of the patient, some drugs may not be included in the therapy of certain patients. In this case, some drugs may not be used especially those that induce suicidal tendencies as this patient is not interacting with people and that make is risky. Assessing and Treating Adult and Geriatric Clients With Mood Disorders Decision Tree Case Study Essay Assignment Example – Geriatric Depression Therapy.

Conclusion

Depression in the elderly is a noteworthy, normal, and developing issue that requires treatment. It has genuine ramifications for the patient, family, and group. Recognizable proof took after by a careful evaluation can help manage the determination of a proper upper prescription. There are a few variables to consider when choosing, altering, and changing antidepressants in the elderly. Together, these techniques can help advance the sheltered utilization of antidepressants in the elderly (Flint & Rifat, 2013). Other than medicines, different treatments for wretchedness that may be considered incorporate different types of psychotherapy and neurostimulation, with electroconvulsive treatment as yet being the highest quality level for extreme or crazy discouragement. Assessing and Treating Adult and Geriatric Clients With Mood Disorders Decision Tree Case Study Essay Assignment Example – Geriatric Depression Therapy.

Foundational Neuroscience Discussion

As a psychiatric mental health nurse practitioner, it is essential for you to have a strong background in foundational neuroscience. In order to diagnose and treat clients, you must not only understand the pathophysiology of psychiatric disorders, but also how medications for these disorders impact the central nervous system. These concepts of foundational neuroscience can be challenging to understand. Therefore, this Discussion is designed to encourage you to think through these concepts, develop a rationale for your thinking, and deepen your understanding by interacting with your colleagues. Foundational Neuroscience Discussion.

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Learning Objectives

Students will:

· Analyze the agonist-to-antagonist spectrum of action of psychopharmacologic agents

· Compare the actions of g couple proteins to ion gated channels

· Analyze the role of epigenetics in pharmacologic action

· Analyze the impact of foundational neuroscience on the prescription of medications

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. Foundational Neuroscience Discussion.

Required Readings

Post
 a response to each of the following: Include sub headings please.

1. Explain the agonist-to-antagonist spectrum of action of psychopharmacologic agents.

2. Compare and contrast the actions of g couple proteins and ion gated channels.

3. Explain the role of epigenetics in pharmacologic action.

4. Explain how this information may impact the way you prescribe medications to clients. Include a specific example of a situation or case with a client in which the psychiatric mental health nurse practitioner must be aware of the medication’s action. Foundational Neuroscience Discussion.

Points to follow when writing a paper:

· Please all bullets points, bold, red and highlighted area must be attended to.

· A clear purpose statement (The purpose of this paper is to…) is required in the introduction of all writings.

· Please review all rubrics.

· Check APA format/setting.

· Your final paragraph should be a summary of the key points of your paper.

· Foundational Neuroscience Discussion. Please personalized where necessary.

Refrain from direct quote

Class Rules

Avoid public facing sites like university web pages or foundation pages (such as the American Cancer Society or the Alzheimer’s Association) and medical sites designed for consumption by the general public (such as Mayo Clinic or WebMD).

you are required to cite scholarly resources including peer-review journals and current practice guidelines
.

May use https://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/index.html

Writer must be familiar with nursing pharmacology Foundational Neuroscience Discussion

NUR 6630 Week 1 Discussion: Foundational Neuroscience

Explain the agonist-to-antagonist spectrum of action of psychopharmacologic agents.

Full agonists allow a receptor site to open up an ion channel to the maximum amount and frequency which is allowed by that particular binding site which causes the maximum amount of downstream signal transduction possible to be utilized at the binding site. The ion channel can open more frequently than with a full agonist alone but requires the help of a second receptor site. An antagonist causes a stabilization in the receptor sites in resting phases which is the same mechanism of action at the receptor site when an agonist is not present. Because there are no changes whether an antagonist is present or not, it is said to be neutral or silent.

Compare and contrast the actions of g couple proteins and ion gated channels.
Partial agonists cause changes in receptors so that ion channels open to a greater extent and with more frequency that at a resting state but less than when a full agonist is present. Antagonists reverse partial antagonists just as it reverses full agonists and result in the receptor site returning to its state of rest. Partial agonists produce ion flow and downstream signal transduction which is more than at a resting state but less than that of a full agonist. When there are unstable neurotransmissions within the brain, a balance must be found to stabilize the receptor output so that there is not too much or too little downstream action occurring. Partial agonists are also referred to as stabilizers since they are typically able to cause an even reaction between extremes of too much or too little action potential (Stahl, 2013).

A class of receptors linked to G proteins are a major target of psychotropic drugs. The G couple proteins have the structure of seven transmembrane regions, spanning the membrane seven times. Each region of the membrane is arranged around a central core which contains a binding site for a neurotransmitter. Drugs can interact at a particular neurotransmitter binding site or at other sites, also called allosteric sites within a receptor. This binding can lead to various modifications of receptor actions by either partially or fully mimicking or blocking any neurotransmitter function which would normally occur at a specific receptor site. Downstream molecular processes can be changed by drug actions as when phosphoproteins are activated or inactivated which results in a difference in which enzymes, receptors, or ion channels are modified by the neurotransmission. These drug actions can also lead to changes in which genes are expressed, altering which proteins are synthesized and which functions are amplified, from synaptogenesis, to receptor and enzyme synthesis, to communication with downstream neurons innervated by the neuron with the G-protein-linked receptor. As a result, drug-induced alterations at the G-protein-linked receptor site can cause actions on psychiatric disorders or symptoms (Stahl, 2013). Foundational Neuroscience Discussion.

Like G proteins, ligand-gated ion channels are a type of receptor which also forms an ion channel. For this reason, they are both ligand-gated ion channel and also ionotropic receptors or ion-channel-linked receptors. They have dual functions, hence the two names. Ligand-gated ion channels consist of long strings of amino acids which are gathered as subunits around an ion channel. There are many binding sites around these subunits for neurotransmitters, ions and drugs. Complex proteins have sites where ions can pass through a channel or bind to the channel, or where a neurotransmitter can act as a binding site and where natural substances or drugs can bind to a site different than where the neurotransmitter binds resulting in an increase or decrease to the sensitivity of a channel opening. In psychopharmacology, the ion channels that are the most important are those that control sodium, calcium, chloride, and potassium. Full agonists will directly change the receptor site to open the ion channel. Antagonists will cause a steady state at the receptor in its resting state which is similar to how a receptor responds when there is no agonist present. Alternatively, drug-induced modifications which occur with ionotropic receptors cause immediate effects by changing the flow of ions resulting in an immediate clinical onset as when medications such as anxiolytics and hypnotics are used. Some drugs that act at the G-protein-linked receptor sites may have a delayed response caused by an instigation in cellular functions that become activated by the signal transduction cascade (Stahl, 2013).

Explain the role of epigenetics in pharmacologic action.

In genetics, there is a DNA code which transcribes specific types of RNA or proteins within cells. While there are greater than 20,000 genes within the human genome, not every gene is expressed, even within the brain. Epigenetics goes a step further than genetics in that there is a determination whether a given gene is made into specific RNA and protein or instead it is just simply ignored or silenced. Further definition states that if a genome is a glossary of all “words” related to protein, than the epigenome is the “story” of all of those “words” into something that is cohesive. The genomic makeup of potential proteins is the same within every single neuron and cell in the body. What causes a normal neuron to malfunction, as in psychiatric diagnoses, or how a neuron winds up a neuron rather than a liver cell is all the result of whether or not specific genes are expressed or silenced. Neurons that are functioning improperly are often impacted by genes with abnormal sequences and if these genes are expressed rather than silenced, mental disorders can ensue. Brain development is not only dependent on inherited genes, but whether or not abnormal genes are expressed, and/or normal genes are silenced. There are many factors which regulate whether or not genes are expressed or silenced and include neurotransmission, the gene makeup, drugs and environment. All of these factors help decide whether or not the brain is one full of learning and memories or drug abuse, stress and psychiatric disorders and whether or not there can be improvement with medications and therapy (Stahl, 2013).

Explain how this information may impact the way you prescribe medications to clients. Include a specific example of a situation or case with a client in which the psychiatric mental health nurse practitioner must be aware of the medication’s action.

In depth knowledge regarding medications, pharmacokinetics and pharmacodynamics are important prior to prescribing. In addition to this, one must understand genetics and factors regarding medication uptake and absorption. Farmer (2014) discusses psychopharmacological treatment from a social work perspective and states that a new way of thinking about mental illness is evolving. The National Institute of Mental Health has worked on a project (the Research Domain Criteria RDoC) to change the thought process behind mental illness diagnoses. The RDoC utilizes data regarding pathophysiology, especially related to genomics and neuroscience when it comes to understanding mental illness. Investigation of the biological underlying of mental disorders is being focused on and a new understanding of different dimensions of functioning related to positive and negative valence systems, cognitive systems, systems for social processes, and arousal/modulatory systems are being included and studied as well as the analysis of genes, molecules, cells, neural circuits, physiology. Client behaviors and self-reports are also considered. The idea is to link neurobiology with mental illness diagnoses and find better medications to treat specific mental disorders. We must understand that psychotropic medications work in the brain and CNS to affect the level of a neurotransmitter. Human behavior is the result of neural activity where an axon sends chemical and electrical messages to receiving neurons and a synapse is a communication point between neurons and where an action potential takes place. As PMHNPs, we must understand the mechanism of action in how a medication works, whether it is an agonist or antagonist, and how the major neurotransmitters (acetyl-choline, norepinephrine, dopamine, serotonin, gamma aminobutyric acid, glutamate) are affected by specific medications. Medications have different effects based on factors such as client age, gender, race and ethnicity. More studies are needed how race and ethnicity may affect medications as pharmacokinetics and pharmacodynamics, as are influenced by genetic factors as well as the environment which includes lifestyle, behavioral patterns, and social interactions. One person’s response to a medication will be determined by gene–environment interaction (Farmer, 2014). Foundational Neuroscience Discussion.

Understanding that psychiatric disorders such as major depressive disorder, drug addiction, and schizophrenia can have multiple gene involvements rather than “one gene/one disease” relation can assist with finding the right medications and treatments for clients. Understanding epigenetic modifications (histone acetylation and deacetylation, DNA methylation) and how these can result in changes in gene expression is looking to be the future of treating psychiatric disorders (Mahgoub & Monteggia, 2013).

PMHNPs must be aware at this time, when prescribing medications such as an SSRI or SNRI, these medications take time to reach therapeutic effect. Patients must be well educated that they will not feel “better” instantly and must be counseled to stay the course with medication compliance and therapies to achieve maximum benefit.

References

Farmer, R. L. (2014). Interface between psychotropic medications, neurobiology, and mental illnesses. 
Smith College Studies in Social Work, 84
(2-3), 255-272.

Mahgoub, M., & Monteggia, L. M. (2013). Epigenetics and psychiatry. 
Neurotherapeutics, 10
, 734-741.

Stahl, S. M. (2013). 
Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications
 (4th ed.). New York, NY: Cambridge University Press.

NUR 6630 Week 1 Discussion: Foundational Neuroscience

To prepare for this Discussion:

Review this week’s Learning Resources.

Reflect on concepts of foundational neuroscience.

Note:
 For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
Submit!

By Day 3

Post
 a response to each of the following:

Explain the agonist-to-antagonist spectrum of action of psychopharmacologic agents.

Compare and contrast the actions of g couple proteins and ion gated channels.

Explain the role of epigenetics in pharmacologic action.

Explain how this information may impact the way you prescribe medications to clients. Include a specific example of a situation or case with a client in which the psychiatric mental health nurse practitioner must be aware of the medication’s action.

Read 
a selection of your colleagues’ responses.

By Day 6

Respond
 to two colleagues in one of the following ways:

If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained.

If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them. Include resources to support your perspective.

Week 1 discussion

Discussion: Foundational Neuroscience

As a psychiatric mental health nurse practitioner, it is essential for you to have a strong background in foundational neuroscience. In order to diagnose and treat clients, you must not only understand the pathophysiology of psychiatric disorders, but also how medications for these disorders impact the central nervous system. These concepts of foundational neuroscience can be challenging to understand. Therefore, this Discussion is designed to encourage you to think through these concepts, develop a rationale for your thinking, and deepen your understanding by interacting with your colleagues. Foundational Neuroscience Discussion.

Learning Objectives

Students will:

Analyze the agonist-to-antagonist spectrum of action of psychopharmacologic agents

Compare the actions of g couple proteins to ion gated channels

Analyze the role of epigenetics in pharmacologic action

Analyze the impact of foundational neuroscience on the prescription of medications

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

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

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press *Preface, pp. ix–x

Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 1, “Chemical Neurotransmission”

Chapter 2, “Transporters, Receptors, and Enzymes as Targets of Psychopharmacologic Drug Action”

Chapter 3, “Ion Channels as Targets of Psychopharmacologic Drug Action”

Document: Midterm Exam Study Guide (PDF)

Document: Final Exam Study Guide (PDF)

Required Media

Laureate Education (Producer). (2016i). Introduction to psychopharmacology [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 3 minutes. Foundational Neuroscience Discussion.

Accessible player

Optional Resources

Laureate Education (Producer). (2009). Pathopharmacology: Disorders of the nervous system: Exploring the human brain [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 15 minutes.

Dr. Myslinski reviews the structure and function of the human brain. Using human brains, he examines and illustrates the development of the brain and areas impacted by disorders associated with the brain.

Accessible player

Laureate Education (Producer). (2012). Introduction to advanced pharmacology [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 8 minutes.

In this media presentation, Dr. Terry Buttaro, associate professor of practice at Simmons School of Nursing and Health Sciences, discusses the importance of pharmacology for the advanced practice nurse.

Accessible player

To prepare for this Discussion:

Review this week’s Learning Resources.

Reflect on concepts of foundational neuroscience.

Week 1 Discussion

Discussion: Foundational Neuroscience

As a psychiatric mental health nurse practitioner, it is essential for you to have a strong background in foundational neuroscience. In order to diagnose and treat clients, you must not only understand the pathophysiology of psychiatric disorders, but also how medications for these disorders impact the central nervous system. These concepts of foundational neuroscience can be challenging to understand. Therefore, this Discussion is designed to encourage you to think through these concepts, develop a rationale for your thinking, and deepen your understanding by interacting with your colleagues.

NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment Week 1 Discussion: Foundational Neuroscience

Required Readings

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

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press *Preface, pp. ix–x

Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter Foundational Neuroscience Discussion.

Chapter 1, “Chemical Neurotransmission”

Chapter 2, “Transporters, Receptors, and Enzymes as Targets of Psychopharmacologic Drug Action”

Chapter 3, “Ion Channels as Targets of Psychopharmacologic Drug Action”

Document: Midterm Exam Study Guide (PDF)

Document: Final Exam Study Guide (PDF)

Required Media

Laureate Education (Producer). (2016i). Introduction to psychopharmacology [Video file]. Baltimore, MD: Author.

NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Week 1 Discussion: Foundational Neuroscience

Note: The approximate length of this media piece is 3 minutes.

Accessible player

Discussion: Foundational Neuroscience Optional Resources

Laureate Education (Producer). (2009). Pathopharmacology: Disorders of the nervous system: Exploring the human brain [Video file]. Baltimore, MD: Author.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

Note: The approximate length of this media piece is 15 minutes.

Dr. Myslinski reviews the structure and function of the human brain. Using human brains, he examines and illustrates the development of the brain and areas impacted by disorders associated with the brain.

Discussion: Foundational Neuroscience Accessible player

Laureate Education (Producer). (2012). Introduction to advanced pharmacology [Video file]. Baltimore, MD: Author.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

Note: The approximate length of this media piece is 8 minutes.

In this media presentation, Dr. Terry Buttaro, associate professor of practice at Simmons School of Nursing and Health Sciences, discusses the importance of pharmacology for the advanced practice nurse.

Accessible player

To prepare for this Discussion:

Review this week’s Learning Resources.

Reflect on concepts of foundational neuroscience.

Assignment: Assessing and Treating Clients With Dementia

The Alzheimer’s Association defines dementia as “a general term for a decline in mental ability severe enough to interfere with daily life” (Alzheimer’s Association, 2016). This term encompasses dozens of cognitive disorders of impaired memory formation, recall, and communication. The care and treatment of clients with dementia is dependent on multiple factors, including the stage of dementia, comorbidities, family support, and even the care setting. In your role, as the psychiatric mental health nurse practitioner, you must be prepared to not only treat clients with these various cognitive disorders, but also the multiple behavioral issues that often accompany them. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with dementia Foundational Neuroscience Discussion.

Reference: Alzheimer’s Association. (2016). What is dementia? Retrieved from http://www.alz.org/what-is-dementia.asp

To prepare for this Assignment:

· Review this week’s Learning Resources. Consider how to assess and treat clients requiring therapy for dementia.

The Assignment

Examine Case Study: An Elderly Iranian Man With Alzheimer’s Disease. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. At each decision point stop to complete the following:

Introduction regarding disease state

High-level summary of patient case

Purpose of the essay statement

Decision #1

What options were listed?

Which decision did you select?

Why did you select this decision? Support your response with evidence and references to the Learning Resources Foundational Neuroscience Discussion.

Why didn’t you select the other two options?

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?

Decision #2

What options were listed?

What option did you choose?

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

Why didn’t you select the other two options?

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? Foundational Neuroscience Discussion

Decision #3

What options were listed?

What option did you choose?

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

Why didn’t you select the other two options?

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?

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

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.

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.

References

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapter, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

· Chapter 13, “Dementia and Its Treatment”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

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.

Review the following medications:

For insomnia

· donepezil

· galantamine

· memantine

· rivastigmine

Bui, Q. (2012). Antidepressants for agitation and psychosis in patients with dementia. American Family Physician, 85(1), 20–22. Retrieved from http://www.aafp.org/journals/afp.html

Note: Retrieved from from the Walden Library databases.

Meltzer, H. Y., Mills, R., Revell, S., Williams, H., Johnson, A., Bahr, D., & Friedman, J. H. (2010). Pimavanserin, a serotonin receptor inverse agonist for the treatment of Parkinson’s disease psychosis. Neuropsychopharmacology, 35, 881–891. Retrieved from http://www.nature.com/npp/journal/v35/n4/pdf/npp2009176a.pdf

Required Media

Laureate Education. (2016h). Case study: An elderly Iranian man with Alzheimer’s disease [Interactive media file]. Baltimore, MD: Author.

BACKGROUND

Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CT-scan of the head) were normal.

According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.”

Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficult “finding the right words” in a conversation and then will shift to an entirely different line of conversation.

SUBJECTIVE

During the clinical interview, Mr. Akkad is pleasant, cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so the PMHNP performs a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia.

MENTAL STATUS EXAM

Mr. Akkad is 76 year old Iranian male who is cooperative with today’s clinical interview. His eye contact is poor. Speech is clear, coherent, but tangential at times. He makes no unusual motor movements and demonstrates no tic. Self-reported mood is euthymic. Affect however is restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. He is alert and oriented to person, partially oriented to place, but is disoriented to time and event [he reports that he thought he was coming to lunch but “wound up here”- referring to your office, at which point he begins to laugh]. Insight and judgment are impaired. Impulse control is also impaired as evidenced by Mr. Akkad’s standing up during the clinical interview and walking towards the door. When the PMHNP asked where he was going, he stated that he did not know. Mr. Akkad denies suicidal or homicidal ideation.

Diagnosis: Major neurocognitive disorder due to Alzheimer’s disease (presumptive)

RESOURCES

§ Folstein, M. F., Folstein, S. E., & McHugh, P. R. (2002). Mini-Mental State Examination (MMSE). Lutz, FL: Psychological Assessment Resources.

Decision Point One

Select what the PMHNP should do:

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/10/mm/alzheimers_disease/img/pill-red.pngBegin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/10/mm/alzheimers_disease/img/pill-blue.png Begin Aricept (donepezil) 5 mg orally at BEDTIME

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/10/mm/alzheimers_disease/img/pill-yellow.pngBegin Razadyne (galantamine) 4 mg orally BID

Decision Point One

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/10/mm/alzheimers_disease/img/pill-blue.pngBegin Aricept (donepezil) 5 mg orally at BEDTIME Foundational Neuroscience Discussion

RESULTS OF DECISION POINT ONE

· Client returns to clinic in four weeks

· The client is accompanied by his son who reports that his father is “no better” from this medication

· He reports that his father is still disinterested in attending religious services/activities, and continues to exhibit disinhibited behaviors

· You continue to note confabulation and decide to administer the MMSE again. Mr. Akkad again scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall

Decision Point Two

Select what the PMHNP should do next:

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/10/mm/alzheimers_disease/img/pill-red.pngIncrease Aricept to 10 mg orally at BEDTIME

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/10/mm/alzheimers_disease/img/pill-blue.pngDiscontinue Aricept and begin Razadyne (galantamine) extended release 24 mg orally daily

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/10/mm/alzheimers_disease/img/pill-yellow.pngDiscontinue Aricept and begin Namenda (memantine) extended release, 28 mg orally daily

Decision Point Two https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/10/mm/alzheimers_disease/img/pill-red.pngIncrease Aricept to 10 mg orally at BEDTIME

RESULTS OF DECISION POINT TWO

· Client returns to clinic in four weeks

· Client’s son reports that the client is tolerating the medication well, but is still concerned that his father is no better

· He states that his father is attending religious services with the family, which the son and the rest of the family is happy about. He reports that his father is still easily amused by things he once found serious

Decision Point Three

Select what the PMHNP should do next:

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/10/mm/alzheimers_disease/img/pill-red.pngContinue Aricept 10 mg orally at BEDTIME Foundational Neuroscience Discussion

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/10/mm/alzheimers_disease/img/pill-blue.pngIncrease Aricept to 15 mg orally at BEDTIME x 6 weeks, then increase to 20 mg orally at BEDTIME

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/10/mm/alzheimers_disease/img/pill-yellow.pngDiscontinue Aricept and begin Namenda 5 mg orally daily

Decision Point Three

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/10/mm/alzheimers_disease/img/pill-red.pngContinue Aricept 10 mg orally at BEDTIME

Guidance to Student

At this point, it would be prudent for the PMHNP to continue Aricept at 10 mg orally at bedtime. Recall that this medication can take several months before stabilization of deterioration is noted. At this point, the client is attending religious services with the family, which has made the family happy. Disinhibition may improve in a few weeks, or it may not improve at all. This is a counseling point that the PMHNP should review with the son.

There is no evidence that Aricept given at doses greater than 10 mg per day has any therapeutic benefit. It can, however, cause side effects. Increasing to 15 and 20 mg per day would not be appropriate.

There is nothing in the clinical presentation to suggest that the Aricept should be discontinued. Whereas it may be appropriate to add Namenda to the current drug profile, there is no need to discontinue Aricept. In fact, NMDA receptor antagonist therapy is often used with cholinesterase inhibitors in combination therapy to treat Alzheimer’s disease. The key to using both medications is slow titration upward toward therapeutic doses to minimize negative side effects.

Finally, it is important to note that changes in the MMSE should be evaluated over the course of months, not weeks. The absence of change in the MMSE after 4 weeks of treatment should not be a source of concern Foundational Neuroscience Discussion

Pediatric Clients With Mood Disorders Therapy Decision Tree Case Study: African American Child Suffering From Depression

Assessing and Treating Pediatric Clients With Mood Disorders

Therapy for Pediatric Clients With Mood Disorders

Case Study: An African American Child Suffering From Depression

Mood disorders can impact every facet of a child’s life, making the most basic activities difficult for clients and their families. This was the case for 13-year-old Kara, who was struggling at home and at school. For more than 8 years, Kara suffered from temper tantrums, impulsiveness, inappropriate behavior, difficulty in judgment, and sleep issues. As a psychiatric mental health nurse practitioner working with pediatric clients, you must be able to assess whether these symptoms are caused by psychological, social, or underlying growth and development issues. You must then be able recommend appropriate therapies.

ORDER A PLAGIARISM-FREE PAPER HERE

This week, as you examine antidepressant therapies, you explore the assessment and treatment of pediatric clients with mood disorders. You also consider ethical and legal implications of these therapies.

Case Study: An African American Child Suffering From Depression

When pediatric clients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult clients with the same disorders, but they also metabolize medications much differently. As a result, psychiatric mental health nurse practitioners must exercise caution when prescribing psychotropic medications to these clients. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting with mood disorders.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment Pediatric Clients With Mood Disorders Therapy Decision Tree Case Study: African American Child Suffering From Depression

Note: This Case Study: An African American Child Suffering From Depression Assignment is the first of 10 assignments that are based on interactive client case studies. For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients.

NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment Pediatric Clients With Mood Disorders Therapy Decision Tree Case Study: African American Child Suffering From Depression

Case Study: An African American Child Suffering From Depression Required Readings

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

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 6, “Mood Disorders”

Chapter 7, “Antidepressants”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter. Pediatric Clients With Mood Disorders Therapy Decision Tree Case Study: African American Child Suffering From Depression.

Review the following medications:

amitriptyline

bupropion

amitriptylinebupropioncitalopramclomipraminedesipraminedesvenlafaxinedoxepinduloxetineescitalopramfluoxetinefluvoxamine

imipramine

ketamine

mirtazapine

nortriptyline

paroxetine

selegiline

sertraline

trazodone

venlafaxine

vilazodone

vortioxetine

citalopram

clomipramine

Case Study: An African American Child Suffering From Depression

Magellan Health, Inc. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. Retrieved from http://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdf

Rao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787–791. doi:10.1002/da.22171 Pediatric Clients With Mood Disorders Therapy Decision Tree Case Study: African American Child Suffering From Depression

Note: Retrieved from Walden Library databases.

Vitiello, B. (2012). Principles in using psychotropic medication in children and adolescents. In J. M. Rey (Ed.), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from http://iacapap.org/wp-content/uploads/A.7-PSYCHOPHARMACOLOGY-072012.pdf

Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.

Note: Retrieved from Walden Library databases.

Case Study: An African American Child Suffering From Depression Required Media

Laureate Education (2016e). Case study: An African American child suffering from depression [Interactive media file]. Baltimore, MD: Author.

Note: This case study will serve as the foundation for this week’s Assignment.

Case Study: An African American Child Suffering From Depression Optional Resources

El Marroun, H., White, T., Verhulst, F., & Tiemeier, H. (2014). Maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes: A systematic review. European Child & Adolescent Psychiatry, 23(10), 973–992. doi:10.1007/s00787-014-0558-3

Gordon, M. S., & Melvin, G. A. (2014). Do antidepressants make children and adolescents suicidal? Journal of Pediatrics and Child Health, 50(11), 847–854. doi:10.1111/jpc.12655

Seedat, S. (2014)NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment . Controversies in the use of antidepressants in children and adolescents: A decade since the storm and where do we stand now? Journal of Child & Adolescent Mental Health, 26(2), iii–v. doi:10.2989/17280583.2014.938497

To prepare for this Case Study: An African American Child Suffering From Depression Assignment:

Review this week’s Learning Resources. Consider how to assess and treat pediatric clients requiring antidepressant therapy. Pediatric Clients With Mood Disorders Therapy Decision Tree Case Study: African American Child Suffering From Depression

The Case Study: An African American Child Suffering From Depression Assignment

Examine Case Study: An African American Child Suffering From Depression. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

Decision #1

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?

Decision #2

NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

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

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?

Also include how ethical considerations might impact your treatment plan and communication with clients. Pediatric Clients With Mood Disorders Therapy Decision Tree Case Study: African American Child Suffering From Depression

BACKGROUND INFORMATION

The client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression.

Client complained of feeling “sad”

Mother reports that teacher said child is withdrawn from peers in class

Mother notes decreased appetite and occasional periods of irritation

Client reached all developmental landmarks at appropriate ages

Physical exam unremarkable

Laboratory studies WNL

Child referred to psychiatry for evaluation

Client seen by Psychiatric Nurse Practitioner

MENTAL STATUS EXAM

Alert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation, but does admit that he often thinks about himself being dead and what it would be like to be dead. Pediatric Clients With Mood Disorders Therapy Decision Tree Case Study: African American Child Suffering From Depression

The PMHNP administers the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression)

Case Study: An African American Child Suffering From Depression RESOURCES

§ Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.

Decision Point One

Select what the PMHNP should do:

Begin Zoloft 25 mg orally daily

Begin Paxil 10 mg orally daily

Begin Wellbutrin 75 mg orally BID

Case Study of the above client

Decision Point One

I selected Zoloft 25 mg orally daily

RESULTS OF DECISION POINT ONE

Client returns to clinic in four weeks

No change in depressive symptoms at all

Decision Point Two

Increase dose to 50 mg orally daily

RESULTS OF DECISION POINT TWO

Client returns to clinic in four weeks

Depressive symptoms decrease by 50%. Cleint tolerating well

Decision Point Three

Maintain current dose

Guidance to Student

At this point, sufficient symptom reduction has been achieved. This is considered a “response” to therapy. Can continue with current dose for additional 4 week to see if any further reductions in depressive symptoms are noted. An increase in dose may be warranted since this is not “full” remission- Discuss pros/cons of increasing drug dose with client at this time and empower the client to be part of the decision. There is no indication that the drug therapy should be changed to an SNRI at this point as the client is clearly responding to this therapy. Pediatric Clients With Mood Disorders Therapy Decision Tree Case Study: African American Child Suffering From Depression

Geriatric Clients With Mood Disorders, Major Depressive Disorder, Bipolar Disorder, Anxiety Disorders, Psychosis and Schizophrenia, Dementia, Attention deficit hyperactivity disorder (ADHD) decision tree case studies.

Assessing and Treating Pediatric Clients With Mood Disorders

Therapy for Pediatric Clients With Mood Disorders

Case Study: An African American Child Suffering From Depression

Mood disorders can impact every facet of a child’s life, making the most basic activities difficult for clients and their families. This was the case for 13-year-old Kara, who was struggling at home and at school. For more than 8 years, Kara suffered from temper tantrums, impulsiveness, inappropriate behavior, difficulty in judgment, and sleep issues. As a psychiatric mental health nurse practitioner working with pediatric clients, you must be able to assess whether these symptoms are caused by psychological, social, or underlying growth and development issues. You must then be able recommend appropriate therapies.

ORDER A PLAGIARISM-FREE PAPER HERE

This week, as you examine antidepressant therapies, you explore the assessment and treatment of pediatric clients with mood disorders. You also consider ethical and legal implications of these therapies.

Case Study: An African American Child Suffering From Depression

When pediatric clients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult clients with the same disorders, but they also metabolize medications much differently. As a result, psychiatric mental health nurse practitioners must exercise caution when prescribing psychotropic medications to these clients. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting with mood disorders.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment Geriatric Clients With Mood Disorders, Major Depressive Disorder, Bipolar Disorder, Anxiety Disorders, Psychosis and Schizophrenia, Dementia, Attention deficit hyperactivity disorder (ADHD) decision tree case studies

Note: This Case Study: An African American Child Suffering From Depression Assignment is the first of 10 assignments that are based on interactive client case studies. For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients.

NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

Case Study: An African American Child Suffering From Depression Required Readings

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

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 6, “Mood Disorders”

Chapter 7, “Antidepressants”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Review the following medications:

amitriptyline

bupropion

amitriptylinebupropioncitalopramclomipraminedesipraminedesvenlafaxinedoxepinduloxetine Geriatric Clients With Mood Disorders, Major Depressive Disorder, Bipolar Disorder, Anxiety Disorders, Psychosis and Schizophrenia, Dementia, Attention deficit hyperactivity disorder (ADHD) decision tree case studiesescitalopramfluoxetine

fluvoxamine

imipramine

ketamine

mirtazapine

nortriptyline

paroxetine

selegiline

sertraline

trazodone

venlafaxine

vilazodone

vortioxetine

citalopram

clomipramine

Case Study: An African American Child Suffering From Depression

Magellan Health, Inc. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. Retrieved from http://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdf

Rao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787–791. doi:10.1002/da.22171

Note: Retrieved from Walden Library databases.

Vitiello, B. (2012). Principles in using psychotropic medication in children and adolescents. In J. M. Rey (Ed.), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from http://iacapap.org/wp-content/uploads/A.7-PSYCHOPHARMACOLOGY-072012.pdf

Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.

Note: Retrieved from Walden Library databases.

Case Study: An African American Child Suffering From Depression Required Media

Laureate Education (2016e). Case study: An African American child suffering from depression [Interactive media file]. Baltimore, MD: Author.

Note: This case study will serve as the foundation for this week’s Assignment.

Case Study: An African American Child Suffering From Depression Optional Resources

El Marroun, H., White, T., Verhulst, F., & Tiemeier, H. (2014). Maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes: A systematic review. European Child & Adolescent Psychiatry, 23(10), 973–992. doi:10.1007/s00787-014-0558-3

Gordon, M. S., & Melvin, G. A. (2014). Do antidepressants make children and adolescents suicidal? Journal of Pediatrics and Child Health, 50(11), 847–854. doi:10.1111/jpc.12655

Seedat, S. (2014)NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment . Controversies in the use of antidepressants in children and adolescents: A decade since the storm and where do we stand now? Journal of Child & Adolescent Mental Health, 26(2), iii–v. doi:10.2989/17280583.2014.938497

To prepare for this Case Study: An African American Child Suffering From Depression Assignment:

Review this week’s Learning Resources. Consider how to assess and treat pediatric clients requiring antidepressant therapy.

The Case Study: An African American Child Suffering From Depression Assignment

Examine Case Study: An African American Child Suffering From Depression. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment Geriatric Clients With Mood Disorders, Major Depressive Disorder, Bipolar Disorder, Anxiety Disorders, Psychosis and Schizophrenia, Dementia, Attention deficit hyperactivity disorder (ADHD) decision tree case studies

Decision #1

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?

Decision #2

NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

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

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?

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

BACKGROUND INFORMATION

The client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression.

Client complained of feeling “sad”

Mother reports that teacher said child is withdrawn from peers in class

Mother notes decreased appetite and occasional periods of irritation

Client reached all developmental landmarks at appropriate ages

Physical exam unremarkable

Laboratory studies WNL

Child referred to psychiatry for evaluation

Client seen by Psychiatric Nurse Practitioner

MENTAL STATUS EXAM

Alert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation, but does admit that he often thinks about himself being dead and what it would be like to be dead.

The PMHNP administers the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression)

Case Study: An African American Child Suffering From Depression RESOURCES

§ Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.

Decision Point One

Select what the PMHNP should do:

Begin Zoloft 25 mg orally daily

Begin Paxil 10 mg orally daily

Begin Wellbutrin 75 mg orally BID

Case Study of the above client

Decision Point One

I selected Zoloft 25 mg orally daily

RESULTS OF DECISION POINT ONE

Client returns to clinic in four weeks

No change in depressive symptoms at all

Decision Point Two

Increase dose to 50 mg orally daily

RESULTS OF DECISION POINT TWO

Client returns to clinic in four weeks

Depressive symptoms decrease by 50%. Cleint tolerating well

Decision Point Three

Maintain current dose

Guidance to Student

At this point, sufficient symptom reduction has been achieved. This is considered a “response” to therapy. Can continue with current dose for additional 4 week to see if any further reductions in depressive symptoms are noted. An increase in dose may be warranted since this is not “full” remission- Discuss pros/cons of increasing drug dose with client at this time and empower the client to be part of the decision. There is no indication that the drug therapy should be changed to an SNRI at this point as the client is clearly responding to this therapy.

SAMPLE DECISION TREE ASSIGNMENT

An Elderly Iranian Man with Alzheimer’s

Alzheimer’s condition is a neurodegenerative disease that begins slowly and worsens over a long period of time. The condition has been associated with almost 70% of all dementia cases in the world. The most prevalent early symptoms entail the absence of memory concerning recent events. As the condition progresses, other symptoms such as language difficulties, mood swings, disorientation, behavioral issues, lack of self-care management, and disorientation may occur (Houmani 
et al.,
 2018). In a gradual manner, all the bodily functions will be lost resulting in eventual death. As much as the disease’s life expectancy varies, the typical expectancy does not go beyond nine years after diagnosis. Importantly, the disease does not have a cure but it could be managed to ensure that the quality of life of patients suffering from it is improved.

The case study for the present assignment entails the examination and treatment of an elderly Iranian man who displays strange behaviors according to his son. Mr. Akan has lost interest in things that erstwhile interested him. Further, the client has been forgetting things and his subjective test revealed confabulation during mental health testing process. Mr. Akad also has restricted affect and impaired impulse and judgment. A mini-mental state examination reveals that Mr. Akad suffers from major neurocognitive disorder caused by presumptive Alzheimer’s disease. This paper describes the assessment outcomes and treatment options for an elderly Iranian man, who has been diagnosed with Alzheimer’s. The condition can be treated with pharmacological interventions, which are dependent on among other factors dosage, proper selection of drug, and time of use, and administration route. Geriatric Clients With Mood Disorders, Major Depressive Disorder, Bipolar Disorder, Anxiety Disorders, Psychosis and Schizophrenia, Dementia, Attention deficit hyperactivity disorder (ADHD) decision tree case studies

NURS 6630 Week 3 Assignment: Assessing and Treating Adult and Geriatric Clients With Mood Disorders

Case Study: An Elderly Hispanic Man With Major Depressive Disorder

Needs to be 6-8 pages, & total references, but 3 need to be Academic References. Apa Format. Please Read the case study and choose one of the medications below and answer the questions below. The instructor states its ok if we don’t choose the best medication for the patient just as long as we answer the questions and state why we chose the medication and why we did not choose the others.

Assignment: Assessing and Treating Adult and Geriatric Clients With Mood Disorders

Advances in genetics and epigenetics have changed the traditional understanding of mood disorders, resulting in new evidence-based practices. In your role as a psychiatric mental health nurse practitioner, it is essential for you to continually educate yourself on new findings and best practices in the field. For this Assignment, you consider best practices for assessing and treating adult and geriatric clients presenting with mood disorders.

Case Study: An Elderly Hispanic Man With Major Depressive Disorder Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 6, “Mood Disorders”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

amitriptyline

bupropion

citalopram

bupropion

citalopram

clomipramine

desipramine

desvenlafaxine

doxepin

duloxetine

escitalopram

fluoxetine

fluvoxamine

imipramine

ketamine

mirtazapine

nortriptyline

paroxetine

selegiline

sertraline

trazodone

venlafaxine

vilazodone

vortioxetine

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

Note: Retrieved from Walden Library databases.

Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389. Retrieved from https://www.researchgate.net/profile/Marie_Asberg/publication/22697065_A_New_Depression_Scale_Designed_to_be_Sensitive_to_Change/links/09e41513f85c708fee000000.pdf

Case Study: An Elderly Hispanic Man With Major Depressive Disorder Required Media

Laureate Education. (2016g). Case study: An elderly Hispanic man with major depressive disorder [Interactive media file]. Baltimore, MD: Author.

Note: This case study will serve as the foundation for this week’s Assignment.

To prepare for this Assignment

Review this week’s Learning Resources. Consider how to assess and treat adult and geriatric clients requiring antidepressant therapy. Geriatric Clients With Mood Disorders, Major Depressive Disorder, Bipolar Disorder, Anxiety Disorders, Psychosis and Schizophrenia, Dementia, Attention deficit hyperactivity disorder (ADHD) decision tree case studies.

The Case Study: An Elderly Hispanic Man With Major Depressive Disorder Assignment

Examine Case Study: An Elderly Hispanic Man With Major Depressive Disorder. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

At each decision point stop to complete the following:

Decision #1

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?

Decision #2

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

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?

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

Case Study: An Elderly Hispanic Man With Major Depressive Disorder

BACKGROUND INFORMATION

The client is a 32-year-old Hispanic American male who came to the United States when he was in high school with his father. His mother died back in Mexico when he was in school. He presents today to the PMHNPs office for an initial appointment for complaints of depression. The client was referred by his PCP after “routine” medical work-up to rule out an organic basis for his depression. He has no other health issues with the exception of some occasional back pain and “stiff” shoulders which he attributes to his current work as a laborer in a warehouse.

SUBJECTIVE

During today’s clinical interview, client reports that he always felt like an outsider as he was “teased” a lot for being “black” in high school. States that he had few friends, and basically kept to himself. He describes his home life as “good.” Stating “Dad did what he could for us, there were 8 of us.” He also reports a remarkably diminished interest in engaging in usual activities, states that he has gained 15 pounds in the last 2 months. He is also troubled with insomnia which began about 6 months ago, but have been progressively getting worse. He does report poor concentration which he reports is getting in “trouble” at work.

MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. He is casually dressed. Speech is clear, but soft. He does not readily make eye contact, but when he does, it is only for a few moments. He is endorsing feelings of depression. Affect is somewhat constricted, but improves as the clinical interview progresses. He denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment and insight appear grossly intact. He is currently denying suicidal or homicidal ideation. The PMHNP administers the 
“Montgomery- Asberg Depression Rating Scale (MADRS)”
 and obtained a score of 51 
(indicating severe depression)
.

RESOURCES

Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389. Geriatric Clients With Mood Disorders, Major Depressive Disorder, Bipolar Disorder, Anxiety Disorders, Psychosis and Schizophrenia, Dementia, Attention deficit hyperactivity disorder (ADHD) decision tree case studies

Decision Point One

Select what the PMHNP should do:

Begin zoloft 25 mg orally daily

Begin Effexor XR 37.5 mg orally daily

Begin Phenelzine 15 mg orally TID

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?

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

Support your rationale with a minimum of three academic resources but need 7 in total.. While you may use the course text to support your rationale, it will not count toward the resource requirement.

Stahl, S. M. (2013). 
Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications 
(4th ed.). New York, NY: Cambridge University Press.

Note: 
To access the following chapters, click on the 
Essential Psychopharmacology, 4th ed
 tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 6, “Mood Disorders”

Stahl, S. M. (2014b). 
The prescriber’s guide 
(5th ed.). New York, NY: Cambridge University Press.

Note: 
To access the following medications, click on the 
The Prescriber’s Guide, 5th ed
 tab on the Stahl Online website and select the appropriate medication.

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

Note: 
Retrieved from Walden Library databases.

Montgomery, S. A., & Asberg, M. (1979). 
A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134
, 382-389. Retrieved from 
https://www.researchgate.net/profile/Marie_Asberg/…

Required Media

Laureate Education. (2016g). 
Case study: An elderly Hispanic man with major depressive disorder
[Interactive media file]. Baltimore, MD: Author.

Note: 
This case study will serve as the foundation for this week’s Assignment.

Case Study: An Elderly Hispanic Man With Major Depressive Disorder

SAMPLE APPROACH

Geriatric Depression Therapy

Mood disorders, such as depression, are prevalent in geriatric population and older adults. According to studies, conditions such as depression may have debilitating impacts on the family, the patient and their social constructs. Further, studies have revealed that there exist particularities in the etiology, management and clinical presentation of mood disorders in the elderly and older adults (Flint, 2012). Thus, taking cognizance of these particularities and their clinical importance are significant for their effective management in the geriatric population. However, before the management, comprehensive diagnostic undertakings including using the Geriatric Depression Scale (American Psychiatric Association, 2013) are necessary so as to identify the kind of condition that a PMHNP nurse will be addressing. After the identification of the significant variables, and the administration of effective drugs to arrest the condition is recommended. The formulation of the treatment regimen for depression depends on the safety and efficacy of a drug. Other medications and psychotherapeutic interventions are encouraged if the first intervention proves unsuccessful. In the current paper, a 31-year old Hispanic has been diagnosed with severe depression based on score of 51 that was obtained from the Montgomery- Asberg Depression Rating Scale (MADRS) (Montgomery & Asberg, 1979) by the PMHNP. The diagnosis, medication choice, and alterations made in the present analysis will facilitate a greater comprehension of how PMHNP nurses can therapeutically address depression in an elderly patient.

NURS 6630 Week 4 Assignment

Assignment: Assessing and Treating Clients with With Bipolar Disorder

Case Study: An Asian American Woman With Bipolar Disorder

Bipolar disorder is a unique disorder that causes shifts in mood and energy, which results in depression and mania for clients. Proper diagnosis of this disorder is often a challenge for two reasons: 1) clients often present as depressive or manic, but may have both; and 2) many symptoms of bipolar disorder are similar to other disorders. Misdiagnosis is common, making it essential for you to have a deep understanding of the disorder’s pathophysiology. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with bipolar disorder.

NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment: Case Study: An Asian American Woman With Bipolar Disorder

Required Readings

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

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 6, “Mood Disorders”

Chapter 8, “Mood Stabilizers”

Stahl, S. M., & Ball, S. (2009b). Stahl’s illustrated mood stabilizers. New York, NY: Cambridge University Press.

To access the following chapters, click on the Illustrated Guides tab and then the Mood Stabilizers tab.

Chapter 4, “Lithium and Various Anticonvulsants as Mood Stabilizers for Bipolar Disorder”

Chapter 5, “Atypical Antipsychotics as Mood Stabilizers for Bipolar Disorder”

Vitiello, B. (2013). How effective are the current treatments for children diagnosed with manic/mixed bipolar disorder? CNS Drugs, 27(5), 331-333. doi:10.1007/s40263-013-0060-3

Note: Retrieved from Walden Library databases.

Chen, R., Wang, H., Shi, J., Shen, K., & Hu, P. (2015). Cytochrome P450 2D6 genotype affects the pharmacokinetics of controlled-release paroxetine in healthy Chinese subjects: comparison of traditional phenotype and activity score systems. European Journal of Clinical Pharmacology, 71(7), 835-841. doi:10.1007/s00228-015-1855-6

Note: Retrieved from Walden Library databases.

Case Study: An Asian American Woman With Bipolar Disorder Required Media

Laureate Education. (2016f). Case study: An Asian American woman with bipolar disorder [Interactive media file]. Baltimore, MD: Author

Note: This case study will serve as the foundation for this week’s Assignment.

Case Study: An Asian American Woman With Bipolar Disorder Optional Resources

Mostafavi, A., Solhi, M., Mohammadi, M., Hamedi, M., Keshavarzi, M., & Akhondzadeh, S. (2014). Melatonin decreases olanzapine induced metabolic side-effects in adolescents with bipolar disorder: a randomized double-blind placebo-controlled trial. Acta Medica Iranica, 52(10), 734-739.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

Retrieved from http://acta.tums.ac.ir/index.php/acta

Analyze ethical and legal implications related to prescribing bipolar therapy to clients across the lifespan ..

Learning Objectives

Students will:

Assess client factors and history to develop personalized plans of bipolar therapy for clients

Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring bipolar therapy

Evaluate efficacy of treatment plans

To prepare for this Assignment:

Review this week’s Learning Resources. Consider how to assess and treat clients requiring bipolar therapy.

The Case Study: An Asian American Woman With Bipolar Disorder Assignment

Examine Case Study: An Asian American Woman With Bipolar Disorder. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. Geriatric Clients With Mood Disorders, Major Depressive Disorder, Bipolar Disorder, Anxiety Disorders, Psychosis and Schizophrenia, Dementia, Attention deficit hyperactivity disorder (ADHD) decision tree case studies

At each decision point stop to complete the following:

Decision #1

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?

Decision #2

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

NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

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?

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

SAMPLE APPROACH FROM STUDENT. IF YOU WANT AN ORIGINAL CUSTOM PAPER FROM OUR EXPERTS, SIMPLY ORDER NOW

Assessing and Treatment for Bipolar Disorder Patient

Introduction

Bipolar disorder is not an uncommon illness. It is a very chronic and severe mental disorder, affecting approximately 1-2% of the adult population. The signs and symptoms of bipolar disorder are different depending on the type of episode (i.e., manic or depressive). Each episode marks a critical change from the way a person usually acts and their typical mood, and can be characterized by a sudden change in the general attitude of the patient, the way the patient thinks and the behavior. 1 The changes will be sudden that it will be noticed by people around (Robert et al., 2017). This dangerous demonstrative unpredictability mood disorder can be found in all area of life, that is, from the poor to the rich, this disorder affects millions of people in all facets of life (Robert et al., 2017). Bipolar disorder can be seen mostly in the age starting at 25years or older, but it is not totally absent in the teenage age. It shows that about 2.6 percent of the population are diagnosed as bipolar. 3 (National Alliance on Mental Illness, 2017).

If not well treated ,Bipolar disorder can be critical; 1 early identification of symptoms with an appropriate treatment plan may include psychotherapy, medications, a healthy lifestyle and a regular schedule will keep the patient healthy (National Alliance on Mental Illness. (2017). 1 The NP should have a good understand of this disorder to be able to take care of this the patient because of its long-term management and how it affects the health in totality (National Alliance on Mental Illness. (2017). 1 My focus of this paper will look into an Asian American Woman with a bipolar disorder, symptoms management, diagnosing the symptom, and the complete treatment. The paper will consider the most safe and appropriate options of treatment and the outcome as the treatment, and care. Geriatric Clients With Mood Disorders, Major Depressive Disorder, Bipolar Disorder, Anxiety Disorders, Psychosis and Schizophrenia, Dementia, Attention deficit hyperactivity disorder (ADHD) decision tree case studies

NURS 6630 Week 5 Assignment

Assignment: Assessing and Treating Clients With Anxiety Disorders

Common symptoms of anxiety disorders include chest pains, shortness of breath, and other physical symptoms that may be mistaken for a heart attack or other physical ailment. These manifestations often prompt clients to seek care from their primary care providers or emergency departments. Once it is determined that there is no organic basis for these symptoms, clients are typically referred to a psychiatric mental health practitioner for anxiolytic therapy. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with anxiety disorders.
Assignment: Assessing and Treating Clients With Anxiety Disorders
 – NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment.

Assignment: Assessing and Treating Clients With Anxiety Disorders
 Required Readings

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

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 9, “Anxiety Disorder and Anxiolytics”

Stahl, S. M., & Grady, M. (2010). Stahl’s illustrated anxiety, stress, and PTSD. New York, NY: Cambridge University Press.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

To access the following chapters, click on the Illustrated Guides tab and then the Anxiety, Stress, and PTSD tab.

Chapter 4, “First-Line Medications for PTSD”

Chapter 5, “Second-Line, Adjunct, and Investigational Medications for PTSD”

Strawn, J. R., Wehry, A. M., DelBello, M. P., Rynn, M. A., & Strakowski, S. (2012). Establishing the neurobiologic basis of treatment in children and adolescents with generalized anxiety disorder. Depression and Anxiety, 29(4), 328–-339. doi:10.1002/da.21913

Note: Retrieved from Walden Library databases.

Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0

Note: Retrieved from Walden Library databases.

Assignment: Assessing and Treating Clients With Anxiety Disorders
 Required Media

Laureate Education. (2016b). Case study: A middle-aged Caucasian man with anxiety [Interactive media file]. Baltimore, MD: Author.

Note: This case study will serve as the foundation for this week’s Assignment.

Assignment: Assessing and Treating Clients With Anxiety Disorders
 Optional Resources

Lupi, M., Martinotti, G., Acciavatti, T., Pettorruso, M., Brunetti, M., Santacroce, R., & … Di Giannantonio, M. (2014). Pharmacological treatments in gambling disorder: A qualitative review. Biomed Research International, 2014. doi:10.1155/2014/537306

To prepare for this Assignment:NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

Review this week’s Learning Resources. Consider how to assess and treat clients requiring anxiolytic therapy.

The Assignment: Assessing and Treating Clients With Anxiety Disorders Assignment

Examine Case Study: A Middle-Aged Caucasian Man With Anxiety. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

Decision #1 NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

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?

Decision #2

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

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?

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

A Middle-Aged Caucasian Man with Anxiety

The case study is about a 46-year old white male who works as a welder. His primary care physician refers the man to psychiatry after a trip to the emergency room where he showed symptoms of a heart attack. The patient indicated instances of chest tightness, shortness of breath, and a feeling of impending doom. He has light hypertension but manages it with low sodium diet; he is also a little overweight. The possibility of myocardial infarction was ruled out in the emergency room, and the electrocardiogram did not reveal significant results. The client admits that he occasionally consumes 3-4 beers to counter work-related stress. The patient takes care of his aging parents and encounters stress at the workplace. The mental health exam reveals that the client is alert and oriented; however, he does not have any suicidal or homicidal thoughts. The psychiatric-mental health practitioner (PMHNP) administered the Hamilton Anxiety Rating Scale (HAM-A) and revealed a score of 26. The PMHNP diagnosed the client with generalized anxiety disorder. The PMHNP made three treatment decisions for the patient; the first was to apply Zoloft 50 mg po daily, start Imipramine 25 mg po BID, and useBuspirone.

NURS 6630 Week 6 Assignment

Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia

NURS 6630 Week 6: Antipsychotic Therapy

According to the National Alliance on Mental Illness, approximately 100,000 people experience psychosis in the United States each year (NAMI, 2016). In practice, clients may present with delusions, hallucinations, disorganized thinking, disorganized or abnormal motor behavior, as well as other negative symptoms that can be disabling for these individuals. Not only are these symptoms one of the most challenging symptom clusters you will encounter, many are associated with other disorders such as depression, bipolar disorder, and disorders on the schizophrenia spectrum. As a psychiatric mental health nurse practitioner, you must understand the underlying neurobiology of these symptoms to select appropriate therapies and improve outcomes for clients.

This week, as you examine antipsychotic therapies, you explore the assessment and treatment of clients with psychosis and schizophrenia. You also consider ethical and legal implications of these therapies.

Assignment:
 Assessing and Treating Clients With Psychosis and Schizophrenia

Psychosis and schizophrenia greatly impact the brain’s normal processes, which interferes with the ability to think clearly. When symptoms of these disorders are uncontrolled, clients may struggle to function in daily life. However, clients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with psychosis and schizophrenia.Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia – NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment.

Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia 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.

Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia Required Readings

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

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 4, “Psychosis and Schizophrenia”

Chapter 5, “Antipsychotic Agents”

Stahl, S. M. (2014b)NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment . The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press. Geriatric Clients With Mood Disorders, Major Depressive Disorder, Bipolar Disorder, Anxiety Disorders, Psychosis and Schizophrenia, Dementia, Attention deficit hyperactivity disorder (ADHD) decision tree case studies

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.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

Review the following medications:

amisulpride

aripiprazole

asenapine

chlorpromazine

clozapine

flupenthixol

fluphenazine

haloperidol

iloperidone

loxapine

lurasidone

olanzapine

paliperidone

perphenazine

quetiapine

risperidone

sulpiride

thioridazine

thiothixene

trifluoperazine

ziprasidone

Naber, D., & Lambert, M. (2009). The CATIE and CUtLASS studies in schizophrenia: Results and implications for clinicians. CNS Drugs, 23(8), 649-659. doi:10.2165/00023210-200923080-00002

Note: Retrieved from Walden Library databases.

Document: Midterm Exam Study Guide (PDF)

Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261-276.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

Note: Retrieved from Walden Library databases.

Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine. Retrieved from https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf

Walden University. (2016). ASC success strategies: Studying for and taking a test. Retrieved from http://academicguides.waldenu.edu/ASCsuccess/ASCtesting

Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia Required Media

Laureate Education. (2016j). Case study: Pakistani woman with delusional thought processes [Interactive media file]. Baltimore, MD: Author

Note: This case study will serve as the foundation for this week’s Assignment.

Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia Optional Resources

Chakos, M., Patel, J. K., Rosenheck, R., Glick, I. D., Hammer, M. B., Tapp, A., & … Miller, D. (2011). Concomitant psychotropic medication use during treatment of schizophrenia patients: Longitudinal results from the CATIE study. Clinical Schizophrenia & Related Psychoses, 5(3), 124-134. doi:10.3371/CSRP.5.3.2

Fangfang, S., Stock, E. M., Copeland, L. A., Zeber, J. E., Ahmedani, B. K., & Morissette, S. B. (2014). Polypharmacy with antipsychotic drugs in patients with schizophrenia: Trends in multiple health care systems. American Journal of Health-System Pharmacy, 71(9), 728-738. doi:10.2146/ajhp130471NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

Lin, L. A., Rosenheck, R., Sugar, C., & Zbrozek, A. (2015). Comparing antipsychotic treatments for schizophrenia: A health state approach. The Psychiatric Quarterly, 86(1), 107-121. doi:10.1007/s11126-014-9326-2

To prepare for this Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia Assignment:

Review this week’s Learning Resources. Consider how to assess and treat clients requiring anxiolytic therapy.

The Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia Assignment

Examine Case Study: Pakistani Woman with Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

Decision #1

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?

Decision #2

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

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?

Decision Point One

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/06/mm/delusional_disorders/img/pill-blue.pngStart Invega Sustenna 234 mg intramuscular X1 followed by 156 mg intramuscular on day 4 and monthly thereafter

RESULTS OF DECISION POINT ONE

· Client returns to clinic in four weeks

· A decrease in PANSS score of 25% is noted at this visit

· Client seems to be tolerating medication

· Client’s husband has made sure she makes her appointments for injections (one thus far)

· Client has noted a 2 pound weight gain but it does not seem to be an important point for her

· Client complains of injection site pain telling the PMHNP that she has trouble siting for a few hours after the injections and doesn’t like having to walk around for such a long period of time

Decision Point Two

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/06/mm/delusional_disorders/img/pill-red.pngContinue same decision made but instruct administering nurse to begin injections into the deltoid at this visit and moving forward

RESULTS OF DECISION POINT TWO

· Client returns to clinic in four weeks

· Client’s PANNS has reduced by a total of 50% from the initiation of Invega sustenna

· When questioned about injection site pain, client states it is much better in the arm

· Client’s weight has increased by an additional 2.5 pounds (total of 4.5 pounds in a 2 month period). She is somewhat bothered by the weight gain and is afraid that her husband does not like it. He is not present at this visit as she brought herself

· Client likes how she feels on the Invega Sustenna but is wondering if there is another drug like it that would not cause the weight gain

Decision Point Three

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/06/mm/delusional_disorders/img/pill-red.pngContinue with the Invega Sustenna. Counsel client on the fact that weight gain from Invega Sustenna is not as much as what other drugs with similar efficacy can cause. Make appointment with a dietician and an exercise physiologist. Follow up in one month

Guidance to Student

Weight gain can occur with Invega Sustenna. It is modest in nature and can be controlled with proper nutrition and exercise. It is always a good idea to try and control a client’s weight through consultation with a dietician and exercise physiologist (life coach) before switching to another agent when a product is showing efficacy for at least 6 months.

Abilify Maintena is a good option for someone who has good response to abilify oral. Remember that Abilify does not bind to the D2 receptor for a great period of time (such as Invega) and can be less affective in certain individuals. Also, remember that akathisia can be a possible side effect. Once an IM long acting medication is given, the effects of the drug (both efficacious and untoward effects) can be maintained for a long duration (up to a month or longer). Tolerability and efficacy should be established with oral medication first before administering the first injection. Also a disadvantage to Abilify Maintena is a 2-week overlap of oral therapy is required due to effective blood levels lagging behind the induction dose.

Qsymia is a weight loss medication that is a combination of Phenteramine and Topiramate. It is only indicated to treat obesity. This client’s BMI (28.9 kg/M2) does not fit the definition of obesity (BMI >30 Kg/M2- Following from CDC website: Class 1: BMI of 30 to < 35, Class 2: BMI of 35 to < 40, Class 3: BMI of 40 or higher. Class 3 obesity is sometimes categorized as “extreme” or “severe” obesity). There are two things wrong with this therapy option. First, there are only a few occasions where add-on therapy to treat a side effect is acceptable and weight gain is not one of those scenarios. Secondly, Phenteramine has a lot of cardiovascular toxicities (such as elevated BP, HR, increased workload on the heart). NURS 6630 Week 7 Assignment Assignment: Assessing and Treating Clients With Pain Case Study: A Caucasian Man With Hip Pain Pain can greatly influence an individual’s quality of life, as uncontrolled pain negatively impacts mood, concentration, and the overall physical and mental well-being of clients. Although pain can often be controlled with medications, the process of assessing and treating clients can be challenging because pain is such a subjective experience. Only the person experiencing the pain truly knows the intensity of the pain and whether there is a need for medication therapies. Sometimes, beliefs about pain and treatments for pain can have an adverse effect on the provider-client relationship. For this Assignment, as you examine the interactive case study consider how you might assess and treat clients presenting with pain.Case Study: A Caucasian Man With Hip Pain : NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment. Geriatric Clients With Mood Disorders, Major Depressive Disorder, Bipolar Disorder, Anxiety Disorders, Psychosis and Schizophrenia, Dementia, Attention deficit hyperactivity disorder (ADHD) decision tree case studies Case Study: A Caucasian Man With Hip Pain Required Readings Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear. Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press. To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter. Chapter 10, “Chronic Pain and Its Treatment” Stahl, S. M., & Ball, S. (2009a). Stahl’s illustrated chronic pain and fibromyalgia. New York, NY: Cambridge University Press.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment To access the following chapter, click on the Illustrated Guides tab and then the Chronic Pain and Fibromyalgia tab. Chapter 5, “Pain Drugs” Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press. 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. Review the following medications: For insomnia amitriptyline amoxapine carbamazepine clomipramine clonidine (adjunct)NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment desipramine dothiepin doxepin duloxetine gabapentin imipramine lamotrigine levetiracetam lofepramine maprotiline memantine milnacipran nortriptyline pregabalin tiagabine topiramate trimipramine valproate (divalproex) zonisamide American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Note: Retrieved from Walden Library databases. National Institute of Neurological Disorders and Stroke. (2016). Pain: Hope through research. Retrieved from http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm#3084_2 Case Study: A Caucasian Man With Hip Pain Required Media Laureate Education (2016a). Case study: A Caucasian man with hip pain [Interactive media file]. Baltimore, MD: Author Note: This case study will serve as the foundation for this week’s Assignment. To prepare for this Assignment:NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment Review this week’s Learning Resources. Consider how to assess and treat clients requiring therapy for pain and sleep/wake disorders. The Case Study: A Caucasian Man With Hip Pain Assignment Examine Case Study: A Caucasian Man With Hip Pain. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. At each decision point stop to complete the following: Decision #1 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? Decision #3 NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology- Case Study: A Caucasian Man With Hip Pain Essay Assignment 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? Decision #2 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? Also include how ethical considerations might impact your treatment plan and communication with clients. Week 10 Assignment Assignment: Assessing and Treating Clients With Dementia Case study: An elderly Iranian man with Alzheimer’s disease The Alzheimer’s Association defines dementia as “a general term for a decline in mental ability severe enough to interfere with daily life” (Alzheimer’s Association, 2016). This term encompasses dozens of cognitive disorders of impaired memory formation, recall, and communication. The care and treatment of clients with dementia is dependent on multiple factors, including the stage of dementia, comorbidities, family support, and even the care setting. In your role, as the psychiatric mental health nurse practitioner, you must be prepared to not only treat clients with these various cognitive disorders, but also the multiple behavioral issues that often accompany them. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with dementia.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment. Reference: Alzheimer’s Association. (2016). What is dementia? Retrieved from http://www.alz.org/what-is-dementia.asp Case study: An elderly Iranian man with Alzheimer’s disease Required Readings Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear. Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment To access the following chapter, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter. Chapter 13, “Dementia and Its Treatment” Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press. 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. Review the following medications: For insomnia donepezil galantamine memantine rivastigmine Bui, Q. (2012). Antidepressants for agitation and psychosis in patients with dementia. American Family Physician, 85(1), 20–22. Retrieved from http://www.aafp.org/journals/afp.html Note: Retrieved from from the Walden Library databases. Meltzer, H. Y., Mills, R., Revell, S., Williams, H., Johnson, A., Bahr, D., & Friedman, J. H. (2010). Pimavanserin, a serotonin receptor inverse agonist for the treatment of Parkinson’s disease psychosis. Neuropsychopharmacology, 35, 881–891. Retrieved from http://www.nature.com/npp/journal/v35/n4/pdf/npp2009176a.pdf Case study: An elderly Iranian man with Alzheimer’s disease Required Media Laureate Education. (2016h). Case study: An elderly Iranian man with Alzheimer’s disease [Interactive media file]. Baltimore, MD: Author.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment Geriatric Clients With Mood Disorders, Major Depressive Disorder, Bipolar Disorder, Anxiety Disorders, Psychosis and Schizophrenia, Dementia, Attention deficit hyperactivity disorder (ADHD) decision tree case studies Note: This case study will serve as the foundation for this week’s Assignment. To prepare for this Assignment: Review this week’s Learning Resources. Consider how to assess and treat clients requiring therapy for dementia. The Case study: An elderly Iranian man with Alzheimer’s disease Assignment Examine Case Study: An Elderly Iranian Man With Alzheimer’s Disease. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment At each decision point stop to complete the following: Decision #1 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? Decision #2 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.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different? Decision #3 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? Also include how ethical considerations might impact your treatment plan and communication with clients. Week 6 Midterm Question 1 A noncompliant patient states, “Why do you want me to put this poison in my body?” Identify the best response made by the psychiatric-mental health nurse practitioner (PMHNP).NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment Geriatric Clients With Mood Disorders, Major Depressive Disorder, Bipolar Disorder, Anxiety Disorders, Psychosis and Schizophrenia, Dementia, Attention deficit hyperactivity disorder (ADHD) decision tree case studies Question 2 Which statement about neurotransmitters and medications is true? Question 3 When an unstable patient asks why it is necessary to add medications to his current regimen, the PMHNP’s best response would be: Question 4 During gene expression, what must occur prior to a gene being expressed? Question 5 While genes have potential to modify behavior, behavior can also modify genes. How do genes impact this process? NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment Assignment: Assessing and Treating Clients With ADHD Case Study: A Young Caucasian Girl With ADHD Not only do children and adults have different presentations for ADHD, but males and females may also have vastly different clinical presentations. They may also respond to medication therapies differently. For example, some ADHD medications may cause children to experience stomach pain, while others can be highly addictive for adults. In your role, as a psychiatric mental health nurse practitioner, you must perform careful assessments and weigh the risks and benefits of medication therapies for clients across the lifespan. For this Assignment, you consider how you might assess and treat clients presenting with ADHD. NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment Learning Case Study: A Young Caucasian Girl With ADHD 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. Case Study: A Young Caucasian Girl With ADHD Required Readings Note: Review all materials from the Discussion. Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998). Revision and restandardization of the Conners’ Teacher Rating Scale (CTRS-R): Factors, structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279-291.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment Note: Retrieved from Walden Library databases. Case Study: A Young Caucasian Girl With ADHD Required Media Laureate Education (2016d). Case study: A young Caucasian girl with ADHD [Interactive media file]. Baltimore, MD: Author Note: This case study will serve as the foundation for this week’s Assignment. To prepare for this Assignment: This case study will serve as the foundation for this week’s Assignment. The Case Study: A Young Caucasian Girl With ADHD Assignment Examine Case Study: A Young Caucasian Girl With ADHD You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. Case Study: A Young Caucasian Girl With ADHD   Three decisions have been made concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. At each decision point there will be three decisions. I will choose one out of the three and give the outcome. At each decision point these are the thoughts to ponder: Decision #1 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? Decision #2 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?Geriatric Clients With Mood Disorders, Major Depressive Disorder, Bipolar Disorder, Anxiety Disorders, Psychosis and Schizophrenia, Dementia, Attention deficit hyperactivity disorder (ADHD) decision tree case studies Decision #3 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? *** Also include how ethical considerations might impact your treatment plan and communication with clients.*** Write paper addressing all section listed based on the decisions Case Study: A Young Caucasian Girl With ADHD   BACKGROUND Katie is an 8 year old Caucasian female who is brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katie’s teacher suggested that she may have ADHD. Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine whether or not she has this condition. The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised”. This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their family primary care provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, 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. The teacher opined that she lacks interest in school work and is easily distracted. Katie is also noted to start things but never finish them, and seldom follows through on instructions and fails to finish her school work. Katie’s parents actively deny that Katie has ADHD. “She would be running around like a wild person if she had ADHD” reports her mother. “She is never defiant or has temper outburst” adds her father. SUBJECTIVE Katie reports that she doesn’t know what the “big deal” is. She states that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds her other subjects boring, and sometimes hard because she feels “lost”. She admits that her mind does wander during class to things that she thinks of as more fun. “Sometimes” Katie reports “I will just be thinking about nothing and the teacher will call my name and I don’t know what they were talking about.” 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. Offers no other concerns at this time. 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 bright. Katie denies visual or auditory hallucinations, no delusional or paranoid thought processes readily appreciated. Attention and concentration are grossly intact based on Katie’s attending to the clinical interview and her ability to count backwards from 100 by serial 2’s and 5’s. Insight and judgment appear age appropriate. Katie denies any suicidal or homicidal ideation. Geriatric Clients With Mood Disorders, Major Depressive Disorder, Bipolar Disorder, Anxiety Disorders, Psychosis and Schizophrenia, Dementia, Attention deficit hyperactivity disorder (ADHD) decision tree case studies Diagnosis:   Attention deficit hyperactivity disorder, predominantly inattentive presentation Decisions Made and Outcomes (Needed to formulate the paper) (Must use and formulate paper based off of the chosen decision. Then tell why the other two decision were not a good choice with in-text citations noted for each.) Choices for Decision 1: Select what the PMHNP should do: Begin Wellbutrin (bupropion) XL 150 mg orally daily  Begin Intuniv extended release 1 mg orally at BEDTIME  Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING Decision Choice Chosen:  Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING ***Explain why other two choice were rejected (not adequate choices)*** Outcome: RESULTS OF DECISION POINT ONE : Client returns to clinic in four weeks Katie’s parents report that they spoke with Katie’s teacher who notices that her symptoms are much better in the morning, which has resulted in improvement in her overall academic performance. However, by the afternoon, Katie is “staring off into space” and “daydreaming” again Katie’s parents are very concerned, however, because Katie reported that her “heart felt” You obtain a pulse rate and find that Katie’s heart is beating about 130 beats per minute Choices for Decision 2: Select what the PMHNP should do:  Continue same dose of Ritalin and re-evaluate in 4 weeks  Change to Ritalin LA 20 mg orally daily in the MORNING  Discontinue Ritalin and begin Adderall XR 15 mg orally daily Decision Choice Chosen:  Change to Ritalin LA 20 mg orally daily in the MORNING ***Explain why other two choice were rejected (not adequate choices)*** Outcome: RESULTS OF DECISION POINT TWO: Client returns to clinic in four weeks Katie’s academic performance is still improved, and the switch to the LA preparation is lasting Katie throughout the school day Katie’s reports of her heart feeling “funny” have gone away. Pulse was 92 during today’s office visit Choices for Decision 3: Decision Point Three Select what the PMHNP should do next:   Maintain current dose of Ritalin LA and reevaluate in 4 weeks  Increase Ritalin LA to 30 mg orally daily  Obtain EKG based on current heart rate Decision Choice Chosen:    Maintain current dose of Ritalin LA and reevaluate in 4 weeks ***Explain why other two choice were rejected (not adequate choices)*** Outcome: Guidance to Student RESULT FROM CHOOSING TO MAINTAIN CURRENT DOES OF RITALIN LA AND REEVALUATE IN 4 WEEKS Guidance to Student At this point, Katie’s symptoms are well controlled (her attention is sustained throughout the school day) and her side effects have gone away following change to a long-acting preparation. There is no indication at this point that the dose should be increased as it is always advisable to use the lowest effective dose of stimulant medication. Katie’s heart rate is appropriate for an 8 year old girl and an EKG would not be indicated based on her heart rate. Make sure that this paper has at least  6 References from 2014 .  Please use in-text citations for each section of each decision. Don’t forget the ethical considerations for this assignment. Make it a section by itself.*** ***Also please make sure when looking at the ethical consideration for this assignment that you look at how the Caucasian (male) ethnicity and pain medications interact.*** SOME RESOURCE Note:  Review all materials from the Discussion. Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998). Revision and restandardization of the Conners’ Teacher Rating Scale (CTRS-R): Factors, structure, reliability, and criterion validity.  Journal of Abnormal Child Psychology, 26 , 279-291. Course Texts These course texts are available through Stahl Online Resources http://stahlonline.cambridge.org/ Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press. Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Geriatric Clients With Mood Disorders, Major Depressive Disorder, Bipolar Disorder, Anxiety Disorders, Psychosis and Schizophrenia, Dementia, Attention deficit hyperactivity disorder (ADHD) decision tree case studies

Skin hair nails and heent assessment essay assignment

NUR 2092 – Health Assessment

Written Assignment: HEENT/Skin/Nails

Purpose:
To apply assessment and documentation skills utilized for physical health assessment.

Overview
: After reading/viewing the module assignment and attending lab, conduct an assessment of the

Head

Eyes

Ears

Nose

Mouth

Face

Neck

Skin

Hair

Nails

Directions:
Conduct a HEENT, skin and nails assessment on a fellow student, friend, or family member. Remember to secure their permission.

ORDER A PLAGIARISM-FREE PAPER HERE

Use the HEENT documentation assignment attached to this assignment module to document your findings. Formulate a SOAP note with both
subjective and objective data
 as indicated on the HEENT attachment.

Submit your work to the Module 7 dropbox. Submit your completed assignment by following the directions linked below. Please check the 
Course Calendar 
for specific due dates.

Save your assignment as a Microsoft Word document. (Mac users, please remember to append the “.docx” extension to the filename.) The name of the file should be your first initial and last name, followed by an underscore and the name of the assignment, and an underscore and the date. An example is shown:
Jstudent_exampleproblem_101504 

 
This skin hair nails and heent assessment essay assignment is worth
20 points
and will be graded using the graded rubric below.

 

Components

Meets Expectations

Needs Improvement

Does Not meet Expectations

Assessment Findings and documentation

10 points

 
An optimal and thorough assessment and summary is present for each system.

Poorly organized/or limited summary of pertinent  assessment

Information.

Less than 50% of pertinent assessment information is addressed or is grossly incomplete and or inaccurate.

 

Soap Note

8 points

Complete and concise summary of pertinent SOAP information.

Poorly organized/or limited summary of pertinent SOAP information.

Less than 50% of pertinent information is addressed or is grossly incomplete and or inaccurate.

Spelling and Grammar

2 point.

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skin hair nails and heent assessment essay assignment

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Student Name:

Patient Age & Gender:

Date:

SKILLS ASSESSMENT

DOCUMENTED FINDINGS

Measurements and V/S

Height/Weight

Body Mass Index (BMI)

skin hair nails and heent assessment essay assignment

Blood Pressure(B/P) – Temperature

Pulse – Respirations

Pain Assessment Scale 1-10

INTEGUMENT/SKIN
(throughout assessment)

Hands/Nails/Palmar creases

Capillary refill time

Color pigmentation

Temperature

Warmth/Cool to touch

S/S of inflammation/infection

Open wounds: type, size, odor, drainage present

Bruises, tattoo’s or identifying marks

skin hair nails and heent assessment essay assignment

Turgor: upper and lower extremities. Tenting?

Lesions/rashes/ dryness/moisture

Hair distribution

HEAD/FACE

Assess Scalp/hair/cranium

Hair distribution

Assess facial Overview: symmetry and couture

CN V: (Trigeminal) Facial Sensation

(Facial) Expression: CN VII: smile/frown/raise eyebrows

EYES

Inspect External Structures: eyelids/lashes/brows

Conjunctivae

Sclera and iris

skin hair nails and heent assessment essay assignment

PERRLA: pupil size equal, round & reactive to light and accommodation (see next)

CN III (Oculomotor) Pupillary Response to accommodation:

-Look near/Look far test or

-Convergence Test

(Optic) CN II Visual Acuity Tests

-Snellen Chart

-Peripheral Field of Vision Test:

How many fingers they see when fingers are presented to both sides at the same time.

Eye movements: CN III (Oculomotor), IV (Trochlear), VI (Abducens):

6 Cardinal Fields of gaze.

Note any Nystagmus

EARS

Inspect External Ear: symmetry, discharge, lesions, shape and couture, piercings

Palpate tragus/Pinna for pain

Inspect inner ear canal: obstruction, drainage, inflammation, cerumen skin hair nails and heent assessment essay assignment

Hearing test CN VIII (Vestibulocochlear) voice test out of site

NOSE

Inspect external nose: shape and symmetry, inflammation

Visualize internal nares: lesions, swelling, symmetry, discharge

Patency of nares/sense of smell CN I (Olfactory)

MOUTH/THROAT

Inspect lips: dryness, color, cracking, lesions

Inspect buccal mucosa: lesions, saliva, swelling, tears

Teeth/gums

Tongue: pink, papillae present,

visualize under to assess frenulum/vascularization

CN XII (Hypoglossal) Tongue Movement: stick tongue out

Inspect Hard/Soft palate

Inspect throat for lesions, inflammation, or post nasal drip.

Swallow test & Gag Reflex CN IX (Glossopharyngeal) & CN X (Vagus).

Inspect tonsils

Say Ahh.. Soft palate and uvula should rise at the midline CN X (Vagus)

NECK

Assess for symmetry

ROM: Chin to chest, turn head R & L

Muscle strength CN II (Accessory) Shoulder shrug against resistance

Palpate trachea in midline

LYMPHNODES

Palpate preauricular, posterior auricular, submental, submandibular, tonsillar

PULSES

Carotid, brachial, radial, popliteal, posterior tibia, dorsalis pedis

 

Document your findings using the SOAP note format regarding 2 impaired systems finding skin hair nails and heent assessment essay assignment. (Example: your patient had a current throat infection, ear ache, head pain or cervical FX)

S-Subjective:

O-Objective:

A-Assessment:

(Formulate 2 ACTUAL nursing DX centered on the medical dx/problem. Remember, actual dx requires R/T (etiology) and AEB (signs/symptoms) factors)

P-Plan:

(List at least 10 nursing interventions are you going to implement for the above assessments)

CC: Sore throat

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Mrs. Carson, 55 yo Caucasian woman presents with sore throat x few days. Patient reports onset of headache a few days ago that progressively got worse and developed a sore throat that she rates 7.5-8/10 pain.  She states she feels “tired, draggy, and head feels clogged.” She complains of dry lips and having difficulty eating due to the sore throat. Unsure of weight changes. She reports a fever of 100 degrees F taken at home skin hair nails and heent assessment essay assignment. She has taken Ibuprofen and Sudafed at home with little relief. Denies ear pain, coughing, pressure in the ears, rashes, neck stiffness or tenderness, chest pain, and stomach pains.

 

PMH: None

 

Meds: None

 

Allergies: None

 

FH: Hodgkins Lymphoma- father

 

SH: denies current tobacco or illicit drug use, although admits to using both in the distant past. Drinks a couple of glasses of a wine per week.

 

ROS:   General:
  Reports fever of 100 deg at home, fatigue, headache

Derm:
  no rash

HEENT: 
Sinus pain and pressure, nasal mucosa and throat red. No nasal d/c. Denies ear pain. Denies cough.

Resp:
See HPI

CV:
Denies chest pain.

GI:
Poor appetite

Endocrine:
Denies excessive hunger, thirst or excessive urination.

MS:
Feels generalized aching of muscles.

Psych:
Denies depression, thoughts of harm to self or others skin hair nails and heent assessment essay assignment.

 

O) Vitals: 110/72, 94bpm, RR20, temp: 101.2, O2 sat: 98% RA, ht 5’6, wt 145lb

Diagnostics: + Rapid Stress Test

General:
Appears tired.

Skin:
Flushed.  No excessive dryness.

HEENT:
Canals clear.  TMs visible, translucent, gray, cone of light and landmarks visible.  Nasal mucosa red, clear d/c, no polyps, septum midline.  Oral mucosa pink and moist, pharyngeal erythema, no exudates, tonsils 2+. No frontal/maxillary sinus tenderness. Neck supple, trachea mid-line. +LAD.  Thyroid without enlargement or nodules.
 

Heart:
normal S1, S2, No MRG

Lungs:
CTA

Extremities:
No edema, pulses equal 2+ bilaterally in all 4 extremities.

 

A)  Streptococcal Pharyngitis

 

P)  #1. Rx: Amoxicillin 500mg BID x 10 days.

Ibuprofen 400mg Q6 PRN fever.

Cough drops/lozenges for throat pain

Gargle with warm water and salt. skin hair nails and heent assessment essay assignment.

Essentials of Pediatric Nursing Exam with Answers.

Item Bank:
  Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

Objective:
    CH 25: The Child with Cardiovascular Dysfunction

 

Question Name: 0001 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

A chest radiograph film is ordered for a child with suspected cardiac problems. The child’s parent asks the nurse, “What will the radiograph show about the heart?” The nurse’s response should be based on knowledge that the x-ray film will show:

  bones of chest but not the heart.

  measurement of electrical potential generated from heart muscle.

*       C.  permanent record of heart size and configuration.

  computerized image of heart vessels and tissues.

 

Correct Answer:   C

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Explanation/Rationale:

ANS:  C

A chest radiograph will provide information on the heart size and pulmonary blood-flow patterns. It will provide a baseline for future comparisons. The heart will be visible, as well as the sternum and ribs. Electrocardiography (ECG) measures the electrical potential generated from heart muscle. Echocardiography will produce a computerized image of the heart vessels and tissues by using sound waves.

 

PTS:    1          DIF:    Cognitive Level: Understand REF:    835

TOP:    Integrated Process: Teaching/Learning

MSC:   Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:57    Date Modified:    03/18/13 16:03:57    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0002 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

The nurse is assessing a child after a cardiac catheterization. Which complication should the nurse be assessing for?

*       A.  Cardiac arrhythmia

  Hypostatic pneumonia

  Heart failure

  Rapidly increasing blood pressure

 

Correct Answer:   A

 

Explanation/Rationale:

ANS:  A

Because a catheter is introduced into the heart, a risk exists of catheter-induced dysrhythmias occurring during the procedure. These are usually transient. Hypostatic pneumonia, heart failure, and rapidly increasing blood pressure are not risks usually associated with cardiac catheterization.

 

PTS:    1          DIF:    Cognitive Level: Apply          REF:    853

TOP:    Integrated Process: Nursing Process: Assessment

MSC:   Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:57    Date Modified:    03/18/13 16:03:57    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0003 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

José is a 4-year-old child scheduled for a cardiac catheterization. Preoperative teaching should be:

  directed at his parents because he is too young to understand.

  detailed in regard to the actual procedures so he will know what to expect.

  done several days before the procedure so that he will be prepared. Essentials of Pediatric Nursing Exam with Answers

*       D.  adapted to his level of development so that he can understand.

 

Correct Answer:   D

 

Explanation/Rationale:

ANS:  D

Preoperative teaching should always be directed at the child’s stage of development. The caregivers also benefit from the same explanations. The parents may ask additional questions, which should be answered, but the child needs to receive the information based on developmental level. Preschoolers will not understand in-depth descriptions and should be prepared close to the time of the cardiac catheterization.

 

PTS:    1          DIF:    Cognitive Level: Apply          REF:    822

TOP:    Integrated Process: Teaching/Learning

MSC:   Area of Client Needs: Health Promotion and Maintenance

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:57    Date Modified:    03/18/13 16:03:57    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0004 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

Which explanation regarding cardiac catheterization is appropriate for a preschool child?

  Postural drainage will be performed every 4 to 6 hours after the test.

  It is necessary to be completely “asleep” during the test.

  The test is short, usually taking less than 1 hour.

*       D.  When the procedure is done, you will have to keep your leg straight for at least 4 hours.

 

Correct Answer:   D

 

Explanation/Rationale:

ANS:  D

The child’s leg will have to be maintained in a straight position for approximately 4 hours. Younger children can be held in the parent’s lap with the leg maintained in the correct position. Postural drainage will not be performed unless the child has corresponding pulmonary problems. The child should be sedated to lie still, but being completely asleep is not necessary. The test will vary in length of time from start to finish.

 

PTS:    1          DIF:    Cognitive Level: Apply          REF:    823

TOP:    Integrated Process: Teaching/Learning

MSC:   Area of Client Needs: Health Promotion and Maintenance

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:57    Date Modified:    03/18/13 16:03:57    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0005 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

The nurse is caring for a school-age child who has had a cardiac catheterization. The child tells the nurse that the bandage is “too wet.” The nurse finds the bandage and bed soaked with blood. The most appropriate initial nursing action is to:

  notify physician.

  apply new bandage with more pressure.

  place the child in Trendelenburg position.

*       D.  apply direct pressure above catheterization site.

 

Correct Answer:   D

 

Explanation/Rationale:

ANS:  D

If bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the percutaneous skin site to localize pressure over the vessel puncture. Notifying a physician and applying a new bandage can be done after pressure is applied. The nurse can have someone else notify the physician while the pressure is being maintained. It is not a helpful intervention to place the girl in the Trendelenburg position. It would increase the drainage from the lower extremities.

 

PTS:    1          DIF:    Cognitive Level: Apply          REF:    823

TOP:    Integrated Process: Nursing Process: Implementation

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:57    Date Modified:    03/18/13 16:03:57    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0006 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

The nurse is preparing an adolescent for discharge after a cardiac catheterization. Which statement by the adolescent would indicate a need for further teaching?

  “I should avoid tub baths but may shower.”

*       B.  “I have to stay on strict bed rest for 3 days.”

  “I should remove the pressure dressing the day after the procedure.”

  “I may attend school but should avoid exercise for several days.”

 

Correct Answer:   B

 

Explanation/Rationale:

ANS:  B

The child does not need to be on strict bed rest for 3 days. Showers are recommended; children should avoid a tub bath. The pressure dressing is removed the day after the catheterization and replaced by an adhesive bandage to keep the area clean. Strenuous activity must be avoided for several days, but the child can return to school.

 

PTS:    1          DIF:    Cognitive Level: Analyze       REF:    823

TOP:    Integrated Process: Teaching/Learning

MSC:   Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:57    Date Modified:    03/18/13 16:03:57    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0007 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

Surgical closure of the ductus arteriosus would:

  stop the loss of unoxygenated blood to the systemic circulation.

  decrease the edema in legs and feet.

  increase the oxygenation of blood.

*       D.  prevent the return of oxygenated blood to the lungs.

 

Correct Answer:   D

 

Explanation/Rationale:

ANS:  D

The ductus arteriosus allows blood to flow from the higher-pressure aorta to the lower-pressure pulmonary artery, causing a right-to-left shunt. If this is surgically closed, no additional oxygenated blood (from the aorta) will return to the lungs through the pulmonary artery. The aorta carries oxygenated blood to the systemic circulation. Because of the higher pressure in the aorta, blood is shunted into the pulmonary artery and the pulmonary circulation. Edema in the legs and feet is usually a sign of heart failure. This repair would not directly affect the edema. Increasing the oxygenation of blood would not interfere with the return of oxygenated blood to the lungs.

 

PTS:    1          DIF:    Cognitive Level: Analyze       REF:    825

TOP:    Integrated Process: Nursing Process: Planning

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:57    Date Modified:    03/18/13 16:03:57    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0008 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

Which defect results in increased pulmonary blood flow?

  Pulmonic stenosis

  Tricuspid atresia

*       C.  Atrial septal defect

  Transposition of the great arteries

 

Correct Answer:   C

 

Explanation/Rationale:

ANS:  C

Atrial septal defect results in increased pulmonary blood flow. Blood flows from the left atrium (higher pressure) into the right atrium (lower pressure) and then to the lungs via the pulmonary artery. Pulmonic stenosis is an obstruction to blood flowing from the ventricles. Tricuspid atresia results in decreased pulmonary blood flow. Transposition of the great arteries results in mixed blood flow.

 

PTS:    1          DIF:    Cognitive Level: Understand REF:    825

TOP:    Integrated Process: Nursing Process: Assessment

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:57    Date Modified:    03/18/13 16:03:57    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0009 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

The nurse is conducting a staff in-service on congenital heart defects. Which structural defect constitutes tetralogy of Fallot?

*       A.  Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy

  Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy

  Aortic stenosis, atrial septal defect, overriding aorta, left ventricular hypertrophy

  Pulmonic stenosis, ventricular septal defect, aortic hypertrophy, left ventricular hypertrophy

 

Correct Answer:   A

 

Explanation/Rationale:

ANS:  A

Tetralogy of Fallot has these four characteristics: pulmonic stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy. There is pulmonic stenosis but not atrial stenosis in tetralogy of Fallot. Right ventricular hypertrophy, not left ventricular hypertrophy, is present in tetralogy of Fallot. Tetralogy of Fallot has right ventricular hypertrophy, not left ventricular hypertrophy, and an atrial septal defect, not aortic hypertrophy.

 

PTS:    1          DIF:    Cognitive Level: Understand REF:    830

TOP:    Integrated Process: Nursing Process: Assessment

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:57    Date Modified:    03/18/13 16:03:57    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0010 Type: MC      Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

A nurse is teaching nursing students the physiology of congenital heart defects. Which defect results in decreased pulmonary blood flow?

  Atrial septal defect

*       B.  Tetralogy of Fallot

  Ventricular septal defect

  Patent ductus arteriosus

 

Correct Answer:   B

 

Explanation/Rationale:

ANS:  B

Tetralogy of Fallot results in decreased blood flow to the lungs. The pulmonic stenosis increases the pressure in the right ventricle, causing the blood to go from right to left across the ventricular septal defect. Atrial and ventricular septal defects and patent ductus arteriosus result in increased pulmonary blood flow.

 

PTS:    1          DIF:    Cognitive Level: Understand REF:    830

TOP:    Integrated Process: Nursing Process: Assessment

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:57    Date Modified:    03/18/13 16:03:57    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0011 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

Which is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures?

  Pulmonary congestion

  Congenital heart defect

*       C.  Heart failure

  Systemic venous congestion

 

Correct Answer:   C

 

Explanation/Rationale:

ANS:  C

The definition of heart failure is the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures to meet the body’s metabolic demands. Pulmonary congestion is an excessive accumulation of fluid in the lungs. Congenital heart defect is a malformation of the heart present at birth. Systemic venous congestion is an excessive accumulation of fluid in the systemic vasculature.

 

PTS:    1          DIF:    Cognitive Level: Understand REF:    830

TOP:    Integrated Process: Nursing Process: Assessment

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:57    Date Modified:    03/18/13 16:03:57    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0012 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

Which is a clinical manifestation of the systemic venous congestion that can occur with heart failure?

  Tachypnea

  Tachycardia

*       C.  Peripheral edema

  Pale, cool extremities

 

Correct Answer:   C

 

Explanation/Rationale:

ANS:  C

Peripheral edema, especially periorbital edema, is a clinical manifestation of systemic venous congestion. Tachypnea is a manifestation of pulmonary congestion. Tachycardia and pale, cool extremities are clinical manifestations of impaired myocardial function.

 

PTS:    1          DIF:    Cognitive Level: Understand REF:    835

TOP:    Integrated Process: Nursing Process: Assessment

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:57    Date Modified:    03/18/13 16:03:57    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0013 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

The nurse is preparing to administer a dose of digoxin (Lanoxin) to a child in heart failure (HF). Which is a beneficial effect of administering digoxin (Lanoxin)?

*       A.  It decreases edema.

  It decreases cardiac output.

  It increases heart size.

  It increases venous pressure.

 

Correct Answer:   A

 

Explanation/Rationale:

ANS:  A

Digoxin has a rapid onset and is useful for increasing cardiac output, decreasing venous pressure, and, as a result, decreasing edema. Cardiac output is increased by digoxin. Heart size and venous pressure are decreased by digoxin.

 

PTS:    1          DIF:    Cognitive Level: Understand REF:    835

TOP:    Integrated Process: Nursing Process: Implementation

MSC:   Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:57    Date Modified:    03/18/13 16:03:57    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0014 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

A nurse is preparing to administer an angiotensin-converting enzyme (ACE) inhibitor. Which drug should the nurse be administering?

*       A.  Captopril (Capoten)

  Furosemide (Lasix)

  Spironolactone (Aldactone)

  Chlorothiazide (Diuril)

 

Correct Answer:   A

 

Explanation/Rationale:

ANS:  A

Captopril is an ACE inhibitor. Furosemide is a loop diuretic. Spironolactone blocks the action of aldosterone. Chlorothiazide works on the distal tubules.

 

PTS:    1          DIF:    Cognitive Level: Remember   REF:    835

TOP:    Integrated Process: Nursing Process: Implementation

MSC:   Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:57    Date Modified:    03/18/13 16:03:57    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0015 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

An 8-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than _____ beats/min.

  60

*       B.  70

  90

  100

 

Correct Answer:   B

 

Explanation/Rationale:

ANS:  B

If a 1-minute apical pulse is less than 70 beats/min for an older child, the digoxin is withheld; 60 beats/min is the cut-off for holding the digoxin dose in an adult. A pulse below 90 to 110 beats/min is the determination for not giving a digoxin dose to infants and young children.

 

PTS:    1          DIF:    Cognitive Level: Apply          REF:    836

TOP:    Integrated Process: Nursing Process: Assessment

MSC:   Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:57    Date Modified:    03/18/13 16:03:57    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0016 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

A 6-month-old infant is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than _____ beats/min.

  60

  70

*       C.  90 to 110

  110 to 120

 

Correct Answer:   C

 

Explanation/Rationale:

ANS:  C

If the 1-minute apical pulse is below 90 to 110 beats/min, the digoxin should not be given to a 6-month-old. 60 beats/min is the cut-off for holding the digoxin dose in an adult. 70 beats/min is the determining heart rate to hold a dose of digoxin for an older child. 110 to 120 beats/min is an acceptable heart rate to administer digoxin to a 6-month-old.

 

PTS:    1          DIF:    Cognitive Level: Apply          REF:    836

TOP:    Integrated Process: Nursing Process: Implementation

MSC:   Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:57    Date Modified:    03/18/13 16:03:57    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0017 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

The nurse is teaching parents about signs of digoxin (Lanoxin) toxicity. Which is a common sign of digoxin toxicity?

  Seizures

*       B.  Vomiting

  Bradypnea

  Tachycardia

 

Correct Answer:   B

 

Explanation/Rationale:

ANS:  B

Vomiting is a common sign of digoxin toxicity. Seizures are not associated with digoxin toxicity. The child will have a slower heart rate, not respiratory rate. The heart rate will be slower, not faster.

 

PTS:    1          DIF:    Cognitive Level: Understand REF:    839

TOP:    Integrated Process: Teaching/Learning

MSC:   Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:57    Date Modified:    03/18/13 16:03:57    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0018 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

The parents of a young child with heart failure tell the nurse that they are “nervous” about giving digoxin (Lanoxin). The nurse’s response should be based on which statement?

  It is a safe, frequently used drug.

  It is difficult to either overmedicate or undermedicate with digoxin.

  Parents lack the expertise necessary to administer digoxin.

*       D.  Parents must learn specific, important guidelines for administration of digoxin.

 

Correct Answer:   D

 

Explanation/Rationale:

ANS:  D

Digoxin has a narrow therapeutic range. The margin of safety between therapeutic, toxic, and lethal doses is very small. Specific guidelines are available for parents to learn how to administer the drug safely and to monitor for side effects. Digoxin is a frequently used drug, but it has a narrow therapeutic range. Small amounts of the liquid are given to infants, making it easy to overmedicate or undermedicate. Parents may lack the necessary expertise to administer the drug at first, but with discharge preparation, they should be prepared to administer the drug safely.

 

PTS:    1          DIF:    Cognitive Level: Apply          REF:    839

TOP:    Integrated Process: Teaching/Learning

MSC:   Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:57    Date Modified:    03/18/13 16:03:57    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0019 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

The nurse is talking to a parent of an infant with heart failure about feeding the infant. Which statement about feeding the child is correct?

*       A.  “You may need to increase the caloric density of your infant’s formula.”

  “You should feed your baby every 2 hours.”

  “You may need to increase the amount of formula your infant eats with each feeding.”

  “You should place a nasal oxygen cannula on your infant during and after each feeding.”

 

Correct Answer:   A

 

Explanation/Rationale:

ANS:  A

The metabolic rate of infants with heart failure is greater because of poor cardiac function and increased heart and respiratory rates. Their caloric needs are greater than those of the average infants, yet their ability to take in the calories is diminished by their fatigue. Infants with heart failure should be fed every 3 hours; a 2-hour schedule does not allow for enough rest, and a 4-hour schedule is too long. Fluids must be carefully monitored because of the heart failure. Infants do not require supplemental oxygen with feedings.

 

PTS:    1          DIF:    Cognitive Level: Apply          REF:    838-839

TOP:    Integrated Process: Nursing Process: Planning

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:57    Date Modified:    03/18/13 16:03:57    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0020 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

As part of the treatment for heart failure, the child takes the diuretic furosemide (Lasix). As part of teaching home care, the nurse encourages the family to give the child foods such as bananas, oranges, and leafy vegetables. These foods are recommended because they are high in:

  chlorides.

*       B.  potassium.

  sodium.

  vitamins.

 

Correct Answer:   B

 

Explanation/Rationale:

ANS:  B

Diuretics that work on the proximal and distal renal tubules contribute to increased losses of potassium. The child’s diet should be supplemented with this electrolyte. With this type of diuretic, potassium must be monitored and supplemented as needed.

 

PTS:    1          DIF:    Cognitive Level: Understand REF:    840

TOP:    Integrated Process: Teaching/Learning

MSC:   Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:57    Date Modified:    03/18/13 16:03:57    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0021 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

An 8-month-old infant has a hypercyanotic spell while blood is being drawn. The nurse’s first action should be to:

  assess for neurologic defects.

*       B.  place the child in the knee-chest position.

  begin cardiopulmonary resuscitation.

  prepare family for imminent death.

 

Correct Answer:   B

 

Explanation/Rationale:

ANS:  B

The first action is to place the infant in the knee-chest position. Blow-by oxygen may be indicated. Neurologic defects are unlikely. The child should be assessed for airway, breathing, and circulation. Often, calming the child and administering oxygen and morphine can alleviate the hypercyanotic spell.

 

PTS:    1          DIF:    Cognitive Level: Apply          REF:    841-842

TOP:    Integrated Process: Nursing Process: Implementation

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:57    Date Modified:    03/18/13 16:03:57    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0022 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes that a risk exists of cerebrovascular accidents (strokes). Which is an important objective to decrease this risk?

  Minimize seizures.

*       B.  Prevent dehydration.

  Promote cardiac output.

  Reduce energy expenditure.

 

Correct Answer:   B

 

Explanation/Rationale:

ANS:  B

In children with persistent hypoxia, polycythemia develops. Dehydration must be prevented in hypoxemic children because it potentiates the risk of strokes. Minimizing seizures, promoting cardiac output, and reducing energy expenditure will not reduce the risk of cerebrovascular accidents.

 

PTS:    1          DIF:    Cognitive Level: Analyze       REF:    841

TOP:    Integrated Process: Nursing Process: Implementation

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:57    Date Modified:    03/18/13 16:03:57    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0023 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

Parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. The nurse’s reply should be based on which statement?

*       A.  Child needs opportunities to play with peers.

  Child needs to understand that peers’ activities are too strenuous.

  Parents can meet all of the child’s needs.

  Constant parental supervision is needed to avoid overexertion.

 

Correct Answer:   A

 

Explanation/Rationale:

ANS:  A

The child needs opportunities for social development. Children usually limit their activities if allowed to set their own pace. The child will limit activities as necessary. Parents must be encouraged to seek appropriate social activities for the child, especially before kindergarten. The child needs to have activities that foster independence. The child will be able to regulate activities.

 

PTS:    1          DIF:    Cognitive Level: Analyze       REF:    843

TOP:    Integrated Process: Teaching/Learning

MSC:   Area of Client Needs: Psychosocial Integrity

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:57    Date Modified:    03/18/13 16:03:57    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0024 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

Which should the nurse consider when preparing a school-age child and the family for heart surgery?

  Unfamiliar equipment should not be shown.

*       B.  Let child hear the sounds of an ECG monitor.

  Avoid mentioning postoperative discomfort and interventions.

  Explain that an endotracheal tube will not be needed if the surgery goes well.

 

Correct Answer:   B

 

Explanation/Rationale:

ANS:  B

The child and family should be exposed to the sights and sounds of the intensive care unit (ICU). All positive, nonfrightening aspects of the environment are emphasized. The child should be shown unfamiliar equipment and its use demonstrated on a doll. Carefully prepare the child for the postoperative experience, including intravenous (IV) lines, incision, and endotracheal tube.

 

PTS:    1          DIF:    Cognitive Level: Analyze       REF:    845

TOP:    Integrated Process: Teaching/Learning

MSC:   Area of Client Needs: Health Promotion and Maintenance

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:58    Date Modified:    03/18/13 16:03:58    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0025 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

Seventy-two hours after cardiac surgery, a young child has a temperature of 101° F. Which action should the nurse take?

  Keep child warm with blankets.

  Apply a hypothermia blanket.

  Record temperature on nurses’ notes.

*       D.  Report findings to physician.

 

Correct Answer:   D

 

Explanation/Rationale:

ANS:  D

In the first 24 to 48 hours after surgery, the body temperature may increase to 37.7° C (100° F) as part of the inflammatory response to tissue trauma. If the temperature is higher or continues after this period, it is most likely a sign of an infection and immediate investigation is indicated. Blankets should be removed from the child to keep the temperature from increasing. Hypothermia blanket is not indicated for this level of temperature. The temperature should be recorded, but the physician must be notified for evaluation. Suctioning should be done only as indicated, not on a routine basis. The child should be suctioned for no more than 5 seconds at one time. Symptoms of respiratory distress are avoided by using appropriate technique.

 

PTS:    1          DIF:    Cognitive Level: Apply          REF:    846

TOP:    Integrated Process: Nursing Process: Implementation

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:58    Date Modified:    03/18/13 16:03:58    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0026 Type: MC      Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

Which is an important nursing consideration when suctioning a young child who has had heart surgery?

  Perform suctioning at least every hour.

  Suction for no longer than 30 seconds at a time.

*       C.  Administer supplemental oxygen before and after suctioning.

  Expect symptoms of respiratory distress when suctioning.

 

Correct Answer:   C

 

Explanation/Rationale:

ANS:  C

If suctioning is indicated, supplemental oxygen is administered with a manual resuscitation bag before and after the procedure to prevent hypoxia. Suctioning should be done only as indicated, not on a routine basis. The child should be suctioned for no more than 5 seconds at one time. Symptoms of respiratory distress are avoided by using appropriate technique. Essentials of Pediatric Nursing Exam with Answers

PTS:    1          DIF:    Cognitive Level: Apply          REF:    846

TOP:    Integrated Process: Nursing Process: Implementation

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:58    Date Modified:    03/18/13 16:03:58    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0027 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

The nurse is caring for a child after heart surgery. Which should the nurse do if evidence is found of cardiac tamponade?

  Increase analgesia.

  Apply warming blankets.

*       C.  Immediately report this to physician.

  Encourage child to cough, turn, and breathe deeply.

 

Correct Answer:   C

 

Explanation/Rationale:

ANS:  C

If evidence is noted of cardiac tamponade, which is blood or fluid in the pericardial space constricting the heart, the physician is notified immediately of this life-threatening complication. Increasing analgesia may be done before the physician drains the fluid, but the physician must be notified. Warming blankets are not indicated at this time. Essentials of Pediatric Nursing Exam with Answers. Encouraging the child to cough, turn, and breathe deeply should be deferred till after the evaluation by the physician.

 

PTS:    1          DIF:    Cognitive Level: Apply          REF:    846

TOP:    Integrated Process: Nursing Process: Implementation

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:58    Date Modified:    03/18/13 16:03:58    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0028 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

Which is an important nursing consideration when chest tubes will be removed from a child?

  Explain that it is not painful.

  Explain that only a Band-Aid will be needed.

*       C.  Administer analgesics before procedure.

  Expect bright red drainage for several hours after removal.

 

Correct Answer:   C

 

Explanation/Rationale:

ANS:  C

It is appropriate to prepare the child for the removal of chest tubes with analgesics. Short-acting medications can be used that are administered through an existing IV line. A sharp, momentary pain is felt. This should not be misrepresented to the child. A petroleum gauze, air-tight dressing will be needed, but it is not a pain-free procedure. Little or no drainage should be found on removal.

 

PTS:    1          DIF:    Cognitive Level: Apply          REF:    846

TOP:    Integrated Process: Nursing Process: Planning

MSC:   Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:58    Date Modified:    03/18/13 16:03:58    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0029 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

Which is the most common causative agent of bacterial endocarditis? Essentials of Pediatric Nursing Exam with Answers.

  Staphylococcus albus

  Streptococcus hemolyticus

  Staphylococcus albicans

*       D.  Streptococcus viridans

 

Correct Answer:   D

 

Explanation/Rationale:

ANS:  D

viridans is the most common causative agent in bacterial (infective) endocarditis. Staphylococcus albus, Streptococcus hemolyticus, and Staphylococcus albicans are not common causative agents.

 

PTS:    1          DIF:    Cognitive Level: Remember   REF:    848

TOP:    Integrated Process: Nursing Process: Assessment

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:58    Date Modified:    03/18/13 16:03:58    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0030 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

Which painful, tender, pea-sized nodules may appear on the pads of the fingers or toes in bacterial endocarditis?

*       A.  Osler nodes

  Janeway lesions

  Subcutaneous nodules

  Aschoff nodes

 

Correct Answer:   A

 

Explanation/Rationale:

ANS:  A

Osler nodes are red, painful, intradermal nodes found on pads of the phalanges in bacterial endocarditis. Janeway lesions are painless hemorrhagic areas on palms and soles in bacterial endocarditis. Subcutaneous nodules are nontender swellings, located over bony prominences, commonly found in rheumatic fever. Aschoff nodules are small nodules composed of cells and leukocytes found in the interstitial tissues of the heart in rheumatic myocarditis.

 

PTS:    1          DIF:    Cognitive Level: Understand REF:    848

TOP:    Integrated Process: Nursing Process: Assessment

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:58    Date Modified:    03/18/13 16:03:58    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0031 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

The primary nursing intervention to prevent bacterial endocarditis is to:

  institute measures to prevent dental procedures.

*       B.  counsel parents of high-risk children about prophylactic antibiotics.

  observe children for complications, such as embolism and heart failure.

  encourage restricted mobility in susceptible children.

 

Correct Answer:   B

 

Explanation/Rationale:

ANS:  B

The objective of nursing care is to counsel the parents of high-risk children about both the need for prophylactic antibiotics for dental procedures and the necessity of maintaining excellent oral health. The child’s dentist should be aware of the child’s cardiac condition. Dental procedures should be done to maintain a high level of oral health Essentials of Pediatric Nursing Exam with Answers. Prophylactic antibiotics are necessary. Children should be observed for complications such as embolism and heart failure and restricted mobility should be encouraged in susceptible children, but maintaining good oral health and prophylactic antibiotics is important.

 

PTS:    1          DIF:    Cognitive Level: Apply          REF:    848

TOP:    Integrated Process: Nursing Process: Assessment

MSC:   Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:58    Date Modified:    03/18/13 16:03:58    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0032 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

Which is a common, serious complication of rheumatic fever?

  Seizures

  Cardiac arrhythmias

  Pulmonary hypertension

*       D.  Cardiac valve damage

 

Correct Answer:   D

 

Explanation/Rationale:

ANS:  D

Cardiac valve damage is the most significant complication of rheumatic fever. Seizures, cardiac arrhythmias, and pulmonary hypertension are not common complications of rheumatic fever.

 

PTS:    1          DIF:    Cognitive Level: Understand REF:    849

TOP:    Integrated Process: Nursing Process: Assessment

MSC:   Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:58    Date Modified:    03/18/13 16:03:58    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0033 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

The nurse is conducting a staff in-service on childhood-acquired heart diseases. Which is a major clinical manifestation of rheumatic fever?

*       A.  Polyarthritis

  Osler nodes

  Janeway spots

  Splinter hemorrhages of distal third of nails

 

Correct Answer:   A

 

Explanation/Rationale:

ANS:  A

Polyarthritis, which is swollen, hot, red, and painful joints, is a major clinical manifestation of rheumatic fever. The affected joints will change every 1 to 2 days. Primarily the large joints are affected. Osler nodes, Janeway spots, and splinter hemorrhages are characteristic of infective endocarditis. Essentials of Pediatric Nursing Exam with Answers.

 

PTS:    1          DIF:    Cognitive Level: Apply          REF:    850

TOP:    Integrated Process: Teaching/Learning

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:58    Date Modified:    03/18/13 16:03:58    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0034 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

The nurse is admitting a child with rheumatic fever. Which therapeutic management should the nurse expect to implement?

*       A.  Administering penicillin

  Avoiding salicylates (aspirin)

  Imposing strict bed rest for 4 to 6 weeks

  Administering corticosteroids if chorea develops

 

Correct Answer:   A

 

Explanation/Rationale:

ANS:  A

The goal of medical management is the eradication of the hemolytic streptococci. Penicillin is the drug of choice. Salicylates can be used to control the inflammatory process, especially in the joints, and reduce the fever and discomfort. Bed rest is recommended for the acute febrile stage, but it does not need to be strict.  Essentials of Pediatric Nursing Exam with Answers.The chorea is transient and will resolve without treatment.

 

PTS:    1          DIF:    Cognitive Level: Apply          REF:    849

TOP:    Integrated Process: Nursing Process: Implementation

MSC:   Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:58    Date Modified:    03/18/13 16:03:58    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0035 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

Which action by the school nurse is important in the prevention of rheumatic fever?

  Encourage routine cholesterol screenings.

  Conduct routine blood pressure screenings.

*       C.  Refer children with sore throats for throat cultures.

  Recommend salicylates instead of acetaminophen for minor discomforts.

 

Correct Answer:   C

 

Explanation/Rationale:

ANS:  C

Nurses have a role in prevention-primarily in screening school-age children for sore throats caused by group A b-hemolytic streptococci. They can achieve this by actively participating in throat culture screening or by referring children with possible streptococcal sore throats for testing. Cholesterol and blood pressure screenings do not facilitate the recognition and treatment of group A b-hemolytic streptococci. Salicylates should be avoided routinely because of the risk of Reye syndrome after viral illnesses.

 

PTS:    1          DIF:    Cognitive Level: Apply          REF:    849-850

TOP:    Integrated Process: Nursing Process: Planning

MSC:   Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:58    Date Modified:    03/18/13 16:03:58    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0036 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

When discussing hyperlipidemia with a group of adolescents, the nurse should explain that cardiovascular disease can be prevented by high levels of:

  cholesterol.

  triglycerides.

  low-density lipoproteins (LDLs).

*       D.  high-density lipoproteins (HDLs).

 

Correct Answer:   D

 

Explanation/Rationale:

ANS:  D

HDLs contain very low concentrations of triglycerides, relatively little cholesterol, and high levels of proteins. It is thought that HDLs protect against cardiovascular disease. Cholesterol, triglycerides, and LDLs are not protective against cardiovascular disease.

 

PTS:    1          DIF:    Cognitive Level: Apply          REF:    851

TOP:    Integrated Process: Teaching/Learning

MSC:   Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:58    Date Modified:    03/18/13 16:03:58    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0037 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

Which is the leading cause of death after heart transplantation?

  Infection

*       B.  Rejection

  Cardiomyopathy

  Heart failure

 

Correct Answer:   B

 

Explanation/Rationale:

ANS:  B

The posttransplant course is complex. The leading cause of death after cardiac transplantation is rejection. Infection is a continued risk secondary to the immunosuppression necessary to prevent rejection. Cardiomyopathy is one of the indications for cardiac transplant. Heart failure is not a leading cause of death.

 

PTS:    1          DIF:    Cognitive Level: Remember   REF:    856

TOP:    Integrated Process: Nursing Process: Assessment

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:58    Date Modified:    03/18/13 16:03:58    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0038 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

When caring for the child with Kawasaki disease, the nurse should know which information?

  A child’s fever is usually responsive to antibiotics within 48 hours.

  The principal area of involvement is the joints.

  Aspirin is contraindicated. Essentials of Pediatric Nursing Exam with Answers.

*       D.  Therapeutic management includes administration of gamma globulin and aspirin.

 

Correct Answer:   D

 

Explanation/Rationale:

ANS:  D

High-dose IV gamma globulin and aspirin therapy is indicated to reduce the incidence of coronary artery abnormalities when given within the first 10 days of the illness. The fever of Kawasaki disease is unresponsive to antibiotics and antipyretics. Mucous membranes, conjunctiva, changes in the extremities, and cardiac involvement are seen. Aspirin is part of the therapy.

 

PTS:    1          DIF:    Cognitive Level: Apply          REF:    859

TOP:    Integrated Process: Nursing Process: Implementation

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:58    Date Modified:    03/18/13 16:03:58    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0039 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

The nurse is teaching nursing students about shock that occurs in children Essentials of Pediatric Nursing Exam with Answers. One of the most frequent causes of hypovolemic shock in children is:

  sepsis.

*       B.  blood loss.

  anaphylaxis.

  congenital heart disease.

 

Correct Answer:   B

 

Explanation/Rationale:

ANS:  B

Blood loss is the most frequent cause of hypovolemic shock in children. Sepsis causes septic shock, which is overwhelming sepsis and circulating bacterial toxins. Anaphylactic shock results from extreme allergy or hypersensitivity to a foreign substance. Congenital heart disease contributes to hypervolemia, not hypovolemia.

 

PTS:    1          DIF:    Cognitive Level: Understand REF:    860

TOP:    Integrated Process: Teaching/Learning

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:58    Date Modified:    03/18/13 16:03:58    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0040 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

Which type of shock is characterized by a hypersensitivity reaction causing massive vasodilation and capillary leaks, which may occur with drug or latex allergy?

  Neurogenic

  Cardiogenic

  Hypovolemic

*       D.  Anaphylactic

 

Correct Answer:   D

 

Explanation/Rationale:

ANS:  D

Anaphylactic shock results from extreme allergy or hypersensitivity to a foreign substance. Neurogenic shock results from loss of neuronal control, such as the interruption of neuronal transmission that occurs from a spinal cord injury Essentials of Pediatric Nursing Exam with Answers. Cardiogenic shock is decreased cardiac output. Hypovolemic shock is a reduction in the size of the vascular compartment, decreasing blood pressure, and low central venous pressure.

 

PTS:    1          DIF:    Cognitive Level: Understand REF:    862-863

TOP:    Integrated Process: Nursing Process: Assessment

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:58    Date Modified:    03/18/13 16:03:58    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0041 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

Which clinical manifestation should the nurse expect to see as shock progresses in a child and becomes decompensated shock?

  Thirst

  Irritability

  Apprehension

*       D.  Confusion and somnolence

 

Correct Answer:   D

 

Explanation/Rationale:

ANS:  D

Confusion and somnolence are beginning signs of decompensated shock. Thirst, irritability, and apprehension are signs of compensated shock.

 

PTS:    1          DIF:    Cognitive Level: Understand REF:    861

TOP:    Integrated Process: Nursing Process: Assessment

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:58    Date Modified:    03/18/13 16:03:58    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0042 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

Which occurs in septic shock?

  Hypothermia

*       B.  Increased cardiac output

  Vasoconstriction

  Angioneurotic edema

 

Correct Answer:   B

 

Explanation/Rationale:

ANS:  B

Increased cardiac output, which results in warm, flushed skin, is one of the manifestations of septic shock. Fever and chills are characteristic of septic shock. Vasodilation is more common than vasoconstriction. Angioneurotic edema occurs as a manifestation in anaphylactic shock.

 

PTS:    1          DIF:    Cognitive Level: Understand REF:    864

TOP:    Integrated Process: Nursing Process: Assessment

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:58    Date Modified:    03/18/13 16:03:58    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0043 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

A child is brought to the emergency department experiencing an anaphylactic reaction to a bee sting. While an airway is being established, the nurse should prepare which medication for immediate administration?

  Diphenhydramine (Benadryl)

  Dobutamine (Dobutarex)

*       C.  Epinephrine (Adrenalin)

  Calcium chloride (calcium chloride)

 

Correct Answer:   C

 

Explanation/Rationale:

ANS:  C

After the first priority of establishing an airway, administration of epinephrine is the drug of choice. Diphenhydramine, an antihistamine, is usually not used for severe reactions. Dobutamine and calcium chloride are not appropriate drugs for this type of reaction.

 

PTS:    1          DIF:    Cognitive Level: Apply          REF:    862

TOP:    Integrated Process: Nursing Process: Implementation

MSC:   Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral Therapy

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:58    Date Modified:    03/18/13 16:03:58    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0044 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

Clinical manifestations of toxic shock syndrome include:

  severe hypertension.

  subnormal temperature.

*       C.  erythematous macular rash.

  papular rash over extremities.

 

Correct Answer:   C

 

Explanation/Rationale:

ANS:  C

One of the diagnostic criteria for toxic shock syndrome is a diffuse macular erythroderma. Hypotension is one of the manifestations. Fever of 38.9° C or higher is a characteristic. Desquamation of the palms and soles of the feet occurs in about 1 to 2 weeks.

 

PTS:    1          DIF:    Cognitive Level: Understand REF:    864

TOP:    Integrated Process: Nursing Process: Assessment

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:58    Date Modified:    03/18/13 16:03:58    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0045 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

A preschool child is scheduled for an echocardiogram. Parents ask the nurse whether they can hold the child during the procedure. The nurse should answer with which response?

  “You will be able to hold your child during the procedure.”

  “Your child can be active during the procedure, but can’t sit in your lap.”

*       C.  “Your child must lie quietly; sometimes a mild sedative is administered before the procedure.”

  “The procedure is invasive so your child will be restrained during the echocardiogram.”

 

Correct Answer:   C

 

Explanation/Rationale:

ANS:  C

Although an echocardiogram is noninvasive, painless, and associated with no known side effects, it can be stressful for children. The child must lie quietly in the standard echocardiographic positions; crying, nursing, or sitting up often leads to diagnostic errors or omissions. Therefore, infants and young children may need a mild sedative; older children benefit from psychological preparation for the test. The distraction of a video or movie is often helpful.

 

PTS:    1          DIF:    Cognitive Level: Apply          REF:    821

TOP:    Integrated Process: Teaching/Learning

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:58    Date Modified:    03/18/13 16:03:58    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0046 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

The nurse is caring for an infant with congestive heart disease (CHD). The nurse should plan which intervention to decrease cardiac demands?

*       A.  Organize nursing activities to allow for uninterrupted sleep.

  Allow the infant to sleep through feedings during the night.

  Wait for the infant to cry to show definite signs of hunger.

  Discourage parents from rocking the infant

 

Correct Answer:   A

 

Explanation/Rationale:

ANS:  A

The infant requires rest and conservation of energy for feeding. Every effort is made to organize nursing activities to allow for uninterrupted periods of sleep. Whenever possible, parents are encouraged to stay with their infant to provide the holding, rocking, and cuddling that help children sleep more soundly. To minimize disturbing the infant, changing bed linens and complete bathing are done only when necessary. Feeding is planned to accommodate the infant’s sleep and wake patterns. The child is fed at the first sign of hunger, such as when sucking on fists, rather than waiting until he or she cries for a bottle because the stress of crying exhausts the limited energy supply Essentials of Pediatric Nursing Exam with Answers. Because infants with CHD tire easily and may sleep through feedings, smaller feedings every 3 hours may be helpful.

 

PTS:    1          DIF:    Cognitive Level: Apply          REF:    839

TOP:    Integrated Process: Nursing Process: Implementation

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:58    Date Modified:    03/18/13 16:03:58    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0047 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

The nurse is admitting a child with coarctation of the aorta. Which figure depicts this congenital heart defect?

*       A.

 

Correct Answer:   A

 

Explanation/Rationale:

ANS:  A

The figure that depicts a narrowing of the aortic arch is coarctation of the aorta. It typically occurs past the ductal area but can occur in other areas along the aortic arch. The figure that depicts an opening between the atria is atrial septal defect. The figure that depicts an opening between the ventricles is ventricular septal defect. The figure that depicts an opening from the atrium to the pulmonary artery is patent ductus arteriosus.

 

PTS:    1          DIF:    Cognitive Level: Analyze       REF:    827

TOP:    Integrated Process: Nursing Process: Assessment

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:58    Date Modified:    03/19/13 10:02:29    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D

Last:                       0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0048 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

Nursing interventions for the child after a cardiac catheterization should include which actions? (Select all that apply.)

  Allow ambulation as tolerated.

  Monitor vital signs every 2 hours.

*       C.  Assess the affected extremity for temperature and color.

  Check pulses above the catheterization site for equality and symmetry.

   Remove pressure dressing after 4 hours.

*       F.   Maintain a patent peripheral intravenous catheter until discharge.

 

Correct Answer:   CF

 

Explanation/Rationale:

ANS:  C, F

The extremity that was used for access for the cardiac catheterization must be checked for temperature and color. Coolness and blanching may indicate arterial occlusion. The child should have a patent peripheral intravenous line (PIV) to ensure adequate hydration. The child should remain on bed rest with the leg extended for a minimum of 4 hours. Initially vital signs are taken every 15 minutes, with emphasis on a heart rate counted for 1 minute. Pulses above the catheterization site should not be affected by the catheterization. Pulses distal to the site should be monitored. The pressure dressings should not be removed for 24 hours.

 

PTS:    1          DIF:    Cognitive Level: Apply          REF:    822-823

TOP:    Integrated Process: Nursing Process: Implementation

MSC:   Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:58    Date Modified:    03/19/13 10:03:17    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D
              
E
              
F

Last:                       0.00          0.00          0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0049 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

Which clinical manifestation should the nurse expect to see as shock progresses in a child and becomes decompensated shock? (Select all that apply.)

  Thirst and diminished urinary output

  Irritability and apprehension

*       C.  Cool extremities and decreased skin turgor

*       D.  Confusion and somnolence

   Normal blood pressure and narrowing pulse pressure

*       F.   Tachypnea and poor capillary refill time

 

Correct Answer:   CDF

 

Explanation/Rationale:

ANS:  C, D, F

Cool extremities, decreased skin turgor, confusion, somnolence, tachypnea, and poor capillary refill time are beginning signs of decompensated shock. Thirst, diminished urinary output, irritability, apprehension, normal blood pressure, and narrowing pulse pressure are signs of compensated shock.

 

PTS:    1          DIF:    Cognitive Level: Analyze       REF:    861

TOP:    Integrated Process: Nursing Process: Assessment

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:58    Date Modified:    03/19/13 10:04:40    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D
              
E
              
F

Last:                       0.00          0.00          0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00          0.00          0.00

 

___________________________________________________________________________________________________

 

Question Name: 0050 Type: MC Objective: CH 25: The Child with Cardiovascular Dysfunction      Item Bank: Hockenberry Wong Essentials of Pediatric Nurs 9th Edition

The nurse is conducting discharge teaching about signs and symptoms of heart failure to parents of an infant with a repaired tetralogy of Fallot. Which signs and symptoms should the nurse include? (Select all that apply.)

  Warm flushed extremities

  Weight loss

*       C.  Decreased urinary output

*       D.  Sweating (inappropriate)

*       E.   Fatigue

 

Correct Answer:   CDE

 

Explanation/Rationale:

ANS:  C, D, E

The signs and symptoms of heart failure include decreased urinary output, sweating, and fatigue. Other signs include pale, cool extremities, not warm and flushed, and weight gain, not weight loss.

 

PTS:    1          DIF:    Cognitive Level: Apply          REF:    844

TOP:    Integrated Process: Teaching/Learning

MSC:   Area of Client Needs: Physiologic Integrity: Physiologic AdaptatioN

Reference/Notes:

 

Keywords:

Points:                 1.00                              Penalty:                 0.00                              Score Mode:   Active

Date Created:    03/18/13 16:03:58    Date Modified:    03/19/13 10:04:52    Date Used:

Difficulty:           Easy                                                             Discrimination:          Low

Item Analysis: Last
                                                                
Item Analysis: Cumulative

No. of Students Responded:     0                                          No. of Students Responded:       0

Correct Responses (%):                                                          Correct Responses (%):

Total Group:                             0.00                                        Total Group:                               0.00

Upper 27% of Group:             0.00                                        Upper 27% of Group:               0.00

Lower 27% of Group:             0.00                                        Lower 27% of Group:               0.00

Point Biserial:                               0.00                                    Point Biserial:                                 0.00

Response Frequencies (%)

A
              
B
              
C
              
D
              
E

Last:                       0.00          0.00          0.00          0.00          0.00

Cumulative:         0.00          0.00          0.00          0.00          0.00

Essentials of Pediatric Nursing Exam with Answers

Erin Davis has Tension Type headache Essay

Erin Davis has Tension Type headache that is a serious condition which may be as a result of the patient getting involved in violence with the intimate partner. There are essential questions that should be asked to the patient in order to get the real picture of the condition. One, the physician should ask the patient at what part of the head is the pain felt, for how long, in what way and how serious is the pain. This is a question that will help the doctor get to rule out some of the possible causes of the pain. The doctor should ask what aggravates the pain. Such cases should include sexual activity or exertion. What relieves the pain? For how long have the patient been having the headache? How frequent do the headaches occur? Erin Davis has Tension Type headache Essay. Has there been a recent head trauma? Or Are the headaches related to visual problems (Kaniecki, 2015).

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Specific clinical findings that are possible to be observed in Erin Davis include the headache pain. The patient may feel some sensation and tightness felt around the forehead, at the back or at the sides of the head. The scalp of the head may appear tender including the shoulders and the neck. The pain felt in the head may be an intense one which may last up to half an hour or even an entire week. At times the patient may lack appetite and show confusion especially when in front of people. The patient will not have any nausea, the patient may be photophobic and phonophobic. The headaches frequencies are irregular and the pain may be felt under emotional distress or when the patient worries so much Erin Davis has Tension Type headache Essay. The patient may show some difficulties in paying attention when being given instruction. No prodrome seen.

There are specific diagnostic studies to be ordered to the patient which include migraines which show almost similar signs and symptoms as the patient is showing. This should be done in order to ensure that the patient is given the correct treatment and avoid any errors or misdiagnosis. It is also essential to check out any possibilities of muscular disorders that are related to the headaches felt by the patient. This will help in ruling out the possibility of the patient having the headaches as a result of the disorders. The patient should go through a screening process that will help out in checking the presence or absence of tumors that may also be the cause of the headaches. This will help in coming up with the right treatment strategy for the patient. Erin Davis has Tension Type headache Essay.

The primary diagnosis for this patient is the tension-type headache because she says at one point that she fell with her boyfriend and got hurt in the head. This could be the reason as to why she suffers the headaches and because all the symptoms shown are of the tension-type headache (Bendtsen, 2016). Erin Davis has Tension Type headache Essay. The differential diagnosis includes Acute Subdural Hematoma in the ED which at many times possess similar symptoms and signs as those seen in tension-type headache. Other include Temporal Arteritis and Migraine headaches that all show similar signs and symptoms of tension-type headache. The reason behind this is because the physician should be precise on the condition of the patient so as to come up with the right treatment plan.

It is essential to seek medical attention as soon as possible once new symptoms are observed. The management plan is to subject the patient to preventative medications that will help in the reduction of the severity of the pain felt. This is essential especially when the patient feels the headaches severely. The preventative medications include Tricyclic antidepressants which may include amitriptyline or protriptyline which are the most commonly used in handling tension type headache. These medications come with side effects that include constipation, dry mouth and drowsiness. Other antidepressants include Effexor XR and Remeron (Mirtazapine). Others that will help in the relaxation of the muscles and the anticonvulsants which include Topamax.

This will require a buildup that will take up to several weeks so that the patient can start responding. Tests that are essential in this case include Magnetic resonance imaging (MRI) which will give a clear image of the patient that will help assessing the progress of the patient. A computerized tomography (CT scan) is essential in ensuring that the patient is not having other abnormal tumors or migraines that may be causing the headaches Erin Davis has Tension Type headache Essay. The patient will also be subjected to pain killers that will help in relieving the pain when the headaches begin (Mathew, 2016). The patient is advised to avoid situations that will cause her from straining such as difficult work. She is also advised to attend therapy sessions that will help in creating a favorable environment with her partner. It is important that the patient visits the doctor after some time in order to ensure that there are no more problems that come up as a result of the headaches. Follow-up is essential and if the problem persists the patient is advised to visit a psychologist for additional help. Erin Davis has Tension Type headache Essay.

 

References

Mathew, P., & Peterlin, B. L. (2016). Tension-type headache. In 
Clinician’s Guide to Chronic Headache and Facial Pain
 (pp. 30-44). CRC Press.

Kaniecki, R. G. (2015). Tension-type headache. In 
Headache and Migraine Biology and Management
 (pp. 149-160).

Bendtsen, L., Ashina, S., Moore, A., & Steiner, T. J. (2016). Muscles and their role in episodic tension‐type headache: implications for treatment. 
European Journal of Pain
, 
20
(2), 166-175. Erin Davis has Tension Type headache Essay.

Ariela Hernandez Acute onset dyspnea and syncope iHuman case study essay

64 years

5′ 3″

200 pounds

Ariela Hernandez

Chief complaint:

Acute onset dyspnea and near syncope

 

Mrs. Hernandez is a 64 year old obese female with HTN, current smoker for the past 40 years, diabetes, right knee replacement surgery 6 weeks ago, complaints of acute onset dyspnea and near syncope started approximately 3 hours ago.  Associated symptoms SOB, cough, right calf slightly tender and swollen.  Physical examination demonstrates signs of possible PE.

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Trace to 1+ edema to ankles on left, 2+ edema to knee on right, well healing incisional scar overlying right knee from recent surgery slightly swollen compared to left right calf slightly tender, left calf non tender, no left joint swelling or erythema, no clubbing or cyanosis, extremities are well perfused Ariela Hernandez Acute onset dyspnea and syncope iHuman case study essay.

Abdomen- normal, no tenderness, no masses appreciated, liver of normal size, smooth edge palpable, spleen normal

At the start of the case click on “Show Patient Record, above the Problem List Icon
.
 Note the three tabs: 1) current visit (blank EMR), 2) Pt. Info Forms (contains Vital Signs for current visit) and 3) 1 month ago (contains records from outpatient surgical visit 1 month ago). These tabs provide vital information.  
You must receive an overall score greater than or equal to 80% to have mastered this course.

For this case there are 22 required history questions:

(CC (2), HPI/Symptom+ Assoc. Symptoms (10), PMH/Surg/Hosp/Meds/Environment (4), Allergies (1), FH (0), SH (0), Prevention/Risk Behaviors (0), ROS (5).

Take the patient’s 
HISTORY
.

Decide of this is a patient that can be treated as an outpatient; focused case – fewer history questions needed versus a patient who might be hospitalized for treatment (comprehensive case) where all components of a history.

o   Document abnormal findings in your problem list.

o   There is no penalty for doing more than what is required. This is worth 
40% of your overall case play score
.

Proceed to perform a 
PHYSICAL ASSESSMENT
.

Assess vital signs and perform the examination appropriate for the type of case identified by the above history. Ariela Hernandez Acute onset dyspnea and syncope iHuman case study essay. Remember the comprehensive cases require a comprehensive physical.

o   Document abnormal findings in your problem list.

o   There is no penalty for doing more than what is required. This is worth 
40% of your overall case play score.

Complete the 
PROBLEM LIST
exercise, pick those problems that match what you have on your problem list.

o   This is worth 
20% of your overall case play score
.

Write a concise problem statement.

Start with a demographic description of your patient and the chief complaint and MSAP. Try to keep your problem statement below 100 words.

 

 

Asked questions:

what is your name

how old are you

where are you

where do you live

where and with whom are you living

do you have any children, spouse, Significant partner

do you practice any religion

why are you seeking help today

any other symptoms

how many years have you been smoking

how much do you smoke a day

do you have any history of lung disease

do you have asthma

do you use any recreational drugs

how is your overall health

tell me about any current or past medical problems

are your immunizations up to date

are you taking any prescription medications

are you taking any over the counter or herbal medications

Ariela Hernandez Acute onset dyspnea and syncope iHuman case study essay

Do you drink alcohol? If so, what do you drink and how many drinks per day

do you take insulin for diabetes

Has anyone suggested that you should reduce the amount of alcohol you drink

Do you drink caffeinated beverages or eat chocolate

Tell me about your diet, what you normally eat

Do you have any problems with: nervousness, depression, lack of interest, sadness, memory loss, or mood changes, or ever hear voices that you know are not there

When you urinate, have you noticed: pain, difficulty starting or stopping, dribbling, incontinence, urgency during day or night. Any changes in frequency? Any blood in your urine

Are you coughing up any sputum

Is there any pattern to your cough

What treatments have you had for your cough

Do you have problems with: nausea, vomiting, constipation, diarrhea, coffee grounds in your vomit, dark tarry stool, bright red blood in your bowel movements, early satiety, bloating

Do you have problems with: muscle or joint pain, redness, swelling, muscle cramps, joint stiffness, joint swelling or redness, back pain, neck or shoulder pain, hip pain

Have you ever been hospitalized

Tell me about your work

Do you have any allergies

Do you have any problems with: headaches that don’t go away with aspirin or Tylenol (acetaminophen), double or blurred vision, difficulty with night vision, problems hearing, ear pain, sinus problems, chronic sore throats, difficulty swallowing

Have you noticed: any bruising, bleeding gums or other sites of increased bleeding

Do you have any of the following: heat or cold intolerance, increased thirst, sweating, frequent urination, change in appetite Ariela Hernandez Acute onset dyspnea and syncope iHuman case study essay

Do you have any of the following: dizziness, fainting, spinning room, seizures, weakness, numbness, tingling, tremor

Is there a pattern to when you have difficulty breathing

Do you have any pain in your chest

Does your chest feel tight or heavy

Do you have any of the following problems: fatigue, difficulty sleeping, unintentional weight loss or gain, fevers, night sweats

Do you have any problems with: itchy scalp, skin changes, moles, thinning hair, brittle nails

Have you been in a situation where you were sitting or lying still for a long time?

Are you short of breath when lying down

Do you awaken at night short of breath?

Do you have unusual heartbeats (palpitations

Do you sleep with pillows to help you breathe

Do you feel as if you are smothering or suffocating?

Do you wheeze?

Any previous medical surgical, or dental procedures

Ever had this illness before

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Do you have pain anywhere, if so where

What is the most distressing symptom for you

Has your level of activity recently changed

Are you in good spirits most of the time

Does anything make your difficulty breathing better or worse

Does anything make your cough better or worse

Do you have a problem with fatigue

Ariela Hernandez Acute onset dyspnea and syncope iHuman case study essay

 

 

 

 

 

 

Reviewed FSG home glucose monitoring results. Still running a bit high. Encouraged patient to schedule visit with PCP.

S: 
Mrs. Hernandez is a 64-year-old woman who is here for routine follow-up 2 weeks s/p right knee replacement. Ariela Hernandez Acute onset dyspnea and syncope iHuman case study essay. Her only complaint is physical therapy is harder than she expected and she still has residual pain. She continues to smoke against our recommendations.

 

O:
VS normal. Surgical scar healing well without signs of infection. Lungs clear, Heart RRR w/o murmur, Abd soft and non-tender, Neuro reflexes x 2 throughout, MSK right knee healing well.

 

A:
Normal recovery for right-knee replacement in obese type 2 diabetic patient who continues to smoke.

 

P:
Continue physical therapy, f/u PCP for diabetes management, continue to encourage weight loss and stress need for ambulation Q2 hours throughout waking hours. Continue to stress the importance of smoking cessation. Ariela Hernandez Acute onset dyspnea and syncope iHuman case study essay.

Angela Cortez iHuman Case study Example Essay

Angela Cortez I-Human

Assessment: Angela is a 17-year-old female who presents with increased fatigue over the past two months. Angela has had recent weight gain. She also presents with increased irritability and tearfulness. Angela describes always being tired and loss of interest in every-day activities. She is obese with mild acne, states she’s feeling unhappy with the way she looks. Currently, Angela denies any suicidal ideation.

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Upon completion of the assessment, it appears that Angela is suffering from adolescent depression disorder. However, it is important to complete lab work to rule out any other cause of her symptoms. A complete blood count, thyroid studies and heterophile antibody test has been completed to determine if some pathological reason is contributing to Angela’s fatigue and lack of energy. The CBC has come back within normal limits, ruling out acute infection as a cause of Angela’s symptoms. Angela Cortez iHuman Case study Example Essay. The thyroid studies are also in normal limits, ruling out thyroid disorder as a cause of symptoms. Due to Angela’s age and symptoms, a heterophile antibody test is appropriate to rule out mononucleosis as a cause of symptoms. This test came back negative, ruling out mononucleosis. A urine cortisol test was completed to rule out pathological causes of Angela’s symptoms. This test was within normal limits.

Due to Angela’s personality changes and irritability, a urine drug screen is appropriate. This test was negative for all drugs. Angela admitted to being sexually active with her former boyfriend, so a pregnancy test is appropriate. The pregnancy test was negative. Angela Cortez iHuman Case study Example Essay.

Angela is mildly obese and has a family history of diabetes mellitus. A fasting blood sugar and hemoglobin A1C are appropriate to be checked. Angela’s blood sugar and hemoglobin A1C are within normal limits.

After ruling out pathological reasons for Angela’s symptoms, the healthcare provider can confidently begin treating for adolescent depression disorder. Angela will need a combination of both pharmacotherapy and psychotherapy. Angela Cortez iHuman Case study Example Essay.

Angela should be started on a selective serotonin re-uptake inhibitor (SSRI) (NIMH, 2018). SSRI’s are the first line antidepressant (NIMH, 2018). SSRI’s are used because they have very little side effects and are less likely to cause overdose in patients (NIMH, 2018). Fluoxetine, which is an SSRI, has been shown to be very effective in children and adolescents (NIMH, 2018).

Psychotherapy should be used in conjunction with pharmacotherapy. Angela should be contracted for safety (NIMH, 2018). A contract for safety is a tool used by the healthcare provider and the patient that the patient signs, stating they will not harm themselves or commit suicide (NIMH, 2018). The combination of pharmacotherapy and psychotherapy has been shown to be the most effective treatment for adolescents with depression (NIMH, 2018). Angela Cortez iHuman Case study Example Essay.

 

References

National Institute of Mental Health. (2018). NIMH: Antidepressant Medications for Children and Adolescents: Information for Parents and Caregivers. Retrieved from https://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/antidepressant-medications-for-children-and-adolescents-information-for-parents-and-caregivers.shtml

 

Angela Cortez is a 17-year-old female who presents with a history of fatigue and lack of energy for the past two months; associated with irritability and weight gain. Her symptoms have led to a decline in her school performance and lack of participation in her usual activities. She has been crying on a near daily basis over the past month. Angela Cortez iHuman Case study Example Essay. On physical exam, she has an elevated BMI, is tearful, and is noted to have acne, striae, and acanthosis. She denies any active suicidal thoughts (i-Human).

Describe the evaluation tool and explain why this tool is essential in the care of the adolescent patient population.

Patient Health Questionnaire (PHQ-9) Modified for Adolescents (PHQ-A) is a self-administered instrument that assesses anxiety, eating, mood and substance use disorders among adolescent primary care patients. It is essential in this population due to the high risks of this age group and the need to assess for and manage/treat mental health disorders Angela Cortez iHuman Case study Example Essay.

Apply the findings of the scholarly research articles to the use of this evaluation tool and describe its validity and reliability.

According to the Journal of Adolescent Health findings support the diagnostic validity of the PHQ-A. The PHQ-A and the clinical interview produced similar estimates of the prevalence rates of anxiety, eating, mood, and substance use disorders. The PHQ-A demonstrated satisfactory sensitivity, specificity, diagnostic agreement, and overall diagnostic accuracy, compared with the clinical interview.  The PHQ-A may be used to assist primary care practitioners in identifying psychiatric disorders among their adolescent patients. Angela Cortez iHuman Case study Example Essay. The PHQ-A is the first such tool to be tested for use in adolescents and offers an acceptable and efficient tool for early detection and recognition of mental disorders in this high-risk group.

Apply this evaluation tool to a patient situation and summarize your opinion of the results

The PHQ-9 Modified for Adolescents PHQ-A was used to evaluate Angela regarding her current symptoms and changes in mood and behavior. Based on responses to the questionnaire and patient interview it is established that she has Depressive Disorder; scoring 19 on the PQH-9. More than half of her responses received a score of 3 in the nearly every day category for feelings, appetite, interests and concentration; for the past two weeks Angela Cortez iHuman Case study Example Essay.

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Describe a plan of care for the patient, depending upon the results

According to the American Family Physician the following is the client plan. Angela will be referred to a psychiatrist for initiation of both psychotherapy and pharmacotherapy in treatment of adolescent depression. As a first line agent she will be started on a selective serotonin reuptake inhibitor (SSRI); with titration over the course of several weeks. SSRIs plus cognitive-behavioral therapy (CBT) have been demonstrated to be effective in treating adolescent depression. The American Family Physician also takes this stance in regard to the PHQ-A; stating that this 9 item screening tool is more sensitive in adolescents than adults.

The initial management plan also includes the following actions:

Review common side effects of medication with the client and family; especially black box warnings and risk of suicide.

Assess patient’s suicide risk. Establish a no-suicide contract. Inquire about firearms in the home and accessibility Angela Cortez iHuman Case study Example Essay.

Provide education and information depression.

Nutritionist referral for regarding healthy eating/choices and physical activity.

Follow-up with PCP to assess management / therapy.

References

Gardner, W. (2014). Screening for Mental Health Problems: Does It Work? 
Journal of Adolescent Health,55
(1), 1-2. doi:10.1016/j.jadohealth.2014.04.019

Ham, P., MD, & Allen, C., PhD. (n.d.). Adolescent Health Screening and Counseling. 
American Family Physician,86
(12), 1109-1116.

Johnson, J. G., PhD, Harris, E. S., MD, & Williams, J. B., DSW. (n.d.). The patient health questionnaire for adolescents: Validation of an instrument for the assessment of mental disorders among adolescent primary care patients. 
Journal of Adolescent Health,30
(3), 196-204 Angela Cortez iHuman Case study Example Essay.