PART No. 1:

You are contacted by an attorney representing a client who has been charged with child abuse and whom faces loss of her child and 15 years in prison. The record indicated that the child was 4 years old and presented to the ER room with a broken arm and a broken leg. There also appeared to be multiple previous fractures. Now, you examine the child and find blue sclera, a sunken chest wall, severe scoliosis, and you observe a triangular face and prominent forehead. You confirm that there have been multiple previous fractures by evaluating the previous X-rays. This is a genetic disorder.

What is the most likely genetic disease that this presents and why?

What is the molecular basis of this disease?

Before, calling the police what should the initial clinician have done?

PART No 2:

Johnny is a 5-year-old Asian boy who is brought to a family practice office with a “runny” nose that started about 1 week ago but has not resolved. He has been blowing his nose quite frequently and “sores” have developed around his nose. His mother states, “The sores started as ‘big blisters’ that rupture; sometimes, a scab forms with a crust that looks like “dried maple syrup” but continues to seep and drain.” She is worried because the lesions are now also on his forearm. Johnny’s past medical and family histories are normal. He has been febrile but is otherwise asymptomatic. The physical examination was unremarkable except for moderate, purulent rhinorrhea and 0.5- to 1-cm diameter weeping lesions around the nose and mouth and on the radial surface of the right forearm. There is no regional lymphadenopathy.

Write a differential of at least three (3) possible diagnoses and explain how each may be a possible answer to the clinical presentation above. Remember, to list the differential in the order of most likely to less likely.

Based upon what you have at the top of the differentials how would you treat this patient?

When would you allow the student back to school? Elaborate on your reasoning?

PART No. 3:

Keisha, a 13-year-old female, has come into your urgent care center. She has red conjunctiva, a cough and a fever of about 104 F, She also has a rash on her face a possibly the beginning of a rash on her arms. About 10 days ago she was around another student who had similar symptoms.

Write three (3) differential diagnoses?

What are some of the complications of this disease, assume that the top of your differential is the definitive?

Assume that the second item you place on your differential is the definitive diagnosis. What are some complications of that disease?

PEER:

NR 507 Week No. 6 Quiz Solutions:

1. Considering the pathophysiology of osteoporosis, which cytokines and hormones decrease receptor activator of RANKL expression?(Points : 2)
2. Rhabdomyolysis is characterized by (Points : 2)
3. Which type of osteoporosis would a person develop after having the left leg in a cast for 8 weeks to treat a compound displaced fracture of the tibia and fibula? (Points : 2)
4. Considering the pathophysiology of osteoporosis, what are the effects of extracellular signal regulated kinases (ERKs) and receptor activator of RANKL on osteoblasts and osteoclasts? (Points : 2)
5. What is the diagnosis of a person who has tennis elbow characterized by tissue degeneration or irritation of the extensor carpi brevis tendon? (Points : 2)
6. Which statement is false about giant cell tumors? (Points : 2)
7. What pattern of bone destruction is described as not well defined and not easily separated from normal bone? (Points : 2)
8. The pain experienced in Legg-Calvé-Perthes disease is referred to as involving (Points : 2)
9. In osteomyelitis, bacteria gain access to the subperiosteal space in the metaphysis, which is considered the “path of least resistance.” What factor makes this route for bacteria the path of least resistance? (Points : 2)
10. Molecular analysis has demonstrated that osteosarcoma is associated with (Points : 2)
11. Ewing sarcoma arises from (Points : 2)
12. Which serum laboratory test is elevated in all forms of osteogenesis imperfecta? (Points : 2)
13. The _ is cartilage that retains the ability to form and calcify new cartilage and deposit bone until the skeleton matures. (Points : 2)
14. Osteochondrosis is caused by a(n) (Points : 2)
15. An insufficient dietary intake of vitamin _ can lead to rickets in children. (Points : 2)
16. In latex allergies, which immunoglobulin is associated with an immediate reaction? (Points : 2)
17. Chickenpox may be followed years later by (Points : 2)
18. Cutaneous vasculitis develops from the deposit of _ in small blood vessels as a toxic response allergen. (Points : 2)
19. Which malignancy is characterized by slow-growing lesions that usually have depressed centers and rolled borders and are frequently located on the face and neck? (Points : 2)
20. Scleroderma is more common in women and is associated with a(n) (Points : 2)
21. Thrush is a superficial infection that commonly occurs in children and is caused by (Points : 2)
22. What is the cause of chickenpox? (Points : 2)
23. Which vascular anomaly is a congenital malformation of dermal capillaries that does not fade with age? (Points : 2)
24. What is a common source of tinea corporis? (Points : 2)
25. Which contagious disease creates a primary skin lesion that is a pinpointed macule, papule, or wheal with hemorrhagic puncture site?(Points : 2)

Many assessment principles are the same for children and adults; however, with adults/older adults, consent for participation in the assessment comes from the actual client and not parents or guardians. The exception to this is adults/older adults who have been determined incapacitated by a court of competent jurisdiction. Some adults may be easier to assess than children/adolescents as they are more psychologically minded. That is, they have better insights into themselves and their motivations than children/adolescents (although this is not universally true).

Older adults present some of their own unique assessment challenges in that they may have higher levels of stigma associated with seeking psychiatric care. Additionally, there are higher rates of neurocognitive disorders superimposed on other clinical conditions such as depression or anxiety, which creates additional diagnostic challenges.

This week, you will develop your own personal format for initial interviews of mental health clients. You also will explore the restrictions and limitations for practice as a PMHNP in your home state and create a plan for passing the national certification exam.

Week 1-developing skills in interviewing and diagnostic reasoning

As we begin Week 1, the module is focused on developing an interview format that provides you with questions/responses that you will use in your work-ups and diagnostic assessments or some call them Psychiatric H & P. By now, you have seen many different formats and ways that providers conduct interviews.

For this document, I encourage you to think of your personal style as well as assure that all relevant information is collected in the first interview. Do not use a template that you find online or that your preceptor uses in the office. The purpose of this assignment is for you to think through how you interview patients. There are many examples online to use as a guide. The key elements are similar to a medical H &P, HPI, PPH, PMH, FH, SH, ROS (psychiatric), MSE, Clinical Assessment and Formulation, Diagnosis, and Plan. This will be your ‘bread and butter’, so to speak for your entire career. It is worth spending some time and effort on this. If you put in a canned template, I will not accept your work.

My personal style is what I would call ‘conversational’. I try to engage in some social conversation to get the visit started and then as the patient talks, I make notes on follow-up questions. I keep a list of the basic things that I need for my write-up: HPI, PPH, PMH, Soc/Dev, Substance use, Medication history, Stressors, coping abilities, therapy history. At the end of what I consider ‘the interview’ I review my list to make sure that I have all the information and I sometimes say to patients, “let me make sure that I got all the information that I need to make an accurate diagnosis and develop a treatment plan”. Then, I will say to the patient, “do you have anything that you’d like to add?”

This conversational style is not for everyone and I know many providers that use more of a ‘checklist’ style. Think about what you want and how you will feel most comfortable. Feel free to provide feedback to your colleagues –there are no right or wrong styles.

Instructions- Week 1:

Despite what you may believe (or may have been told), there is no such thing as one “right” way to do an interview. In fact, there are numerous books written about the various ways of conducting the clinical interview. In actual clinical practice, you will find the format that “works” best for you and addresses your unique strengths and the needs of the client.

In this Discussion, you will practice finding the interview format that works for you and share those ideas with your colleagues for feedback.

                                                                  Learning Objectives

Students will:

Develop formats for initial interviews of mental health clients

To prepare for this Discussion:

Review the Learning Resources.

Develop an interview format you would use for an initial interview of a client.

                                                       ASSIGNMENT

Attach the interview format document you would use for an initial interview of a client.

Describe what interview format your preceptor uses for the initial interview of a client.

Describe which element of your interview format is most helpful in your practice.

                                           Learning Resources

Required Readings

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

Section 5.1, “Psychiatric Interview, Mental Status Examination” (pp. 192–211)

Section 5.2, “The Psychiatric Report and Medical Record” (pp. 211–217)

Section 5.3, “Psychiatric Rating Scales” (pp. 217–236)

Section 5.5, “Personality Assessment: Adults and Children” (pp. 246–257)

Section 5.7, “Medical Assessment and Laboratory Testing in Psychiatry” (pp. 266–275)

Chapter 6, “Classification in Psychiatry” (pp. 290–308)

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

“Cautionary Statement for Forensic Use of DSM-5”

“Assessment Measures”

“Cultural Formulation”

“Glossary of Technical Terms”

“Glossary of Cultural Concepts of Distress”

Barton Associates. (2017). Nurse practitioner scope of practice laws. Retrieved from https://www.bartonassociates.com/locum-tenens-resources/nurse-practitioner-scope-of-practice-laws/

American Psychiatric Association. (2016). Practice guidelines for the psychiatric

evaluation of adults. Retrieved from http://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760

Required Media

Laureate Education (Producer). (2017b). Working with Adults and Older Adults” [Video file]. Baltimore, MD: Author.

Hagen, B. (Producer). (n.d.-a). Conducting a mental status exam [Video file]. Mill Valley, CA: Psychotherapy.net.

Optional Resources

American Psychological Association. (2008). Assessment of older adults with diminished capacity. Retrieved from https://www.apa.org/pi/aging/programs/assessment/capacity-psychologist-handbook.pdf

Rosen, S. L., & Reuben, D. B. (2011). Geriatric assessment tools. Mount Sinai Journal of Medicine, 78(4), 489–497. doi:10.1002/msj.20277

Substance Abuse and Mental Health Services Administration (SAMHSA). (2015). TIP 59: Improving cultural competence. Retrieved from http://store.samhsa.gov/product/TIP-59-Improving-Cultural-Competence/SMA15-4849

Students are required to maintain weekly reflective narratives throughout the course to combine into one course-long reflective journal that integrates leadership and inquiry into current practice as it applies to the Professional Capstone and Practicum course.

In your journal, you will reflect on the personal knowledge and skills gained throughout this course. The journal should address a variable combination of the following, depending on your specific practice immersion clinical experiences:

New practice approaches

Intraprofessional collaboration

Health care delivery and clinical systems

Ethical considerations in health care

Population health concerns

The role of technology in improving health care outcomes

Health policy

Leadership and economic models

Health disparities

Students will outline what they have discovered about their professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and finally, how the student met the competencies aligned to this course.

While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin.

Contemporary Organization Evaluation

Details:

In today’s fast-paced and global community, most organizations are faced with constant change. Research contemporary organizations that are currently responding to a significant change within the industry, such as disruptive technology; state, government, or industry regulations; environmental constraints; judicial or legislative rulings; etc.

Choose one organization from your research that has recently responded to major change or is currently responding to change. Write a paper (1,250-1,500 words) discussing how well the organization is responding to the change dynamics. Include the following:

1. Describe the organization and the change to which it is responding.
2. Discuss the degree to which the change has been disruptive and how the organization has responded to the dynamics created by this change.
3. Evaluate the strategies the organization used in its change plan and determine the level of success the organization experienced with the strategies.
4. Determine the effect the change had on stakeholders, and to what degree stakeholders have resisted. Assess how well stakeholder resistance was addressed.
5. Evaluate the overall implications the change had on interdepartmental collaboration.
6. In your opinion, how well did the leaders of the organization respond and prepare for the change? What worked and what did not work with the strategies they implemented?
7. What modifications would you suggest the leaders of the organization make in order to better address the change dynamics? What additional strategies would you recommend to assist the organization through this change?

Prepare this assignment according to the guidelines found in the APA Style Guide.

Plagiarism Free.

RESOURCES

Textbook

1. The Heart of Change: Real-Life Stories of How People Change Their Organizations

Read Chapter/Step 6 in The Heart of Change: Real-Life Stories of How People Change Their Organizations.

http://gcumedia.com/digital-resources/harvard-business-school-press/2012/the-heart-of-change_real-life-stories-of-how-people-change-their-organizations_ebook_1e.php

e-Library Resource

1. Backseat Leaders

Read “Backseat Leaders,” by Schlachter and Hildebrandt, from Leadership Excellence Essentials (2012).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=82953867&site=ehost-live&scope=site

1. Change Management: Leadership, Values and Ethics

Read “Change Management: Leadership, Values and Ethics,” by By, Burnes, and Oswick, from Journal of Change Management (2012).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=73326520&site=ehost-live&scope=site

1. Group Imago and Group Development: Two Theoretical Additions and Some Ensuing Adjustments

Read “Group Imago and Group Development: Two Theoretical Additions and Some Ensuing Adjustments,” by Tudor, from Transactional Analysis Journal (2013).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2014-04423-008&site=ehost-live&scope=site

1. May I Have Your Attention Please? A Review of Change Blindness

Read “May I Have Your Attention Please? A Review of Change Blindness,” by Ellis, from Organization Development Journal (2012).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=94475438&site=ehost-live&scope=site

You have been named the Administrative Director at Trident International Hospital (TIH) and will be presenting your PPT to the Board of Directors at TIH for approval. TIH is restructuring to meet the current needs of their consumers.

For this assignment, you are responsible for creating a department organizational chart for both the inpatient and outpatient departments at TIH. Using the research and information presented in your Case 1 assignment, you should:

Design a department organization chart for TIH’s inpatient and outpatient department.

You may create your own or use the one of the templates at the following link: http://templatelab.com/organizational-chart-templates/#.

Include in the charts at least 2 units in each department, e.g., acute inpatient units, inpatient rehabilitation, skilled nursing, etc. (An example of a department organization chart can be access here: http://annals.org/data/Journals/AIM/20209/10FF4.jpeg)

In the slides following each chart you are to:

Describe the personnel that will staff these units.

Explain the importance of having your chosen units.

Explain how the chosen units meet the needs of health care consumers.

Your PPT should be professional and provide substantial information about the two departments at TIH.

Your presentation should be at least 5-6 slides (not including the title and reference slide). Speaker notes are required.

Assignment Expectations

Conduct additional research to gather sufficient information to support your design of your department organization chart.

Limit your PPT to a maximum of 6 slides.

Support your powerpoint with peer-reviewed articles, with at least 3-4 references. Use the following source for additional information on how to recognize peer-reviewed journals: http://www.angelo.edu/services/library/handouts/peerrev.php.

You may use the following source to assist in your formatting your assignment: https://owl.english.purdue.edu/owl/resource/560/01/.

For additional information on reliability of sources review the following source: https://www.edb.utexas.edu/petrosino/Legacy_Cycle/mf_jm/Challenge%201/website%20reliable.pdf.