Mood and Anxiety Disorders in Children and Adolescents

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Mood and Anxiety Disorders in Children and Adolescents

 

Week 5: Mood and Anxiety Disorders in Children and Adolescents

School and going out with my friends used to be fun, but not anymore. Mom keeps telling me just to go out and have fun, but I don’t see the point of trying. All my friends are better than I am. I keep having these headaches and just feel worthless. I used to get As and Bs in school, but not anymore. I can’t concentrate at school. I would rather be at home sleeping. Mood and Anxiety Disorders in Children and Adolescents Mood and Anxiety Disorders in Children and Adolescents

—Madison, age 16

Mood and anxiety disorders can be particularly challenging to address in childhood and adolescence for many reasons. Children may not be able to fully express or understand their feelings and behaviors. Parents may misattribute or not recognize signs and symptoms. The symptoms of disorders also vary when present in children as opposed to adults. The PMHNP needs to know how to diagnose these conditions and must understand the importance of integrating medication management strategies with both individual and family therapy to optimize treatment outcomes.

Learning Objectives

Students will:

  • Explain signs and symptoms of mood and anxiety disorders in children and adolescents
  • Explain the pathophysiology of mood and anxiety disorders in children and adolescents
  • Explain diagnosis and treatment methods for mood and anxiety disorders in children and adolescents
  • Develop patient education materials for mood and anxiety disorders in children and adolescents

Learning Resources

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Required Readings (click to expand/reduce)

 

Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental health. American Psychiatric Association Publishing.

  • Chapter 3, “Common Clinical Concerns”
  • Chapter 7, “A Brief Version of DSM-5″
  • Chapter 8, “A stepwise approach to Differential Diagnosis”
  • Chapter 10, “Selected DSM-5 Assessment Measures”
  • Chapter 11, “Rating Scales and Alternative Diagnostic Systems”

Shoemaker, S. J., Wolf, M. S., & Brach, C. (2014). The patient education materials assessment tool (PEMAT) and user’s guide. Agency for Healthcare Research and Quality. https://www.ahrq.gov/sites/default/files/publications/files/pemat_guide.pdf

 

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

  • Chapter 60, “Anxiety Disorders”
  • Chapter 61, “Obsessive Compulsive Disorder”
  • Chapter 62, “Bipolar Disorder in Childhood”
  • Chapter 63, “Depressive Disorders in Childhood and Adolescence”

Required Media (click to expand/reduce)

 

Center for Rural Health. (2020, May 18). Disruptive mood dysregulation disorder & childhood bipolar disorder [Video]. YouTube. https://youtu.be/tSfYXkst1vM Mood and Anxiety Disorders in Children and Adolescents

Mood Disorders Association of BC. (2014, November 20). Children in depression [Video]. YouTube. https://youtu.be/Qg-BBKB1nJc

Psych Hub Education. (2020, January 7). LGBTQ youth: Learning to listen. [Video]. YouTube. https://www.youtube.com/watch?v=Wn4AVjMMYX4

 

Medication Review

Review the FDA-approved use of the following medicines related to treating mood and anxiety disorders in children and adolescents.

Bipolar depression Bipolar disorder
lurasidone (age 10–17)
olanzapine-fluoxetine combination (age 10–17)		 aripiprazole (age 10–17)
asenapine  (for mania or mixed episodes, age 10–17)
lithium (for mania, age 12–17)olanzapine (age 13–17)
quetiapine (age 10–17)
risperidone (age 10–17)
Generalized anxiety disorder Depression
duloxetine (age 7–17) escitalopram (age 12–17)
fluoxetine (age 8–17)

 

Obsessive-compulsive disorder
clomipramine (age 10–17)
fluoxetine (age 7–17)
fluvoxamine (age 8–17)
sertraline (age 6–17)

Assignment: Patient Education for Children and Adolescents

Patient education is an effective tool in supporting compliance and treatment for a diagnosis. It is important to consider effective ways to educate patients and their families about a diagnosis—such as coaching, brochures, or videos—and to recognize that the efficacy of any materials may differ based on the needs and learning preferences of a particular patient. Because patients or their families may be overwhelmed with a new diagnosis, it is important that materials provided by the practitioner clearly outline the information that patients need to know.

Photo Credit: Getty Images

For this Assignment, you will pretend that you are a contributing writer to a health blog. You are tasked with explaining important information about an assigned mental health disorder in language appropriate for child/adolescent patients and/or their caregivers.

To Prepare

  • By Day 1, your Instructor will assign a mood or anxiety disorder diagnosis for you to use for this Assignment.
  • Research signs and symptoms for your diagnosis, pharmacological treatments, nonpharmacological treatments, and appropriate community resources and referrals.

The Assignment

In a 300- to 500-word blog post written for a patient and/or caregiver audience, explain signs and symptoms for your diagnosis, pharmacological treatments, nonpharmacological treatments, and appropriate community resources and referrals.
Although you are not required to respond to colleagues, collegial discussion is welcome.

 

Week 5: Mood and Anxiety Disorders in Children and Adolescents

School and going out with my friends used to be fun, but not anymore. Mom keeps telling me just to go out and have fun, but I don’t see the point of trying. All my friends are better than I am. I keep having these headaches and just feel worthless. I used to get As and Bs in school, but not anymore. I can’t concentrate at school. I would rather be at home sleeping.

—Madison, age 16

Mood and anxiety disorders can be particularly challenging to address in childhood and adolescence for many reasons. Children may not be able to fully express or understand their feelings and behaviors. Parents may misattribute or not recognize signs and symptoms. The symptoms of disorders also vary when present in children as opposed to adults. The PMHNP needs to know how to diagnose these conditions and must understand the importance of integrating medication management strategies with both individual and family therapy to optimize treatment outcomes. Mood and Anxiety Disorders in Children and Adolescents

Learning Objectives

Students will:

  • Explain signs and symptoms of mood and anxiety disorders in children and adolescents
  • Explain the pathophysiology of mood and anxiety disorders in children and adolescents
  • Explain diagnosis and treatment methods for mood and anxiety disorders in children and adolescents
  • Develop patient education materials for mood and anxiety disorders in children and adolescents

Learning Resources

Required Readings (click to expand/reduce)

 

Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental health. American Psychiatric Association Publishing.

  • Chapter 3, “Common Clinical Concerns”
  • Chapter 7, “A Brief Version of DSM-5″
  • Chapter 8, “A stepwise approach to Differential Diagnosis”
  • Chapter 10, “Selected DSM-5 Assessment Measures”
  • Chapter 11, “Rating Scales and Alternative Diagnostic Systems”

Shoemaker, S. J., Wolf, M. S., & Brach, C. (2014). The patient education materials assessment tool (PEMAT) and user’s guide. Agency for Healthcare Research and Quality. https://www.ahrq.gov/sites/default/files/publications/files/pemat_guide.pdf

 

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

  • Chapter 60, “Anxiety Disorders”
  • Chapter 61, “Obsessive Compulsive Disorder”
  • Chapter 62, “Bipolar Disorder in Childhood”
  • Chapter 63, “Depressive Disorders in Childhood and Adolescence”

Required Media (click to expand/reduce)

 

Center for Rural Health. (2020, May 18). Disruptive mood dysregulation disorder & childhood bipolar disorder [Video]. YouTube. https://youtu.be/tSfYXkst1vM

Mood Disorders Association of BC. (2014, November 20). Children in depression [Video]. YouTube. https://youtu.be/Qg-BBKB1nJc

Psych Hub Education. (2020, January 7). LGBTQ youth: Learning to listen. [Video]. YouTube. https://www.youtube.com/watch?v=Wn4AVjMMYX4

 

 

Medication Review

Review the FDA-approved use of the following medicines related to treating mood and anxiety disorders in children and adolescents.

Bipolar depression Bipolar disorder
lurasidone (age 10–17)
olanzapine-fluoxetine combination (age 10–17)		 aripiprazole (age 10–17)
asenapine  (for mania or mixed episodes, age 10–17)
lithium (for mania, age 12–17)olanzapine (age 13–17)
quetiapine (age 10–17)
risperidone (age 10–17)
Generalized anxiety disorder Depression
duloxetine (age 7–17) escitalopram (age 12–17)
fluoxetine (age 8–17)

 

Obsessive-compulsive disorder
clomipramine (age 10–17)
fluoxetine (age 7–17)
fluvoxamine (age 8–17)
sertraline (age 6–17)

Assignment: Patient Education for Children and Adolescents

Patient education is an effective tool in supporting compliance and treatment for a diagnosis. It is important to consider effective ways to educate patients and their families about a diagnosis—such as coaching, brochures, or videos—and to recognize that the efficacy of any materials may differ based on the needs and learning preferences of a particular patient. Because patients or their families may be overwhelmed with a new diagnosis, it is important that materials provided by the practitioner clearly outline the information that patients need to know.

Photo Credit: Getty Images

For this Assignment, you will pretend that you are a contributing writer to a health blog. You are tasked with explaining important information about an assigned mental health disorder in language appropriate for child/adolescent patients and/or their caregivers.

To Prepare

  • By Day 1, your Instructor will assign a mood or anxiety disorder diagnosis for you to use for this Assignment.
  • Research signs and symptoms for your diagnosis, pharmacological treatments, nonpharmacological treatments, and appropriate community resources and referrals.

The Assignment

In a 300- to 500-word blog post written for a patient and/or caregiver audience, explain signs and symptoms for your diagnosis, pharmacological treatments, nonpharmacological treatments, and appropriate community resources and referrals.
Although you are not required to respond to colleagues, collegial discussion is welcome.

 

 

 

 

 

 

 

 

 

Nursing homework help

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Nursing homework help

Module2

Weeks 3-4

 Topic Assigned Content/Readings

 

 Assignments/Due Dates
 Week 3

 

 

Models to Guide Implementation and Sustainability of EBP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Evidence-Based Practice

Models

 

 

 

Critically appraising the evidence

 

 

 

 

 ReadMelnyk & Fineout-Overholt  Ch. 14

 

Review APA Chapters 1-8 Nursing homework help

 

 

Assignment:Chose a EBP model that aligns with your PICO(T)and Complete Research Model Worksheet

Instructions:After reading Chapter 14 in Melnyk & Fineout-Overholt. Review the following models and choose one that best fits your PICO(T), the organization where you work or where you would implement the PICO(T):

IOWA Model of EBP, John Hopkins Nursing Process for EBP,Stetler Model of EBP, Stevens Start Model, Clinical Scholar Model, PARIHS Elements and Sub-elements, and ARCC Model

Once you have chosen your EBP model complete the Research Model worksheet found in this module.  This will guide your EBP study based on your specific PICO(T) ( and will be included in your  Research Paper) Please complete this worksheet using APA 7th ed format .

Review the following in Module 2 to provide guidance and examples in further detail:

Research Model Worksheet

Research Model Example Nursing homework help

 

 

Submit Research Model Worksheet to the drop box Sunday by 11:59pm

 

 

 

 Quizzes Due:

No quiz due this week

 

Discussion:

No discussion due this week

 

Assignment: Submit Research Model worksheet to drop box Sunday by 11:59

 

 

 

 

 

 

 
Week  4

 

Quantitative and Qualitative Evidence 

 

 

  

Critically appraising the evidence

 

Technical Writing

 

 

 

 

 

 

 

Professional Writing

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ORDER A PLAGIARISM FREE PAPER NOW

ReadMelnyk & Fineout- Overholt Chapters 5, 6,17. 18

 

Review: Literature Review Content found in Module 2

 

Read: Differences between qualitative and quantitative articles handout found in the content area of Module 2.

 

Discussion:  Using the MSU library data baseidentify one Quantitative  and one Qualitative article for your PICO (T) that demonstrates support your desired clinical question/intervention outcome and complete a literature review table for those articles . Answer all discussion questions for this section.

 

Make sure to continue to add articles from searches to the Database Research Table.

 

Assignment: Follow the Literature Review Rubric and Instructions and complete the Literature Review Template for your Quantitative and Qualitative articles as part of your discussion for week 4.

 

 

Looking ahead: Week 5 is when the first draft of Research Review (Part 1)

 

 

 

 Quizzes Due:

No quiz due this week

 

Discussion:

Initial responsesdue Wednesday by 11:59pm. Response to 2 peers and self-grading quiz due by Sunday at 11:59pm

 

Assignment:Submit your literature review template to the dropbox by Sunday at 11:59pm

 

 

 

 

 

 

IDENTIFY A KEY ISSUE IN THE U.S. HEALTHCARE SYSTEM.

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I need a 6 page powerpoint with the following:You will need to do the following:1. Identify a key issue in the U.S. healthcare system that requires you (as a current or emerging leader) to make critical decisions about it. For some examples of healthcare issues see the Forbes article The Five Biggest Problems in Health Care Today athttp://www.forbes.com/sites/leahbinder/2013/02/21/the-five-biggest-problems-in-health- care-today/.Select ONE issue that you would like to address in your persuasive speech (the issues are NOT limited to the ones in the Forbes article and can include any other issues you may thinkof).2. Do some research on the selected issue to determine its scope current and future consequences and potential (realistic)solutions.3. As a leader take a position on the issue and defend your decision in light of your leadership philosophy. Prepare a persuasive speech in which you would need to a) explain the severity of the issue and its current (or potential) consequences b) propose ONE [due to time constraints] way of addressing the issue and c) justify your choice of thesolution.4. The main goal of the powerpoint is to be persuasive and convince the audience that the problem you selected is critical and warrants immediate attention and your proposal is the right one to implement. The main goal of this project is to apply the theory learned in class to how become an effective leader and influence others without relying on formal power and authority but utilizing your social capital expertise and ability to grasp the entirety of the complexsituation.

Nursing homework help

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Nursing homework help

Consider the following scenario:

As a DNP-prepared nurse working in a rural clinic, you have a large population of patients with type 2 diabetes whose HbA1c levels are greater than 7% and body mass index (BMI) is over 30. You design a 9-month practice change project to impact these values.

ORDER A PLAGIARISM FREE PAPER NOW

Based on an exhaustive search and appraisal of research studies, you select an evidence-based intervention—diabetic self-management education (DSME)—to translate to your local rural clinic.

The evidence-based intervention includes exercise, healthy eating, and understanding the importance of regular blood glucose monitoring.

Before implementing the intervention, you retrieve aggregate data from 3, 6, and 9 months from medical records prior to the intervention being implemented. Data included HbA1c levels, BMIs, and numbers of patients with uncontrolled HbA1c. You also collected demographic data.

You collect the same data at 3, 6, and 9 months after implementation of the evidence-based intervention (DSME).

Pre-implementation and post-implementation data include the following. Nursing homework help

 

As a DNP-prepared nurse, you will analyze descriptive statistics, such as measures of central tendency and variability, to describe outcomes of a practice change project. Reflect upon this scenario and the data presented. What conclusions would you make at the end of this practice change project? What recommendations would you make to stakeholders for continuing the diabetes self-management education (DSME) program based on these results?

In order to respond to this discussion question, you will first need to complete the following calculations and consider responses to your analysis of the descriptive statistics.

  1. Perform the following calculations: Nursing homework help
    • Based on the data set provided, calculate the average percentage of patients with uncontrolled diabetes (HbA1c>7) both pre-implementation and post-implementation.
      • Pre—implementation —90% have uncontrolled Diabetes
      • Post —-implementation—50% have uncontrolled Diabetes
    • Next, calculate the mean pre-implementation and post-implementation HbA1c values for patients involved in this practice change project.
      • Mean pre—implementation—7.96
      • Mean post—implementation—7.5
    • Now calculate the pre-implementation and post-implementation median score of HbA1c levels.
      • Median pre—7.65       Median post—7.0
    • Next, calculate the pre-implementation and post-implementation standard deviation of HbA1c levels of patients involved in the practice change project. The standard deviation will determine the spread of increase or decrease in HbA1c levels.
      • Preintervention 1.4 postintervention 1.4
    • Finally, calculate the pre-implementation and post-implementation range of HbA1c levels. If no outliers exist, the range will determine how close together HbA1c levels are in the patients involved.
      • Preintervention 5 postintervention 4.9
  1. Based on your analysis of the descriptive statistics, what determinations related to the mean HbA1c levels following implementation of the evidence-based intervention can be made?
  2. As you reflect upon HbA1c levels, you observe that patient #10 HbA1c levels are an outlier. What does this do to your understanding of the data?

 

Cognitive Behavioral Therapy

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Cognitive Behavioral Therapy

APA 7 FORMAT SHOULD ONLY BE USED

NO PLAGIARISM ALLOWED

PLEASE NO INTERNET SOURCES

SCHOLARLY SOURCES WITHIN 5 YEARS SHOULD ONLY BE USED

Support your response with specific examples from this week’s media (CHECK THE LINK I PROVIDED) and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly and attach the PDFs of your sources. Cognitive Behavioral Therapy

Discussion: Cognitive Behavioral Therapy: Comparing Group, Family, and Individual Settings Cognitive Behavioral Therapy

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There are significant differences in the applications of cognitive behavior therapy (CBT) for families and individuals. The same is true for CBT in group settings and CBT in family settings. In your role, it is essential to understand these differences to appropriately apply this therapeutic approach across multiple settings. For this Discussion, as you compare the use of CBT in individual, group, and family settings, consider challenges of using this approach with groups you may lead, as well as strategies for overcoming those challenges. Cognitive Behavioral Therapy

 

To prepare:

  • Review the videos in this week’s Learning Resources and consider the insights provided on CBT in various settings.

 

Post an explanation of how the use of CBT in groups compares to its use in family or individual settings. Explain at least two challenges PMHNPs might encounter when using CBT in one of these settings. Support your response with specific examples from this week’s media and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly and attach the PDFs of your sources. Cognitive Behavioral Therapy

 

LINK TO VIDEOS TO WATCH IS BELOW

 

 

 

Beck Institute for Cognitive Behavior Therapy (2018, June 7). CBT for couples https://youtu.be/JZH196rOGsc

 

 

MedCircle. (2019, December 13). What a cognitive behavioral therapy (CBT)

 

 

PsychExamReview. (2019, April 30). Cognitive therapy, CBT, & group approaches (intro psych tutorial #241)

https://youtu.be/A2_NN1Q7Rfg Cognitive Behavioral Therapy

 

Evidence-Based Practice Inquiry

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Evidence-Based Practice Inquiry

Module2

Weeks 3-4

 Topic Assigned Content/Readings

 

 Assignments/Due Dates
 Week 3

 

 

Models to Guide Implementation and Sustainability of EBP

 

 

Evidence-Based Practice Inquiry

 

 

 

 

 

 

 

 

 

 

 

 Evidence-Based Practice

Models

 

 

 

Critically appraising the evidence

 

 

 

 

 ReadMelnyk & Fineout-Overholt  Ch. 14

 

Review APA Chapters 1-8

 

 

Assignment:Chose a EBP model that aligns with your PICO(T)and Complete Research Model Worksheet

Instructions:After reading Chapter 14 in Melnyk & Fineout-Overholt. Review the following models and choose one that best fits your PICO(T), the organization where you work or where you would implement the PICO(T):

IOWA Model of EBP, John Hopkins Nursing Process for EBP,Stetler Model of EBP, Stevens Start Model, Clinical Scholar Model, PARIHS Elements and Sub-elements, and ARCC Model

Once you have chosen your EBP model complete the Research Model worksheet found in this module.  This will guide your EBP study based on your specific PICO(T) ( and will be included in your  Research Paper) Please complete this worksheet using APA 7th ed format .

Review the following in Module 2 to provide guidance and examples in further detail:

Research Model Worksheet

Research Model Example

 

 

Submit Research Model Worksheet to the drop box Sunday by 11:59pm

 

 

 

 Quizzes Due:

No quiz due this week

 

Discussion:

No discussion due this week

 

Assignment: Submit Research Model worksheet to drop box Sunday by 11:59

 

 

 

 

 

 

 
Week  4

 

Quantitative and Qualitative Evidence 

 

 

  

Critically appraising the evidence

 

Technical Writing

 

 

 

 

 

 

 

Professional Writing

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  

ReadMelnyk & Fineout- Overholt Chapters 5, 6,17. 18

 

Review: Literature Review Content found in Module 2

 

Read: Differences between qualitative and quantitative articles handout found in the content area of Module 2.

 

Discussion:  Using the MSU library data baseidentify one Quantitative  and one Qualitative article for your PICO (T) that demonstrates support your desired clinical question/intervention outcome and complete a literature review table for those articles . Answer all discussion questions for this section.

 

Make sure to continue to add articles from searches to the Database Research Table.

 

Assignment: Follow the Literature Review Rubric and Instructions and complete the Literature Review Template for your Quantitative and Qualitative articles as part of your discussion for week 4.

 

 

Looking ahead: Week 5 is when the first draft of Research Review (Part 1)

 

 

 

 Quizzes Due:

No quiz due this week

 

Discussion:

Initial responsesdue Wednesday by 11:59pm. Response to 2 peers and self-grading quiz due by Sunday at 11:59pm

 

Assignment:Submit your literature review template to the dropbox by Sunday at 11:59pm

 

 

 

 

 

 

 

Research Utilization Model

Student Name__________________________

Name of Model:

Iowa Model of Evidence-Based Practice to Promote Quality Care

Citation: (Ciliska et al., 2011, pp. 251-254).

Research Question / PICO(T)

In individuals undergoing elective total joint arthroplasty, how does preoperative placement of indwelling urinary catheters versus postoperative intermittent urinary catheterization affect urinary tract infections postoperatively?

Explanation of model and application to research question/ literature review paper

The Iowa Model of Evidence-Based Practice to Promote Quality Care (Ciliska et al., 2011, pp. 251-254) begins by formation of an evidenced based practice question. Then individuals from all departments or areas that may be impacted are gathered as a panel.  The evidenced based question guides the panel’s review of the current literature. Based on those findings, recommendations are made to implement a change in practice (Ciliska et al., 2011, pp. 251-254).  In gathering a panel and jointly formulating recommendations, all departments and areas are able to have a voice.  This process helps develop ownership in the practice change and ensures a continuum of investment by the group in the process.  Once a recommendation for change is reached, a pilot for change is initiated (Ciliska et al., 2011, pp. 251-254).  Strengths and weaknesses of the recommended change are noted during the pilot.  These findings are brought back to the original panel when the pilot is finished for evaluation.  According to Ciliska et al. (2011), the panel reviews the findings and decides how to enact the change system wide if the pilot was successful.  The panel can modify the change and send it back into another pilot if the findings were mixed.  Rejection of the findings can also be a result of the pilot, which will begin the process over from the literature review and choosing a different practice change (Ciliska et al., 2011, pp. 251-254).

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The research review will use the above evidence-based question in conjunction with the Iowa Model of Evidence-Based Practice to Promote Quality Care to guide the nursing practice change.  The proposed panel should consist of representation from the surgical care ward, the post-anesthesia care unit, the intra-operative nurses and the orthopedic surgeons.  The research included in this paper will provide the foundation for the panel to make recommendations to answer the research question and formulate an evidenced based practice change.

 

Reference

Ciliska, D., DiCenso, A., Melnyk, B.M., Fineout-Overholt, E., Stetler, C., Cullen, L., Larrabee, J.H., Schultz, A.A., Rycroft-Malone, J., Newhouse, R.P., & Dang, D. (2011). Models to guide evidence-based practice.  In H. Surrena (Ed).  Evidence-based practice in nursing & healthcare: a guide to best practice (2nd ed.).  (pp. 251-254).  Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins

 

 

Nursing homework help

/in /by

Nursing homework help

Consider the following scenario:

As a DNP-prepared nurse working in a rural clinic, you have a large population of patients with type 2 diabetes whose HbA1c levels are greater than 7% and body mass index (BMI) is over 30. You design a 9-month practice change project to impact these values.

Based on an exhaustive search and appraisal of research studies, you select an evidence-based intervention—diabetic self-management education (DSME)—to translate to your local rural clinic. Nursing homework help

ORDER A PLAGIARISM FREE PAPER NOW

The evidence-based intervention includes exercise, healthy eating, and understanding the importance of regular blood glucose monitoring.

Before implementing the intervention, you retrieve aggregate data from 3, 6, and 9 months from medical records prior to the intervention being implemented. Data included HbA1c levels, BMIs, and numbers of patients with uncontrolled HbA1c. You also collected demographic data. Nursing homework help

You collect the same data at 3, 6, and 9 months after implementation of the evidence-based intervention (DSME).

Pre-implementation and post-implementation data include the following.

 

As a DNP-prepared nurse, you will analyze descriptive statistics, such as measures of central tendency and variability, to describe outcomes of a practice change project. Reflect upon this scenario and the data presented. What conclusions would you make at the end of this practice change project? What recommendations would you make to stakeholders for continuing the diabetes self-management education (DSME) program based on these results?

In order to respond to this discussion question, you will first need to complete the following calculations and consider responses to your analysis of the descriptive statistics.

  1. Perform the following calculations:
    • Based on the data set provided, calculate the average percentage of patients with uncontrolled diabetes (HbA1c>7) both pre-implementation and post-implementation.
      • Pre—implementation —90% have uncontrolled Diabetes
      • Post —-implementation—50% have uncontrolled Diabetes
    • Next, calculate the mean pre-implementation and post-implementation HbA1c values for patients involved in this practice change project.
      • Mean pre—implementation—7.96
      • Mean post—implementation—7.5
    • Now calculate the pre-implementation and post-implementation median score of HbA1c levels.
      • Median pre—7.65       Median post—7.0
    • Next, calculate the pre-implementation and post-implementation standard deviation of HbA1c levels of patients involved in the practice change project. The standard deviation will determine the spread of increase or decrease in HbA1c levels.
      • Preintervention 1.4 postintervention 1.4
    • Finally, calculate the pre-implementation and post-implementation range of HbA1c levels. If no outliers exist, the range will determine how close together HbA1c levels are in the patients involved.
      • Preintervention 5 postintervention 4.9
  1. Based on your analysis of the descriptive statistics, what determinations related to the mean HbA1c levels following implementation of the evidence-based intervention can be made?
  2. As you reflect upon HbA1c levels, you observe that patient #10 HbA1c levels are an outlier. What does this do to your understanding of the data?

 

Cognitive Behavioral Therapy

/in /by

Cognitive Behavioral Therapy

APA 7 FORMAT SHOULD ONLY BE USED

NO PLAGIARISM ALLOWED

PLEASE NO INTERNET SOURCES

SCHOLARLY SOURCES WITHIN 5 YEARS SHOULD ONLY BE USED

Support your response with specific examples from this week’s media (CHECK THE LINK I PROVIDED) and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly and attach the PDFs of your sources. Cognitive Behavioral Therapy

ORDER A PLAGIARISM FREE PAPER NOW

Discussion: Cognitive Behavioral Therapy: Comparing Group, Family, and Individual Settings

 

There are significant differences in the applications of cognitive behavior therapy (CBT) for families and individuals. The same is true for CBT in group settings and CBT in family settings. In your role, it is essential to understand these differences to appropriately apply this therapeutic approach across multiple settings. For this Discussion, as you compare the use of CBT in individual, group, and family settings, consider challenges of using this approach with groups you may lead, as well as strategies for overcoming those challenges. Cognitive Behavioral Therapy

 

To prepare:

  • Review the videos in this week’s Learning Resources and consider the insights provided on CBT in various settings.

 

Post an explanation of how the use of CBT in groups compares to its use in family or individual settings. Explain at least two challenges PMHNPs might encounter when using CBT in one of these settings. Support your response with specific examples from this week’s media and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly and attach the PDFs of your sources. Cognitive Behavioral Therapy

 

LINK TO VIDEOS TO WATCH IS BELOW

 

 

 

Beck Institute for Cognitive Behavior Therapy (2018, June 7). CBT for couples https://youtu.be/JZH196rOGsc Cognitive Behavioral Therapy

 

 

MedCircle. (2019, December 13). What a cognitive behavioral therapy (CBT)

 

 

PsychExamReview. (2019, April 30). Cognitive therapy, CBT, & group approaches (intro psych tutorial #241)

https://youtu.be/A2_NN1Q7Rfg Cognitive Behavioral Therapy

 

Nursing homework help

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Nursing homework help

Coxiella burnetti
Background

The life cycle of Coxiella burnetii wasn’t described until 1981, although the bacterium had been recognized more than 40 years earlier. Observations made by many researchers were finally assembled to show that this bacterium has a more complex life cycle than most. See if you can propose a life cycle for this bacterium from the information provided. Nursing homework help

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Coccoid and bacillary forms of Coxiella burnetii were first described in 1938. Subsequently, other researchers described round particles that passed through bacteriological filters (0.45 µm) and were capable of infecting guinea pig cells.

In 1981, electron microscopy studies of Coxiella revealed a large cell variant (LCV) and a small cell variant (SCV). The LCV has inner and outer membranes separated by a periplasm containing little peptidoglycan. The SCV lacks a periplasm and has a large peptidoglycan layer. LCVs develop a dense area in the periplasm at one end of the cell when nutrients are depleted or the pH increases. This area contains DNA and ribosomes.

In one study, suspensions of C. burnetii were put in distilled water, exposed to sonication (high-frequency vibration used to disrupt cells), and incubated at 45° C for 3 hr. Only SCVs were present after this treatment. Coxiella undergo binary fission in a host cell phagolysozyme. LCVs metabolize and divide more rapidly than SCVs.

* Please be sure to submit your answers to the following questions as an attachment to the dropbox within this week’s assignment section.

  1. Propose a life cycle for Coxiella. Nursing homework help

 

 

 

  1. Why do Coxiella show variable Gram stain results-that is, they may stain gram-positive or gram-negative? Should they be classified as gram-positive or gram-negative?

 

 

 

  1. What disease does burnetii cause? Why can this disease be transmitted by airborne routes while other (closely related) rickettsia require insects and ticks for transmission to humans? Nursing homework help

 

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Comments

Responses such as “I agree”, “thanks for that information – I didn’t know that”, “I experienced that also”, etc. will not receive participation credit. Please do not repeat what is already mentioned in the post. Responses should be a minimum of 150 words and minimum of 2 peer reviewed or scholarly sources with 5 years

Please do not to “cut and paste” answers from your references such as lists, bullet points, etc. This will not receive points for responses that are “cut and paste” even if you provide a citation.

Post 1:

Aging is a continuing, ongoing progression of natural alteration that initiates in early adulthood. Throughout the early mid-phase, several bodily utilities start to weaken progressively. The psychological, biological variations that proceed in the human physique result in senescence, the failure of biological purposes, and the aptitude to familiarize with metabolic stress. Evolving age is the primary hazard influence for chronic illness. According to Rocque et al. (2016), geriatric syndrome the term frequently castoff to denote collective health difficulties in elder grownups that do not suit different organ-specific illness classes and that have multifactorial bases; this comprises complications like feebleness, cognitive damage, delirium, incontinence, malnourishment, tumbles, gait diseases, stress ulcers, sleep syndromes, sensual discrepancies, weariness, and lightheadedness. These are communal in older adults and can primarily influence the excellence of life and incapacity. Nursing homework help

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Elder abuse is a solo or recurrent action, or deficiency of right deed, happening in any association where there is an anticipation of trust, which causes damage or suffering to an older individual. According to Rowe et al. (2016), complications that recount to the elderly such as purposeful weakening and dementia, are collective and frequently unrecognized or incompetently addressed hence elder abuse. Rush et al. (2017) suggests that nurses can practice comprehensive geriatric assessment all-inclusive, a multidisciplinary procedure that aids to evaluate the fragile older individual so that their medical circumstances, psychological health, practical capability, and communal conditions can be measured in aspect and from which patients with insubstantiality fractures can help meaningfully. The main emphasis of care is to meet the requirements of the older individuals ensuing skeletal trauma through their care path and guarantee that they obtain a similarly high standard of professional care within orthopedic amenities as they would inside a situation concentrating in the care of older individuals.

References

Rocque, G. B., Partridge, E. E., Pisu, M., Martin, M. Y., Demark-Wahnefried, W., Acemgil, A., …& Taylor, R. A. (2016). The patient care connects program: transforming health care through lay navigation. Journal of oncology practice, 12(6), e633-e642.

Rowe, J. W., Fulmer, T., & Fried, L. (2016). Preparing for better health and health care for an aging population. Jama, 316(16), 1643-1644.

Rush, K. L., Hickey, S., Epp, S., &Janke, R. (2017). Nurses’ attitudes towards older people care an integrative review. Journal of Clinical Nursing, 26(23-24), 4105-4116. Nursing homework help

 

 

Post 2:

Due to the increasingly growing population of older adults in the United Staes, nurses must be familiar with the aging process and the nuances of caring for elderly patients. It is predicted that older adults will make up 21% of the population by 2030 and that there will be 20 million adults aged 85 and over by 2060 (Green, 2018). To better care for these patients, it is important to understand that they often have multiple chronic health conditions which makes providing care for them more complex. Due to having multiple chronic health conditions, elderly patients are at an increased risk for polypharmacy which is defined as prescriptions for five or more drugs. Polypharmacy is concerning in the elderly population because it is associated with falls, adverse drug reactions, and poor adherence to prescribed drug regime (Mabuchi et al., 2020).

Additionally, aging is associated with changes in each body system that the nurse should be aware of. Aging adults have thinner skin that is more prone to tears and bruising; blood vessels become stiffer and harder which causes the heart to work more to pump blood; bones are more prone to fractures due to reduction in their size and density; older adults are more prone to constipation due to inadequate fluid intake or medication side effects.

References:

Green, S. Z. (2018). Health Assessment of the Aging Adult. Health Assessment: Foundations for Effective Practice. https://lc.gcumedia.com/nrs434vn/health-assessment-foundations-for-effective-practice/v1.1/#/chapter/5

Mabuchi, T., Hosomi, K., Yokoyama, S., & Takada, M. (2020). Polypharmacy in elderly patients in Japan: Analysis of Japanese real‐world databases. Journal of Clinical Pharmacy and Therapeutics, 45(5), 991–996. https://doi.org/10.1111/jcpt.13122

 

 

Post 3:

The aging process is characterized by the accumulation of several molecular and cellular damage over the years which leads to a gradual decrease in both physical and mental ability, the risk of having diseases increases and death can happen eventually. Individuals experience this differently (World Health Organization, 2021). As the elderly person’s health health declines, and are more isolated socially, he or she tends to rely on the person taking care of him or her. If the person is physically frail, the caregiver may neglect him or her, or even engage in physical abuse. Some of these victims are aware that they are being abused, but the fear of being neglected prevents them from reporting the case or even mention it. But for those who have memory loss, they may not remember things that happened (National Institute of Justice, 2013). Nursing homework help

Nurses should put certain things into consideration when assessing older adults as compared to middle-aged adults. The nurse should be aware that older adults may have geriatric syndromes- a term used to refer to common health problems that older adults may have, they may not be organ-specific, and have multifactorial causes like frailty, cognitive impairment, etc. Sometimes, these problems are often unrecognizable or not addressed properly. Identifying the specific problems to aging is important so that interventions can be directed to meet the specific needs of the patients. Older adults should also be assessed for all kinds of abuse as this age makes them vulnerable. Unlike the middle-aged adults whose assignments are mainly organ related (Spirgien and Brent, 2018).

National Institute of Justice, (2013). Causes and characteristics of elder abuse. https://nij.ojp.gov/topics/articles/causes-and-characteristics-elder-abuse

 

Spirgien L. and Brent L., (2018). Comprehensive geriatric assessment from nursing perspective. https://www.ncbi.nlm.gov/books/NBK543827/

 

World Health Organization, (2021). Aging and health. https://www.who.int/news-room/fact-sheets/detail/aging-and-health

 

 

Post 4:

As one gets older there are some changes associated with old aging. aging characteristics are said to be progressive, intrinsic and universal. Some of the changes that occur in old age include, physical, psychological and physiological. Some of these changes are considered as normal aging process, E, g., wrinkles and gray hair. aging affects the teeth, heart and sexuality (Mayo Clinic). Characteristics of aging process includes Cardiovascular system-there is stiffening of the blood vessels and arteries, causing the heart to work harder to pump blood, predisposing to high-blood pressure and other cardiovascular problems. Memory and Thinking Skills-the brain undergoes changes that may have minor effects on memory or thinking skills. Eyes and Ears-aging may cause the eye to have difficulty with focusing on objects, sensitivity to glare, trouble adapting to different levels of light, aging can also affect the lens causing clouded vision or cataracts. There may be hard hearing or high frequencies following a conversation in a crowded room. Mouth–the gums may pull back from the teeth, teeth may start falling off, dry mouth. teeth and gum may become vulnerable to infection. Skin-there is thinning of skin, loss of elasticity and more fragile, easily bruised. decreased production of oil causing dry skin. wrinkles, spots and skin tags. Bladder and Urinary tract-bladder becomes less elastic, weakness of bladder and pelvic floor muscles, enlarged of inflamed prostate in males, leading to incontinence. Digestive system- structural changes in large intestine, lack of exercise, low fiber diet and dehydration causes constipation in old age. Bones, Joints and muscles-Bones shrink in size and density, loss of calcium causes bone weakness subsequently fracture. shorter in height. loss of muscle strength, endurance and flexibility, also, coordination, stability and balance (Mayo Clinic).

Functional dependence/disability, Poor Physical health, Cognitive impairment, Poor mental health and low income are aging characteristics that can lead to elder abuse (WHO). Memory issue le. g., Alzheimer causes vulnerability to elder abuse like, Physical abuse, Neglect and Financial abuse, depending on the nature of relationship between the abuser and the victim. abusers are family members, sometimes, offspring of the victim, long term dependent of victim. due to health or financial issues will be abusing the victim. Financial exploitation due to unrecognized cognitive impairment {NIJ}.

The nurse should have a good knowledge about geriatric and aging process. Health assessment of elderly is the same strategy of head-toe assessment, but assessment of elderly may take more time, especially if they are confused. A comprehensive health assessment including interviews to obtain important information, like, mental status, family health history, social history-alcohol or substance usage including smoking. allergies, medication. past medical history. Nurse should observe the appearance of the skin- cleanliness, dehydration, scars and injuries. Eyes- vision, if there is need for glasses or change of available one. any issues like cataract or glaucoma. Mouth-teeth and gum disease. Ears -check for hearing difficulty, or if there need for hearing aide. Check for frailty and balance. Check the medication, elderly is at risk for polypharmacy, that is multiple medications which can cause drug reactions. Ask questions about the living environment to prevent falls.

References:

WHOs Global Strategy and Actions plan on ageing and Health and the UN Decade of Healthy Agency (2021-2030). who.int/news-room/fact-sheets/detail/elder-abuse

NIJ National Institute of Justice, Strengthen Science. Advance Justice.

nij.ojp.gov/topics/articles/causes-and-characteristics-el

Aging: What to expect-Mayo clinic-https://www.mayoclinic.org-aging