An understanding of cells and cell behavior is a critically important component of disease diagnosis and treatment. But some diseases can be complex in nature, with a variety of factors and circumstances impacting their emergence and severity.Effective disease analysis often requires an understanding that goes beyond isolated cell behavior. Genes, the environments in which cell processes operate, the impact of patient characteristics, and racial and ethnic variables all can have an important impact.Photo Credit: Getty Images/Hero ImagesAn understanding of the signals and symptoms of alterations in cellular processes is a critical step in the diagnosis and treatment of many diseases. For APRNs, this understanding can also help educate patients and guide them through their treatment plans.In this Assignment, you examine a case study and analyze the symptoms presented. You identify cell, gene, and/or process elements that may be factors in the diagnosis, and you explain the implications to patient health.To prepare:By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.The Assignment (1- to 2-page case study analysis)Develop a 1- to 2-page case study analysis in which you:Explain why you think the patient presented the symptoms described.Identify the genes that may be associated with the development of the disease.Explain the process of immunosuppression and the effect it has on body systems.By Day 7 of Week 2Submit your Case Study Analysis Assignment by Day 7 of Week 2.Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates). All papers submitted must use this formatting.

Assignment 2: Assessing and Treating Patients With Sleep/Wake DisordersSleep disorders are conditions that result in changes in an individual’s pattern of sleep (Mayo Clinic, 2020). Not surprisingly, a sleep disorder can affect an individual’s overall health, safety, and quality of life. Psychiatric nurse practitioners can treat sleep disorders with psychopharmacologic treatments, however, many of these drugs can have negative effects on other aspects of a patient’s health and well-being. Additionally, while psychopharmacologic treatments may be able to address issues with sleep, they can also exert potential challenges with waking patterns. Thus, it is important for the psychiatric nurse practitioner to carefully evaluate the best psychopharmacologic treatments for patients that present with sleep/wake disorders.Reference: Mayo Clinic. (2020). Sleep disorders. https://www.mayoclinic.org/diseases-conditions/sleep-disorders/symptoms-causes/syc-20354018To prepare for this Assignment:Review this week’s Learning Resources, including the Medication Resources indicated for this week.Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with sleep/wake disorders.The Assignment: 5 pagesExamine Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.Introduction to the case (1 page)Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.Decision #1 (1 page)Which decision did you select?Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.Decision #2 (1 page)Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.Decision #3 (1 page)Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.Conclusion (1 page)Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.Learning ResourcesRequired Readings (click to expand/reduce)American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596Fernandez-Mendoza, J., & Vgontzas, A. N. (2013). Insomnia and its impact on physical and mental health. Current Psychiatry Reports, 15(12), 418. https://doi.org/10.1007/s11920-012-0418-8Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179–1192. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388122/Morgenthaler, T. I., Kapur, V. K., Brown, T. M., Swick, T. J., Alessi, C., Aurora, R. N., Boehlecke, B., Chesson, A. L., Friedman, L., Maganti, R., Owens, J., Pancer, J., & Zak, R. (2007). Practice parameters for the treatment of narcolepsy and other hypersomnias of central origin. SLEEP, 30(12), 1705–1711. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_Narcolepsy.pdfMorgenthaler, T. I., Owens, J., Alessi, C., Boehlecke, B, Brown, T. M., Coleman, J., Friedman, L., Kapur, V. K., Lee-Chiong, T., Pancer, J., & Swick, T. J. (2006). Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children. SLEEP, 29(1), 1277–1281. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_NightWakingsChildren.pdfSateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017). Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 13(2), 307–349. https://jcsm.aasm.org/doi/pdf/10.5664/jcsm.6470Winkleman, J. W. (2015). Insomnia disorder. The New England Journal of Medicine, 373(15), 1437–1444. https://doi.org/10.1056/NEJMcp1412740Medication Resources (click to expand/reduce)IBM Corporation. (2020). IBM Micromedex. https://www.micromedexsolutions.com/micromedex2/librarian/deeplinkaccess?source=deepLink&institution=SZMC%5ESZMC%5ET43537Note: To access the following medications, use the IBM Micromedex resource. Type the name of each medication in the keyword search bar. Be sure to read all sections on the left navigation bar related to each medication’s result page, as this information will be helpful for your review in preparation for your Assignments.alprazolamamitriptylineamoxapineamphetaminedesipraminediazepamdoxepineszopicloneflunitrazepamflurazepamhydroxyzineimipraminelemborexantlorazepammelatoninmethylphenedatemodafinilarmodafinilcarnitineclomipramineclonazepamnortriptylinepitolisantramelteonsodium oxybatesolriamfetolSSRI’stemazepamtrazodonetriazolamtrimipraminewellbutrinzaleplonzolpidemInsomnia31-year-old MaleBACKGROUNDThis week, we examine a 31-year-old male who presents to the office with a chief complaint of insomnia.SUBJECTIVEPatient is a 31-year-old male. He states that his insomnia has gotten progressively worse over the past 6 months. Per the patient, he has never been a “great sleeper” but is now having difficulty both falling asleep and staying asleep at night. The problem began approximately 6 months ago after the sudden loss of his fiancé. The patient states this is affecting his ability to perform his job, which is a forklift operator at a local chemical company. The patient states he has used diphenhydramine in the past to sleep but does not like the way it makes him feel the morning after. He states he has fallen asleep on the job due to lack of sleep from the night before. The patient’s medical record from his previous physician states that he has a history of opiate abuse, which began after he broke his ankle in a skiing accident and was prescribed hydrocodone/apap (acetaminophen) for acute pain management. The patient has not received a prescription for an opiate analgesic in 4 years. The patient states recently he has been using alcohol to help him fall asleep, approximately four beers prior to bed.MENTAL STATUS EXAMThe patient is alert and oriented to person, place, time, event. He makes good eye contact and is dressed appropriately for time of year. He denies auditory/visual hallucinations. Judgement, insight, and reality contact are all intact. Patient denies suicidal/homicidal ideation, and is future oriented.Decision Point OneSelect what you should do:Zolpidem: 10 mg daily at bedtimeTrazodone: 50–100 mg daily at bedtimeHydroxyzine: 50 mg daily at bedtimeInsomnia31-year-old MaleDecision Point OneZolpidem: 10 mg daily at bedtimeRESULTS OF DECISION POINT ONEPatient returns to clinic in 2 weeks.Patient states the medication “knocked him out” but felt he slept well.His new girlfriend was concerned as he woke up in the middle of the night and cooked breakfast, yet the patient has no recollection of the occurrence.Patient states that the medication helps him sleep especially well when taken with a beer right before bedtime. Patient denies auditory/visual hallucinations and is future oriented.Decision Point TwoDecrease zolpidem to 5 mg daily at bedtimeRESULTS OF DECISION POINT TWOPatient returns to clinic in 2 weeks.Patient states his episodes of “nighttime activity” has greatly decreased.His girlfriend told him that one time in the 2 weeks he got up and was getting ready to go for a drive.Patient denies auditory/visual hallucinations and is future oriented.Patient states that he likes the way the zolpidem helps him sleep and “is good with continuing to take it if most of the time I sleep through the night undisturbed.”Decision Point ThreeSelect what you should do next:Maintain dose. Patient to return in 4 weeks for follow up appointmentDiscontinue zolpidem 5 mg tablets. Initiate therapy with Intermezzo 5 mg sublingual tablet nightly at bedtime, as needed. Follow up in 4 weeksDiscontinue zolpidem. Initiate therapy with trazodone 50 mg nightly at bedtime. Instruct patient he may take up to 100 mg if 50 mg is ineffective. Follow up in 4 weeksInsomnia31-year-old MaleDecision Point OneZolpidem: 10 mg daily at bedtimeRESULTS OF DECISION POINT ONEPatient returns to clinic in 2 weeks.Patient states the medication “knocked him out” but felt he slept well.His new girlfriend was concerned as he woke up in the middle of the night and cooked breakfast, yet the patient has no recollection of the occurrence.Patient states that the medication helps him sleep especially well when taken with a beer right before bedtime. Patient denies auditory/visual hallucinations and is future oriented.Decision Point TwoDecrease zolpidem to 5 mg daily at bedtimeRESULTS OF DECISION POINT TWOPatient returns to clinic in 2 weeks.Patient states his episodes of “nighttime activity” has greatly decreased.His girlfriend told him that one time in the 2 weeks he got up and was getting ready to go for a drive.Patient denies auditory/visual hallucinations and is future oriented.Patient states that he likes the way the zolpidem helps him sleep and “is good with continuing to take it if most of the time I sleep through the night undisturbed.”Decision Point ThreeMaintain dose. Patient to return in 4 weeks for follow up appointmentGuidance to StudentZolpidem is a medication that has a host of negative side effects. It should not be the first choice of therapy due to these side effects. Caution must be exercised if prescribing this medication to a patient. The patient should be instructed not to mix the medication with alcohol or any other medication unless first speaking with their provider.In this case, the patient is experiencing complex sleep behavior. It is prudent as the patient’s healthcare provider to discontinue this medication and prescribe something different.Trazodone is a selective serotonin reuptake inhibitor that is a much safer choice. In adults you will want to start with 50mg at bedtime and titrate up as needed.USE 6 RESOURCES FROM SCHOOL RESOURCES

Assignment: Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD“Fear,” according to the DSM-5, “is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat” (APA, 2013). All anxiety disorders contain some degree of fear or anxiety symptoms (often in combination with avoidant behaviors), although their causes and severity differ. Trauma-related disorders may also, but not necessarily, contain fear and anxiety symptoms, but their primary distinguishing criterion is exposure to a traumatic event. Trauma can occur at any point in life. It might not surprise you to discover that traumatic events are likely to have a greater effect on children than on adults. Early-life traumatic experiences, such as childhood sexual abuse, may influence the physiology of the developing brain. Later in life, there is a chronic hyperarousal of the stress response, making the individual vulnerable to further stress and stress-related disease.Photo Credit: Hill Street Studios / Blend Images / Getty ImagesFor this Assignment, you practice assessing and diagnosing patients with anxiety disorders, PTSD, and OCD. Review the DSM-5 criteria for the disorders within these classifications before you get started, as you will be asked to justify your differential diagnosis with DSM-5 criteria.To Prepare:Review this week’s Learning Resources and consider the insights they provide about assessing and diagnosing anxiety, obsessive-compulsive, and trauma- and stressor-related disorders.Download the Comprehensive Psychiatric Evaluation Template, which you will use to complete this Assignment. Also review the Comprehensive Psychiatric Evaluation Exemplar to see an example of a completed evaluation document.By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.Consider what history would be necessary to collect from this patient.Consider what interview questions you would need to ask this patient.Identify at least three possible differential diagnoses for the patient.By Day 7 of Week 4Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.Incorporate the following into your responses in the template:Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?Objective: What observations did you make during the psychiatric assessment?Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).Learning ResourcesRequired Readings (click to expand/reduce)American Psychiatric Association. (2013). Anxiety disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm05American Psychiatric Association. (2013). Obsessive compulsive and related disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm06American Psychiatric Association. (2013). Trauma- and stressor-related disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm07Sadock, B. J., Sadock, V. A., and Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.Chapter 9, Anxiety DisordersChapter 10, Obsessive-Compulsive and Related DisordersChapter 11, Trauma- and Stressor-Related DisordersChapter 31.11 Trauma-Stressor Related Disorders in ChildrenChapter 31.13 Anxiety Disorders in Infancy, Childhood, and AdolescenceChapter 31.14 Obsessive-Compulsive Disorder in Childhood and AdolescenceDocument: Comprehensive Psychiatric Evaluation TemplateDocument: Comprehensive Psychiatric Evaluation ExemplarRequired Media (click to expand/reduce)Classroom Productions. (Producer). (2015). Anxiety disorders [Video]. Walden University.Classroom Productions. (Producer). (2012). The neurobiology of anxiety [Video]. Walden University.Classroom Productions. (Producer). (2015). Obsessive-compulsive disorders [Video]. Walden University.Classroom Productions. (Producer). (2015). Trauma, PTSD, and Trauma-Informed Care [Video]. Walden University.MedEasy. (2017). Anxiety, OCD, PTSD and related psychiatric disorders | USMLE & COMLEX [Video]. YouTube. https://www.youtube.com/watch?v=-BwzQF9DTlYVideo Case Selections for Assignment (click to expand/reduce)Selectoneof the following videos to use for your Assignment this week. Then, access the document “Case History Reports” and review the additional data about the patient in the specific video number you selected.Symptom Media. (Producer). (2017). Training title 15 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-15Symptom Media. (Producer). (2016). Training title 21 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-21Symptom Media. (Producer). (2016). Training title 37 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-37Symptom Media. (Producer). (2016). Training title 40 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-40Symptom Media. (Producer). (2017). Training title 55 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-55Symptom Media. (Producer). (2017). Training title 85 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-85Symptom Media. (Producer). (2018). Training title 95 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-95Document: Case History Reports

Assignment: Looking Ahead: Application Assignment Net Revenue and BudgetingYou will begin this assignment in Week 4 and it will be due by Day 7 of Week 5.No one can predict the future, but accountants and financial managers must try and do exactly that!  By examining net revenue, costs, and cash flow, you can get a clearer picture of what to expect in your organization’s (or one with which you are familiar) fiscal future. Using these metrics to look forward will enable you to more effectively plan budgets that accomplish organizational goals.When developing a budget, what variables do you have to take into account? In health care organizations, two of the largest groups of factors that you must consider are first, volume, and second, staffing and supply. The number of patients and tests performed each day, as well as employees and their pay rates are all crucial pieces of information when determining a budget.In this Assignment, you address five scenarios: net revenue, fixed and variable costs, cash flow, volume budget, and staffing and supplies budget.Note: For those Assignments in this course that require you to perform calculations you must:Use the Excel spreadsheet template for the Week 5 assignment.Show all your calculations and formulas in the spreadsheet.Answer any questions included with the problems (as text in the Excel spreadsheet).A title and reference page are NOT needed in this assignment.  Put your name and assignment at the top of the Excel spreadsheet.For those not comfortable with the use of Microsoft Excel, this week’s Optional Resources suggest several tutorials.To prepare:Review the information in this week’s Learning Resources regarding net revenue, fixed and variable costs, and cash flow, and how they are used in financial decision making.Review the budgeting information in Week 5 Learning Resources dealing with volume, staffing, and supplies budget.View the following tutorial videos, provided in this week’s Learning Resources.Week 5 Application Assignment Tutorial: Cash Flow ScenarioWeek 5 Application Assignment Tutorial: Fixed Variable ScenarioWeek 5 Application Assignment Tutorial: Net Revenue ScenarioWeek 5 Application Assignment Tutorial: Staffing and Supply Budget ScenarioWeek 5 Application Assignment Tutorial: Volume Budget ScenarioUse the Week 5 Application Assignment Template, provided in this week’s Learning Resources, to complete this assignment. Carefully examine the information in each of the scenarios and provide the necessary calculations. Using this information will help you answer the questions.Note: All the scenarios will be submitted as one document.  Each scenario will be on a different tab in the spreadsheet.Scenario 1: Net Revenue ScenarioYour clinic provides four kinds of services:Comprehensive initial medical consultation is priced at $250Established patient limited visit is priced at $75Established patient intermediate visit is priced at $125Established patient comprehensive visit is priced at $250Question: The profile of your patients is such that the average collection rate is 75%. Assuming you have 100 visits of each type each month, what amount of new revenue will you generate in the next 12 months?Scenario 2: Fixed/Variable Cost ScenarioYou have performed a cost analysis of your health care organization and have determined the following: based on the latest three years of information, your annual cost of operations is $1,600,000 with annual volume of 10,000 procedures. You have determined that certain of your supply items are fixed in nature (those marked with an F) while others are variable (marked with a V).Question: An insurance company that is considering directing its 1,000 units per year of procedure business to your organization has approached you. For the last three years, you have been charging a price of $165 per procedure (with a 100% collection rate). Your board has mandated that you make $5 of profit from each of the procedures. You obviously want the highest possible price, but as you enter the negotiations, what is the lowest possible price you would be willing to accept from this payer?Hint: Calculate the variable cost.Scenario 3: Cash Flow ScenarioYour new business venture will begin operation on July 1, 20X2. You will hire staff effective January 1, 20X2 with a cost of $40,000 per month. You know from experience that collections lag billing by 3 months (in other words, once you bill for a service, you must wait 90 days for the payment to be received.) Your business volume is projected to be as follows:Question: If you have $380,000 of cash on hand on January 1, 20X2, how much cash will you have at the end of June 20X3?  Assume a 100% collection rate.Scenario 4: Volume Budget ScenarioYou manage lab services in a large hospital. You have the following data on both the hospital’s budgeted patient days and visits for budget year 20XX along with the ratio of lab tests to patient days or visits.Question: Based on this raw data provided , how many lab tests would you anticipate for the coming budget year? If each test is priced at $20.00, how much gross revenue would you budget? Assuming each full-time lab technician (FTE) can perform 200,000 tests each year, how many full-time lab technicians would you plan for?Example on Template: 2 North Bldg calculated.  You will need to complete 2 South Bldg, ICU and OPDScenario 5: Staffing and Supply Budget ScenarioCalculate the supplies budget necessary to operate your unit for the fiscal year beginning January 1, 20X8. It is your expectation that you will perform 24,820 procedures in the budget year. The following spending data is available for the period January 1 to March 31, 20X7 during which time procedure volume amounted to 3,240. Items marked (F) are considered fixed, those marked (V) are considered variable. Inflation is planned at 4%.In reviewing performance to date, you note that in January, you purchased $150,000 of D5W fluid replacement charged to IV solutions, which represents an entire year’s supply. In addition, you returned $2,800 of office supplies for credit from the vendor in Febuary. These supplies were purchased in a previous fiscal year.You also need to prepare the salary budget for the same fiscal year. You have determined that staff needs are for 6.5 FTEs.A pay raise will be given to all staff on October 1st of each year at a rate of 8 percent. In making your calculations, always round to the nearest whole dollar for annual salary amounts, but keep pennies in the hourly pay rates. New staff begins the new fiscal year at $16.00 per hour.This Assignment will be due by Day 7 of Week 5. Be sure and include all of your calculations.