Nursing Homework Help

/in /by

Mrs G, a 55 year old Hispanic female, presents to the office for her annual exam. She reports that lately she has been very fatigued and just does not seem to have any energy. This has been occurring for 3 months. She is also gaining weight since menopause last year. She joined a gym and forces herself to go twice a week, where she walks on the treadmill at least 30 minutes but she has not lost any weight, in fact she has gained 3 pounds. She doesn’t understand what she is doing wrong. She states that exercise seems to make her even more hungry and thirsty, which is not helping her weight loss. She wants get a complete physical and to discuss why she is so tired and get some weight loss advice. She also states she thinks her bladder has fallen because she has to go to the bathroom more often, recently she is waking up twice a night to urinate and seems to be urinating more frequently during the day. This has been occurring for about 3 months too. This is irritating to her, but she is able to fall immediately back to sleep.

ORDER NOW FOR CUSTOMIZED SOLUTION PAPERS

Current medications: Tylenol 500 mg 2 tabs daily for knee pain. Daily multivitamin
PMH: Has left knee arthritis. Had chick pox and mumps as a child. Vaccinations up to date.
GYN hx: G2 P1. 1 SAB, 1 living child, full term, wt 9lbs 2 oz. LMP 15months ago. No history of abnormal Pap smear.
FH: parents alive, well, child alive, well. No siblings. Mother has HTN and father has high cholesterol.
SH: works from home part time as a planning coordinator. Married. No tobacco history, 1-2 glasses wine on weekends. No illicit drug use
Allergies: NKDA, allergic to cats and pollen. No latex allergy
Vital signs: BP 129/80; pulse 76, regular; respiration 16, regular
Height 5’2.5”, weight 185 pounds
General: obese female in no acute distress. Alert, oriented and cooperative.
Skin: warm dry and intact. No lesions noted
HEENT: head normocephalic. Hair thick and distribution throughout scalp. Eyes without exudate, sclera white. Wears contacts. Tympanic membranes gray and intact with light reflex noted. Pinna and tragus nontender. Nares patent without exudate. Oropharynx moist without erythema. Teeth in good repair, no cavities noted. Neck supple. Anterior cervical lymph nontender to palpation. No lymphadenopathy. Thyroid midline, small and firm without palpable masses. Nursing Homework Help
CV: S1 and S2 RRR without murmurs or rubs
Lungs: Clear to auscultation bilaterally, respirations unlabored.
Abdomen- soft, round, nontender with positive bowel sounds present; no organomegaly; no abdominal bruits. No CVAT.

ORDER NOW FOR CUSTOMIZED SOLUTION PAPERS

Labwork:
CBC: WBC 6,000/mm3 Hgb 12.5 gm/dl Hct 41% RBC 4.6 million MCV 88 fl MCHC 34 g/dl RDW 13.8%
UA: pH 5, SpGr 1.013, Leukocyte esterase negative, nitrites negative, 1+ glucose; small protein; negative for ketones
CMP:
Sodium 139
Potassium 4.3
Chloride 100
CO2 29
Glucose 126
BUN 12
Creatinine 0.7
GFR est non-AA 94 mL/min/1.73 ​
GFR est AA ​101 mL/min/1.73
Calcium 9.5
Total protein 7.6
Bilirubin, total 0.6
Alkaline phosphatase 72
AST 25
ALT 29
Anion gap 8.10
Bun/Creat 17.7
Hemoglobin A1C: 6.9 %
TSH: 2.35, Free T 4 0.8 ng/dL
Cholesterol: TC 230 mg/dl, LDL 144 mg/dl; VLDL 36 mg/dl; HDL 38mg/dl, Triglycerides 232
EKG: normal sinus rhythm

Use the categories below to create section headings for your paper. Review the APA Manual for paper format instructions.
Introduction: briefly discuss the purpose of this paper.
Assessment: review the provided case study information.
Identify the primary, secondary and differential diagnoses for the patient. Use the 601 SOAP note format as a guide to develop your diagnoses.
Each diagnosis will include the following information:
1. ICD 10 code.
2. A brief pathophysiology statement which his no longer that 2 sentences, paraphrased and includes common signs and symptoms of the diagnosis.
3. The patient’s pertinent positive and negative findings, including a brief 1-2 sentence statement which links the subjective and objective findings (including lab data and interpretation).
4. A rationale statement which summarizes why the diagnosis was chosen. Nursing Homework Help
5. Do not include quotes, paraphrase all scholarly information and provide an intext citation to your scholarly reference. Use the Reference Guidelines document for information on scholarly references.
Plan (there are five (5) sections to the management plan)
1. Diagnostics. List all labs and diagnostic test you would like to order. Each test includes a rationale statement following the listed lab which includes the diagnosis for the test, the purpose of the test and how the test results will contribute to your management plan. Each rationale statement is cited.
2. Medications: Each medication is listed in prescription format. Each prescribed and OTC medication is linked to a specific diagnosis and includes a paraphrased EBP rationale for prescribing.
3. Education: section includes personalized detailed education on all five (5) subcategories: diagnosis, each medication purpose and side effects, diet, personalized appropriate exercise recommendations and warning sign for diagnosis and medications if applicable. All education steps are linked to a diagnosis, paraphrased, and include a paraphrased EBP rationale. Review the NR601 SOAP note guideline for more detailed information.
4. Referrals: any recommended referrals are appropriate to the patient diagnosis and current condition, is linked to a specific diagnosis and includes a paraphrased EBP rationale with in text citation.
5. Follow up: Follow up includes a specific time, not a time range, to return to PCP office for next scheduled appointment. Includes EBP rationale with in text citation.
Medication costs: in this section students will research the costs of all prescribed and OTC monthly medications. Students may use Good Rx, Epocrates or another resource (can use local pharmacy websites) which provides medication costs. Students will list each medication, the monthly cost of the medication and the reference source. Students will calculate the monthly cost of the case study patient’s prescribed and OTC medications and provide the total costs of the month’s medications. Reflect on the monthly cost of the medications prescribed. Discuss if prescriptions were adjusted due to cost. Discuss if will you use medication pricing resources in future practice.
SOAP note: A focused SOAP note, written on a separate page, follows the assignment. The SOAP note is written following the provided SOAP note format.
• The subjective section is organized to follow the SOAP note format. The ROS is focused, only pertinent body systems are included. Only provided information is included in the ROS. No additional data is added.
• The objective section is maintained as written, no additional information is added.
• The assessment section includes only the diagnoses and ICD 10 codes. Diagnosed are labeled as primary, secondary or differential diagnoses. Rationale is not included in the SOAP note.
• The plan includes 5 sections. Rationale is not included in the SOAP note. Nursing Homework Help

The Ethics and Legalities of Medication Error Disclosure

/in /by

The Ethics and Legalities of Medication Error Disclosure

Consider the following scenario:

You are working as an advanced practice nurse at a community health clinic. You make an error when prescribing a drug to a patient. You do not think the patient would know that you made the error, and it certainly was not intentional.
To prepare:
Consider the ethical implications of disclosure and nondisclosure.
Research federal and state laws for advanced practice nurses. Reflect on the legal implications of disclosure and nondisclosure for you and the health clinic.
Consider what you would do as the advanced practice nurse in this scenario including whether or not you would disclose your error.
Review the Institute for Safe Medication Practices website in the Learning Resources. Consider the process of writing prescriptions. Think about strategies to avoid medication errors. The Ethics and Legalities of Medication Error Disclosure

ORDER NOW FOR CUSTOMIZED SOLUTION PAPERS

By Day 7
Write a 2- to 3- page paper that addresses the following:

Explain the ethical and legal implications of disclosure and nondisclosure. Be sure to reference laws specific to your state.
Describe what you would do as the advanced practice nurse in this scenario including whether or not you would disclose your error. Provide your rationale.
Explain the process of writing prescriptions including strategies to minimize medication errors.

use these references in paper

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.

Crigger, N., & Holcomb, L. (2008). Improving nurse practitioner practice through rational prescribing. The Journal for Nurse Practitioners, 4(2), 120–125. The Ethics and Legalities of Medication Error Disclosure

https://www.americannursetoday.com/medication-errors-best-practices/

https://www.ismp.org/recommendations/error-prone-abbreviations-list

https://www.deadiversion.usdoj.gov/pubs/manuals/pract/index.html

Philipsen, N. C., & Soeken, D. (2011). Preparing to blow the whistle: A survival guide for nurses. The Journal for Nurse Practitioners, 7(9), 740–746.

Note: Retrieved from the Walden Library databases. The Ethics and Legalities of Medication Error Disclosure

Cancer and Women\’s and Men\’s Health

/in /by

Cancer and Women\’s and Men\’s Health

The American Cancer Society estimates that by the end of 2012, more than 226,000 women will be diagnosed with breast cancer and more than 241,000 men will be diagnosed with prostate cancer (American Cancer Society, 2012a; American Cancer Society 2012b). With such prevalence of women’s and men’s cancers, patient education and preventive services are essential. In clinical settings, advanced practice nurses must assist physicians in educating patients on risk factors, preventive services, and for patients diagnosed with cancer, on potential drug treatments. The clinical implications of women’s and men’s cancer greatly depend on early detection, which is primarily achieved through preventive services. In this Assignment, you consider the short-term and long-term implications of cancer and drug treatments associated with women’s and men’s health, as well as appropriate preventive services.

ORDER NOW FOR CUSTOMIZED SOLUTION PAPERS

To prepare:
Select a type of cancer associated with women’s or men’s health such as breast, cervical, or ovarian cancer in women and prostate cancer in men.
Locate and review articles examining the type of cancer you selected.
Review the U.S. Preventive Services Task Force article in the Learning Resources. Think about available preventive services that providers might recommend for patients at risk of this type of cancer.
Select two of the following factors: genetics, gender, ethnicity, age, or behavior. Reflect on how these factors might impact decisions related to preventive services.
Consider drug treatment options for patients diagnosed with the type of cancer you selected including short-term and long-term implications of the treatments. Cancer and Women\’s and Men\’s Health
By Day 7
Write a 2- to 3- page paper that addresses the following:

Describe available preventive services that providers might recommend for patients at risk of the type of cancer you selected.
Explain how the factors you selected might impact decisions related to preventive services.
Describe drug treatment options for patients diagnosed with the type of cancer you selected. Explain the short-term and long-term implications of these treatments.

Reminder: Please make sure the paper includes a title page (including a purpose statement), introduction, summary, and references. Lastly please follow uploaded rubric.  Cancer and Women\’s and Men\’s Health

PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY

/in /by

PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY

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

Required Media (follow the link or just read the case study and the decisions below)
Laureate Education. (2016g). Case study: An elderly Hispanic man with major depressive disorder [Interactive media file]. Baltimore, MD: Author. PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY
Note: This case study will serve as the foundation for this week’s Assignment.

ORDER NOW FOR CUSTOMIZED SOLUTION PAPERS

Case Study: Hispanic Male w/Major Depressive Disorder (MDD)
BACKGROUND INFORMATION
The client is a 32-year-old Hispanic American male who came to the United States when he was in high school with his father. His mother died back in Mexico when he was in school. He presents today to the PMHNPs office for an initial appointment for complaints of depression. The client was referred by his PCP after \”routine\” medical work-up to rule out an organic basis for his depression. He has no other health issues with the exception of some occasional back pain and \”stiff\” shoulders which he attributes to his current work as a laborer in a warehouse.
SUBJECTIVE
During today\’s clinical interview, client reports that he always felt like an outsider as he was \”teased\” a lot for being \”black\” in high school. States that he had few friends, and basically kept to himself. He describes his home life as \”good.\” Stating \”Dad did what he could for us, there were 8 of us.\” He also reports a remarkably diminished interest in engaging in usual activities, states that he has gained 15 pounds in the last 2 months. He is also troubled with insomnia which began about 6 months ago, but have been progressively getting worse. He does report poor concentration which he reports is getting in \”trouble\” at work.
MENTAL STATUS EXAM
The client is alert, oriented to person, place, time, and event. He is casually dressed. Speech is clear, but soft. He does not readily make eye contact, but when he does, it is only for a few moments. He is endorsing feelings of depression. Affect is somewhat constricted, but improves as the clinical interview progresses. He denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment and insight appear grossly intact. He is currently denying suicidal or homicidal ideation. The PMHNP administers the \”Montgomery- Asberg Depression Rating Scale (MADRS)\” and obtained a score of 51 (indicating severe depression). PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY
RESOURCES
§ Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389.

Decisions Made and Outcomes (Needed to formulate the paper) You can follow my decision or choose yours if you are able to follow the link
Choices for Decision 1: Start Zoloft 25 mg orally daily, Effexor XR 37.5 mg orally daily, or Phenelzine 15 mg orally TID.
My decision: I chose to begin Effexor XR 37.5 mg orally daily.
Outcome: RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
Client reports that there is no change in depressive symptoms at all. Now choose what to do.

Choices for Decision 2: Increase Effexor XR to 75 mg orally daily, Change to Cymbalta 30 mg orally daily, or augment with an atypical antipsychotic.
My decision: I chose to increased dose of Effexor XR to 75 mg orally daily
Outcome: RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Client reports an improvement in depressive symptoms
Montgomery- Asberg Depression Rating Scale (MADRS) decreased from 51 to 38 (25% reduction)

Choices for Decision 3: Increase Effexor XR dose to 112.5 mg orally daily, continue same dose of medication (Effexor XR 75 mg), or augment with Wellbutrin XL 150 mg orally daily
My decision: Increase Effexor XR dose to 112.5 mg orally daily
Outcome: Guidance to Student
At this point, the PMHNP would have two choices to discuss with the client- the current dose of drug can be maintained if the client is feeling better and is not offering any complaints of side effects. The dose can also be increased at this point, but the PMHNP must counsel client regarding the possibility of side effects. The use of an augmenting agent is not appropriate at this time as we have not reached a maximum dose with Effexor (in fact, 75 mg is still a relatively small dose), displaying primarily SSRI properties only (recall that at lower doses, Effexor exerts a greater effect on serotonergic receptors than norepinephrine at low doses).
***Make sure that this paper has at least 5 References. Please use in-text citations. Don\’t forget the ethical considerations for this assignment. Can be included as a section by itself.*** PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY

To prepare for this Assignment:
• Review the Learning Resources. Consider how to assess and treat adult and geriatric clients requiring antidepressant therapy.

The Assignment
Examine Case Study above: An Elderly Hispanic Man With Major Depressive Disorder. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
• At each decision point stop to complete the following:
o Decision #1
 Which decision did you select?
 Why did you select this decision? Support your response with evidence and references to the Learning Resources.
 What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
 Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

o Decision #2
 Why did you select this decision? Support your response with evidence and references to the Learning Resources.
 What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
 Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

ORDER NOW FOR CUSTOMIZED SOLUTION PAPERS

o Decision #3
 Why did you select this decision? Support your response with evidence and references to the Learning Resources.
 What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
 Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

• Also include how ethical considerations might impact your treatment plan and communication with clients.
Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY

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

 Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
• Chapter 6, “Mood Disorders”
 Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Note: To access the following medications, click on the The Prescriber\’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.
Review the following medications:
• amitriptyline
• bupropion
• citalopram
• clomipramine
• desipramine
• desvenlafaxine
• doxepin
• duloxetine
• escitalopram
• fluoxetine
• fluvoxamine
• imipramine
• ketamine
• mirtazapine
• nortriptyline
• paroxetine
• selegiline
• sertraline
• trazodone
• venlafaxine
• vilazodone
• vortioxetine

 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
 Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389. Retrieved from https://www.researchgate.net/profile/Marie_Asberg/publication/22697065_A_New_Depression_Scale_Designed_to_be_Sensitive_to_Change/links/09e41513f85c708fee000000.pdf

Course Texts
These course texts are available through Stahl Online Resources
http://stahlonline.cambridge.org/
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, PSYCHOPHARMACOLOGIC APPROACHES TO TREATMENT OF PSYCHOPATHOLOGY

Reflective Paper on Leadership Skills

/in /by

Reflective Paper on Leadership Skills

Follow rubric.

The purpose of this reflective paper on leadership skill is to assist students to gain an understanding of nursing leadership and management. This reflective scholarly writing is designed to help students organize their thouphts on leadership skills, to document their work and experiences. It is designed to reflect their thinking process.

 

Instructions

 

This assignment requires personal relfection. You must reflect on your own leadership skills and personality. Therefore, you can write in the first person if you choose to do so. Reference to peer reviewed literature is required to demonstrate understanding of leadership thoeires and practice and will form the basis of your personal reflection.

ORDER NOW FOR CUSTOMIZED SOLUTION PAPERS

Instructions/Component of the Reflection:

 

Identify and reflect on one leadership skill from a personal perspective

Include a critical reflection of the leadership skill, your own thinking and learning processes as well as implications for future learning. Reflective Paper on Leadership Skills

Identify what you can do to to enhance your personal leadership capacity

The reflection must be one page in length

It should be typed, double-spaced and in a 12-point Times New Roman font with 1-inch margins.

Grammar and spelling will be evaluated.

Rubric

Some Rubric (1)

Some Rubric (1)

Criteria Ratings Pts

This criterion is linked to a Learning Outcome Description of criterion

Date:_________ Grading Criteria            Possible Points  Points Earned Provide an introduction Professor comments: 10 Provide an overview on one leadership skill from a personal perspective Professor comments: 15      Include a critical reflection of the leadership skill, your own thinking and learning processes as well as implications for future learning. Professor comments: 30            Identify what you can do to to enhance your personal leadership capacity Professor comments: 20               Discuss and explain the implication, relevancy and significance of the leadership skill to nursing. Professor comments: 10        Provide a conclusion Professor comments: 5. Reflective Paper on Leadership Skills

100.0 pts

Total Points: 100.0

Advanced Practice Nurse Assignment

/in /by

Advanced Practice Nurse Assignment

As an advanced practice nurse, you will examine patients presenting with a variety of disorders. You must, therefore, understand how the body normally functions so that you can identify when it is reacting to changes. Often, when changes occur in body systems, the body reacts with compensatory mechanisms. These compensatory mechanisms, such as adaptive responses, might be signs and symptoms of alterations or underlying disorders. In the clinical setting, you use these responses, along with other patient factors, to lead you to a diagnosis. Advanced Practice Nurse Assignment

Consider the following scenarios:

Scenario 1:

Jennifer is a 2-year-old female who presents with her mother. Mom is concerned because Jennifer has been “running a temperature” for the last 3 days. Mom says that Jennifer is usually healthy and has no significant medical history. She was in her usual state of good health until 3 days ago when she started to get fussy, would not eat her breakfast, and would not sit still for her favorite television cartoon. Since then she has had a fever off and on, anywhere between 101oF and today’s high of 103.2oF. Mom has been giving her ibuprofen, but when the fever went up to 103.2oF today, she felt that she should come in for evaluation. A physical examination reveals a height and weight appropriate 2-year-old female who appears acutely unwell. Her skin is hot and dry. The tympanic membranes are slightly reddened on the periphery, but otherwise normal in appearance. The throat is erythematous with 4+ tonsils and diffuse exudates. Anterior cervical nodes are readily palpable and clearly tender to touch on the left side. The child indicates that her throat hurts “a lot” and it is painful to swallow. Vital signs reveal a temperature of 102.8oF, a pulse of 128 beats per minute, and a respiratory rate of 24 beats per minute. Advanced Practice Nurse Assignment

ORDER NOW FOR CUSTOMIZED SOLUTION PAPERS

Scenario 2:

Jack is a 27-year-old male who presents with redness and irritation of his hands. He reports that he has never had a problem like this before, but about 2 weeks ago he noticed that both his hands seemed to be really red and flaky. He denies any discomfort, stating that sometimes they feel “a little bit hot,” but otherwise they feel fine. He does not understand why they are so red. His wife told him that he might have an allergy and he should get some steroid cream. Jack has no known allergies and no significant medical history except for recurrent ear infections as a child. He denies any traumatic injury or known exposure to irritants. He is a maintenance engineer in a newspaper building and admits that he often works with abrasive solvents and chemicals. Normally he wears protective gloves, but lately they seem to be in short supply so sometimes he does not use them. He has exposed his hands to some of these cleaning fluids, but says that it never hurt and he always washed his hands when he was finished.

Scenario 3:

Martha is a 65-year-old woman who recently retired from her job as an administrative assistant at a local hospital. Her medical history is significant for hypertension, which has been controlled for years with hydrochlorothiazide. She reports that lately she is having a lot of trouble sleeping, she occasionally feels like she has a “racing heartbeat,” and she is losing her appetite. She emphasizes that she is not hungry like she used to be. The only significant change that has occurred lately in her life is that her 87-year-old mother moved into her home a few years ago. Mom had always been healthy, but she fell down a flight of stairs and broke her hip. Her recovery was a difficult one, as she has lost a lot of mobility and independence and needs to rely on her daughter for assistance with activities of daily living. Martha says it is not the retirement she dreamed about, but she is an only child and is happy to care for her mother. Mom wakes up early in the morning, likes to bathe every day, and has always eaten 5 small meals daily. Martha has to put a lot of time into caring for her mother, so it is almost a “blessing” that Martha is sleeping and eating less. She is worried about her own health though and wants to know why, at her age, she suddenly needs less sleep.

To Prepare

Review the three scenarios, as well as Chapter 6 in the Huether and McCance text.
Identify the pathophysiology of the disorders presented in each of the three scenarios, including their associated alterations. Consider the adaptive responses to the alterations.
Review the examples of “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in this week’s Learning Resources. Then select one of the disorders you identified from the scenarios. Use the examples in the media as a guide to construct a mind map for the disorder you selected. Consider the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations. Advanced Practice Nurse Assignment
Review the Application Assignment Rubric found under Course Information
To Complete

Write a 2- to 3-page paper excluding the title page, reference page and Mind Map that addresses the following:

For each of the three scenarios explain the pathophysiology, associated alterations and the patients’ adaptive responses to the alterations caused by the disease processes. You are required to discuss all three scenarios within the paper component of this assignment.
Construct one mind map on a selected disorder presented in one of the scenarios. Your Mind Map must include the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.

Required references: (2 of the 4 should include)
Hammer, G. G. , & McPhee, S. (2014). Pathophysiology of disease: An introduction to clinical medicine. (7th ed.) New York, NY: McGraw-Hill Education.

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby. Advanced Practice Nurse Assignment

The Ethics and Legalities of Medication Error Disclosure

/in /by

The Ethics and Legalities of Medication Error Disclosure

Consider the following scenario:

You are working as an advanced practice nurse at a community health clinic. You make an error when prescribing a drug to a patient. You do not think the patient would know that you made the error, and it certainly was not intentional.
To prepare:
Consider the ethical implications of disclosure and nondisclosure.
Research federal and state laws for advanced practice nurses. Reflect on the legal implications of disclosure and nondisclosure for you and the health clinic.
Consider what you would do as the advanced practice nurse in this scenario including whether or not you would disclose your error.
Review the Institute for Safe Medication Practices website in the Learning Resources. Consider the process of writing prescriptions. Think about strategies to avoid medication errors. The Ethics and Legalities of Medication Error Disclosure

ORDER NOW FOR CUSTOMIZED SOLUTION PAPERS

Write a 2 page paper that addresses the following:

Explain the ethical and legal implications of disclosure and nondisclosure. Be sure to reference laws specific to your state.
Describe what you would do as the advanced practice nurse in this scenario including whether or not you would disclose your error. Provide your rationale.
Explain the process of writing prescriptions including strategies to minimize medication errors.

Please include an introduction and summary. References should be within the last five years. Thank you.

American writer Nikki Giovanni once said: “Mistakes are a fact of life. It is the response to the error that counts” (Goodreads, 2012). Whenever you make an error when writing a prescription, you must consider the ethical and legal implications of your error—no matter how seemingly insignificant it might be. You may fear the possible consequences and feel pressured not to disclose the error. Regardless, you need to consider the potential implications of non-disclosure. How you respond to the prescription error will affect you, the patient, and the health care facility where you practice. In this Assignment, you examine ethical and legal implications of disclosure and nondisclosure of personal error. The Ethics and Legalities of Medication Error Disclosure

Assessing and Treating Clients with With Bipolar Disorder

/in /by

Assessing and Treating Clients with With Bipolar Disorder

The Assignment

 

Examine Case Study: An Asian American Woman With Bipolar Disorder. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client\’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

ORDER NOW FOR CUSTOMIZED SOLUTION PAPERS

Decision #1

Which decision did you select?

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

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

Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different? Assessing and Treating Clients with With Bipolar Disorder

 

Decision #2

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

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

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

The Assignment

 

Examine Case Study: An Asian American Woman With Bipolar Disorder. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client\’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

 

Decision #1

Which decision did you select?

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

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

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

 

Decision #2

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

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

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

 

Decision #3

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

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

Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

 

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

 

Finally: 1. Complete the decision tree (keep track of what you selected. come up with a rational reason why you chose it. Come up with patient specific rational reason behind not choosing the other two options not chosen).

 

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

 

Case Study: Bipolar Therapy for Client of Korean Descent/Ancestry:

 

BACKGROUND INFORMATION

 

The client is a 26-year-old woman of Korean descent who presents to her first appointment following a 21-day hospitalization for onset of acute mania. She was diagnosed with bipolar I disorder.

Upon arrival in your office, she is quite \”busy,\” playing with things on your desk and shifting from side to side in her chair. She informs you that \”they said I was bipolar, I don\’t believe that, do you? I just like to talk, and dance, and sing. Did I tell you that I liked to cook?\”

She weight 110 lbs. and is 5\’ 5\”

 

SUBJECTIVE

 

Patient reports \”fantastic\” mood. Reports that she sleeps about 5 hours/night to which she adds \”I hate sleep, it\’s no fun.\”

You reviewed her hospital records and find that she has been medically worked up by a physician who reported her to be in overall good health. Lab studies were all within normal limits. You find that the patient had genetic testing in the hospital (specifically GeneSight testing) as none of the medications that they were treating her with seemed to work.

Genetic testing reveals that she is positive for CYP2D6*10 allele.

Patient confesses that she stopped taking her lithium (which was prescribed in the hospital) since she was discharged two weeks ago.

 

MENTAL STATUS EXAM

 

The patient is alert, oriented to person, place, time, and event. She is dressed quite oddly- wearing what appears to be an evening gown to her appointment. Speech is rapid, pressured, tangential. Self-reported mood is euthymic. Affect broad. Patient denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, but insight is clearly impaired. She is currently denying suicidal or homicidal ideation.

The Young Mania Rating Scale (YMRS) score is 22

 

RESOURCES

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

 

Decisions Made and Outcomes (Needed to formulate the paper)

 

Choices for Decision 1: Select what the PMHNP should do: Begin Lithium 300 mg orally BID, Begin Risperdal 1 mg orally BID, or Begin Seroquel XR 100 mg orally at HS.

My decision: I chose to begin Lithium 300 mg orally BID.

Outcome: RESULTS OF DECISION POINT ONE: Client returns to clinic in four weeks

Client informs the PMHNP that she has been taking her drug \”off and on\” only when she \”feels like she needs it\”

Today\’s presentation is similar to the first day you met her

 

Choices for Decision 2: Select what the PMHNP should do:Increase Lithium to 450 mg orally BID, Assess rationale for non-compliance to elicit reason for non-compliance and educate client re: drug effects, and pharmacology, or Switch to Depakote ER 500 mg orally at HS.

My decision: I chose to switch to Depakote ER 500 mg orally at HS.

Outcome: RESULTS OF DECISION POINT TWO: Client returns to clinic in four weeks

Client reports that she has been compliant and you notice a marked reduction in manic symptoms. Young Mania Rating Scale was 11 (50% reduction from first office visit)

Client reports that she has gained 6 pounds over the last 4 weeks and wants to stop the medication because of this Client returns to clinic in four weeks

 

Choices for Decision 3: Decision Point Three Select what the PMHNP should do next: Educate client regarding diet/weight loss and continue client on the same drug/dose, Decrease Depakote ER to 250 mg orally at HS, or Switch medication to Zyprexa 15 mg orally daily at HS

My decision: I choose to educate client regarding diet/weight loss and continue client on the same drug/dose

Outcome: Guidance to Student

The PMHNP should begin by educating the client regarding weight loss/and importance of diet/exercise while taking Depakote which can cause weight gain. Decreasing the dose of Depakote would not be appropriate as she still has symptoms and decreasing dose of Depakote may result in some weight loss, it may result in a return of manic symptoms. The PMHNP can switch to Zyprexa but if weight gain is the issue, then this will be compounded by Zyprexa which is associated with significant weight gain (up to 20 kg over a 24 month period). Assessing and Treating Clients with With Bipolar Disorder

ORDER NOW FOR CUSTOMIZED SOLUTION PAPERS

***Write on each decision. Make sure that this paper has at least 5 References. Please use in-text citations. Don\’t forget the ethical considerations for this assignment. Make it a section by itself.***

 

Decision #3

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

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

Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

 

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

 

Finally: 1. Complete the decision tree (keep track of what you selected. come up with a rational reason why you chose it. Come up with patient specific rational reason behind not choosing the other two options not chosen).

 

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

 

Case Study: Bipolar Therapy for Client of Korean Descent/Ancestry:

 

BACKGROUND INFORMATION

 

The client is a 26-year-old woman of Korean descent who presents to her first appointment following a 21-day hospitalization for onset of acute mania. She was diagnosed with bipolar I disorder.

Upon arrival in your office, she is quite \”busy,\” playing with things on your desk and shifting from side to side in her chair. She informs you that \”they said I was bipolar, I don\’t believe that, do you? I just like to talk, and dance, and sing. Did I tell you that I liked to cook?\”

She weight 110 lbs. and is 5\’ 5\”

 

SUBJECTIVE

 

Patient reports \”fantastic\” mood. Reports that she sleeps about 5 hours/night to which she adds \”I hate sleep, it\’s no fun.\”

You reviewed her hospital records and find that she has been medically worked up by a physician who reported her to be in overall good health. Lab studies were all within normal limits. You find that the patient had genetic testing in the hospital (specifically GeneSight testing) as none of the medications that they were treating her with seemed to work.

Genetic testing reveals that she is positive for CYP2D6*10 allele.

Patient confesses that she stopped taking her lithium (which was prescribed in the hospital) since she was discharged two weeks ago.

 

MENTAL STATUS EXAM

 

The patient is alert, oriented to person, place, time, and event. She is dressed quite oddly- wearing what appears to be an evening gown to her appointment. Speech is rapid, pressured, tangential. Self-reported mood is euthymic. Affect broad. Patient denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, but insight is clearly impaired. She is currently denying suicidal or homicidal ideation.

The Young Mania Rating Scale (YMRS) score is 22

 

RESOURCES

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

 

Decisions Made and Outcomes (Needed to formulate the paper)

 

Choices for Decision 1: Select what the PMHNP should do: Begin Lithium 300 mg orally BID, Begin Risperdal 1 mg orally BID, or Begin Seroquel XR 100 mg orally at HS.

My decision: I chose to begin Lithium 300 mg orally BID.

Outcome: RESULTS OF DECISION POINT ONE: Client returns to clinic in four weeks

Client informs the PMHNP that she has been taking her drug \”off and on\” only when she \”feels like she needs it\”

Today\’s presentation is similar to the first day you met her

 

Choices for Decision 2: Select what the PMHNP should do:Increase Lithium to 450 mg orally BID, Assess rationale for non-compliance to elicit reason for non-compliance and educate client re: drug effects, and pharmacology, or Switch to Depakote ER 500 mg orally at HS.

My decision: I chose to switch to Depakote ER 500 mg orally at HS.

Outcome: RESULTS OF DECISION POINT TWO: Client returns to clinic in four weeks

Client reports that she has been compliant and you notice a marked reduction in manic symptoms. Young Mania Rating Scale was 11 (50% reduction from first office visit)

Client reports that she has gained 6 pounds over the last 4 weeks and wants to stop the medication because of this Client returns to clinic in four weeks

 

Choices for Decision 3: Decision Point Three Select what the PMHNP should do next: Educate client regarding diet/weight loss and continue client on the same drug/dose, Decrease Depakote ER to 250 mg orally at HS, or Switch medication to Zyprexa 15 mg orally daily at HS

My decision: I choose to educate client regarding diet/weight loss and continue client on the same drug/dose

Outcome: Guidance to Student

The PMHNP should begin by educating the client regarding weight loss/and importance of diet/exercise while taking Depakote which can cause weight gain. Decreasing the dose of Depakote would not be appropriate as she still has symptoms and decreasing dose of Depakote may result in some weight loss, it may result in a return of manic symptoms. The PMHNP can switch to Zyprexa but if weight gain is the issue, then this will be compounded by Zyprexa which is associated with significant weight gain (up to 20 kg over a 24 month period).

 

***Write on each decision. Make sure that this paper has at least 5 References. Please use in-text citations. Don\’t forget the ethical considerations for this assignment. Make it a section by itself.*** Assessing and Treating Clients with With Bipolar Disorder

Nursing Care Model Paper

/in /by

Nursing Care Model Paper

Read your text, Finkelman (2016), pp- 111-116.
Observe staff in delivery of nursing care provided. Practice settings may vary depending on availability.
Identify the model of nursing care that you observed. Be specific about what you observed, who was doing what, when, how and what led you to identify the particular model.
Write a 5-7 page paper.
You are required to complete the assignment using the productivity tools required by Chamberlain University, which is Microsoft Office Word 2013 (or later version), or Windows and Office 2011 (or later version) for MAC. You must save the file in the \”.docx\” format. Do NOT save as Word Pad. A later version of the productivity tool includes Office 365, which is available to Chamberlain students for FREE by downloading from the student portal at http://my.chamberlain.edu (Links to an external site.)Links to an external site.. Click on the envelope at the top of the page. Nursing Care Model Paper

ORDER NOW FOR CUSTOMIZED SOLUTION PAPERS

Review and summarize two scholarly resources (not including your text) related to the nursing care model you observed in the practice setting.
Review and summarize two scholarly resources (not including your text) related to a nursing care model that is different from the one you observed in the practice setting.
Discuss your observations about how the current nursing care model is being implemented. Be specific.
Recommend a different nursing care model that could be implemented to improve quality of nursing care, safety and staff satisfaction. Be specific.
Provide a summary/conclusion about this experience/assignment and what you learned about nursing care models.
Write your paper using APA format using Microsoft Office 2010 or later.

Psychiatric and Medical Conditions Assignment

/in /by

Psychiatric and Medical Conditions Assignment

Kim is a 25-year-old woman who presented to an outpatient clinic for an evaluation. She complained of episodes of sadness, often unexplained, as well as difficulty controlling her temper and handling stressful situations. Her sadness would sometimes last an entire week, was very intense, and occurred all day every day, but she reported that she would eventually return to her normal self. Her sadness was sometimes accompanied by a restless energy and irritability that precipitated arguments with her husband. These arguments would sometimes lead to Kim hitting her husband or throwing things at him. The periods of restless, heightened energy, and irritability would often switch abruptly back to a state of intense, depressed mood. When depressed, Kim would sleep excessively and had a tendency to overeat. She would isolate herself from others, let the housework go, and found it hard to get anything done. During the initial interview, Kim is very animated and dramatic. Her response to the question- “What brings you here to see us today? – lasted 8 minutes without interruption. Kim switched topics a number of times, and her speech was moderately pressured. Her affect would alternate between laughing and crying.
Kim smokes 1-2 packs of cigarettes per day. She drinks 5 caffeinated soft drinks per day. She has been taking birth control pills since she had a baby 8 months ago. She has been somewhat healthy, but since delivering the baby, she continues to gain weight and complains of headaches that are increasing in frequency and duration. These brief, but intense, periods of depressed mood have only started since the delivery of the baby. Prior to the delivery, she was a very outgoing and happy person, and had never been treated for mood or anxiety problems. However, anxiety and depression runs in her family. Her maternal grandfather was diagnosed with “manic depression” and hospitalized in a state mental health facility on 3 occasions. Several other relatives abused alcohol and/or cocaine. Her father was an alcoholic. Kim admits to occasional alcohol use, “only 2-3 times a week.” Her mother had been treated for depression, and also had a history of hypertension and heart disease. Her maternal grandmother had a history of anxiety, diabetes and hypertension. Psychiatric and Medical Conditions Assignment
Kim was diagnosed with Bipolar disorder and placed on divalproex sodium (Depakote) and olanzapine (Zyprexa). The divalproex sodium dosage was titrated to 1500 mg/day in divided doses over 10 days. She was prescribed olanzapine 10mg 1 tablet at bedtime. Her sleep patterns returned to normal and she felt less irritable. This improvement continued over the next 4 weeks, and her brief, depressed moods disappeared. Her serum valproate level was 65µg/mL.
Two months into treatment, Kim calls the office and reports that she’s noticed a 16 lb. weight gain. She states her weight is now at 238 lbs. (height is 5’2). She reports worsening headaches, frequent urination, is always thirsty, and feels hungry all the time. She reports recent, intermittent periods of fatigue. Mood wise, she states she is doing very well.

ORDER NOW FOR CUSTOMIZED SOLUTION PAPERS

1. Looking at Kim’s physical symptoms, her history, and her family’s medical/mental history, which psychiatric and medical disorders is she at risk for? Explain why.

2. Based on the information provided above, what labs would you have drawn? Explain why.

3. What education should have been provided to Kim regarding her medications at the initiation of treatment? Would you change her medications at this time? Explain why or why not. If so, what other psychotropic medications could be considered. Explain why.

4. Based on the information provided above, what lifestyle changes would you recommend to Kim? Explain why.

5. What referrals should be made? Explain why. Psychiatric and Medical Conditions Assignment