Patient Presentation of Dementia, Delirium, and Depression

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Patient Presentation of Dementia, Delirium, and Depression

With the prevalence of dementia, delirium, and depression in the growing geriatric population, you will likely care for elderly patients with these disorders. While many symptoms of dementia, delirium, and depression are similar, it is important that you are able to identify those that are different and properly diagnose patients. A diagnosis of one of these disorders is often difficult for patients and their families. In your role as the advanced practice nurse, you must help patients and their families manage the disorder by facilitating necessary treatments, assessments, and follow-up care. Consider the patient presentations in the following case studies. What distinct symptoms or factors would lead you to a diagnosis of dementia, delirium, or depression? Patient Presentation of Dementia, Delirium, and Depression

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Case Study 1:

HPI: Mrs. Mayfield is a 75-year-old woman who is brought to the emergency room by the police at 11 p.m. She was found wandering and confused in a local neighborhood. The police were called when Mrs. Mayfield tried to use her key on a neighbor’s door. When confronted by the police she became abusive, confused, and frightened and looked very pale and agitated. The police could not establish her correct address and they subsequently brought her to the emergency room.

Review of Symptoms (ROS): Unable to obtain at this time.

Objective Data:
PE:
VS: Pulse 96 and regular; B/P 150/90; Axillary temperature 99°F.

General: She appears clean and well nourished, with no signs of injury, trauma, or neglect.

Her physical exam is unremarkable except –

Neuro: No gross focal neurological signs, but she is only intermittently cooperative. Her mental status fluctuates and a full neurological evaluation is not possible at this time.

Psych: A & O x 1 to person only.  She has episodes of agitation and alternating withdrawal/somnolence. During the examination, it takes several attempts to gain Mrs. Mayfield’s attention to answer questions, but once focused, she rambles on in a disorganized and incoherent way.  Patient Presentation of Dementia, Delirium, and Depression

Case Study 2:

CC: “irritable and forgetful”

HPI: Mrs. White, a 78-year-old married woman, is brought to the office of her primary care provider by her husband because of increasing forgetfulness and irritability over the past 3 months. Mr. White claims that his wife has had problems for several years now, but has just gotten “worse in her memory” in the past few months. She recently misplaced her purse and accused her son of stealing it.

On three occasions, she left the stove on and boiled a pot dry, nearly causing a fire. She recently put a container of ice cream into the washing machine instead of into the freezer and her husband did not discover it for more than a week. Mrs. White claims her family wants to take her money and leave her with nothing. “No matter what they say, there is nothing wrong with me,” she states.

Past Medical History (PMH) includes: hypothyroidism, treated with Synthroid, and successful treatment of breast cancer approximately 15 years prior. She also takes over-the-counter ibuprofen for chronic lower back pain and occasional Benadryl to help her sleep at night.

Objective data: Her physical examination is within normal limits.

Case Study 3:

HPI: Mr. George is a 72-year-old male who has lived alone since his wife died approximately 1 year ago. He has lived in the same house for 45 years. He is brought in by his son who is concerned that his father has lost more than 35 pounds over the past year. Mr. George admits to not eating well because “I don’t know how to cook for myself.”

PMH: He has been in good health with the exception of hypertension, which is well controlled.

Social history: He spends most of his time watching sports on television. He occasionally drinks one or two cans of beer when he is watching TV. He does go to his son’s house to visit with his grandchildren about once a week, and he says he enjoys that. He does not receive any social services, he still drives but only in the daytime, and he does not participate in any other leisure activities.

Objective data: His physical examination is normal. He responds correctly to questions, although he appears to have a flat affect. Patient Presentation of Dementia, Delirium, and Depression

To prepare:

  • Review Chapters 6–8 of the Holroyd-Leduc and Reddy text.
  • Select one of the three case studies. Reflect on the way the patient presented in the case study you selected, including whether the patient might be presenting with dementia, delirium, or depression.
  • Think about how you would further evaluate the patient based on medical history, current drug treatments, and the patient’s presentation. Consider whether you would modify drug treatments, use additional assessment tools, and/or refer the patient to a specialist.

Post  an explanation of whether you suspect the patient in the case study you selected is presenting with dementia, delirium, or depression and why. Then, explain how you would further evaluate the patient in the case study based on medical history, current drug treatments, and the way the patient presented. Include whether you would modify drug treatments, use additional assessment tools, and/or refer the patient to a specialist.

Patient Presentation of Dementia, Delirium, and Depression

Diagnosing Gastrointestinal Disorders

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Diagnosing Gastrointestinal Disorders

In primary care settings, patients often present with abdominal pain. Although this is frequently a sign of a gastrointestinal (GI) disorder, abdominal pain could also be the result of other systemic disorders, making this type of pain difficult to assess. While abdominal pain is most common, many other GI symptoms also overlap multiple disorders, further increasing the difficulty in diagnosing and treating patients. This makes provider-patient communication essential. You must be able to formulate questions that will prompt the patient to provide the necessary information, as this will guide your assessment and diagnosis. For this Discussion, consider potential diagnoses for the patients in the following case studies. Diagnosing Gastrointestinal Disorders

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Case Study 1:
A 49-year-old man presents to the office complaining of vague abdominal discomfort over the past few days. He states he does not feel like eating and has not moved his bowels for the last 2 days. His patient medical history includes an appendectomy at age 22 and borderline hypertension, which he is trying to control with diet and exercise. He takes no medications and has no known allergies. Positive physical exam findings include a temperature of 99.9 degrees Fahrenheit, heart rate of 98, respiratory rate of 24, and blood pressure of 150/72. The abdominal exam reveals abdominal distention, diminished bowel sounds, and lower left quadrant tenderness without rebound.

Case Study 2:
A 40 year-old female presents to the office with the chief complaint of diarrhea. She has been having recurrent episodes of abdominal pain, diarrhea, and rectal bleeding. She has lost 9 pounds in the last month. She takes no medications, but is allergic to penicillin.  She describes her life as stressful, but manageable. The physical exam reveals a pale middle- aged female in no acute distress. Her weight is 140 pounds (down from 154 at her last visit over a year ago), blood pressure of 94/60 sitting and 86/50 standing, heart rate of 96 and regular without postural changes, respiratory rate of 18, and O2 saturation 99%. Further physical examination reveals:
Skin: w/d, no acute lesions or rashes
Eyes: sclera clear, conj pale
Ears: no acute changes
Nose: no erythema or sinus tenderness
Mouth: membranes pale, some slight painful ulcerations, right buccal mucosa, tongue beefy red, teeth good repair
Neck: supple, no thyroid enlargement or tenderness, no lymphadenopathy
Cardio: S1 S2 regular, no S3 S4 or murmur
Lungs: CTA w/o rales, wheezes, or rhonchi
Abdomen: scaphoid, BS hyperactive, generalized tenderness, rectal +occult blood

Case Study 3:
A 52-year-old male presents to the office for a routine physical. The review of symptoms reveals anorexia, heartburn, and weight loss over the past 6 months. The heartburn is long standing, occurring most days during the week. He takes TUMS or Rolaids to relieve the discomfort. The patient describes occasional use of ibuprofen for back pain, but denies other medications including herbals. He has no known allergies. He was adopted so does not know his family history. Social history reveals that, although he stopped smoking ten years ago, he smoked for 20 years. He occasionally consumes alcohol on the weekends only. The only positive physical exam finding for this patient was slight epigastric tenderness. The remainder of his exam was negative and the rectal exam was negative for blood. Diagnosing Gastrointestinal Disorders

To prepare:

  • Review this week’s media presentations and Part 12 of the Buttaro et al. text in the Learning Resources.
  • Select one of the three case studies listed above. Reflect on the provided patient information including history and physical exams.
  • Think about a differential diagnosis. Consider the role the patient history and physical exam played in diagnosis.
  • Reflect on potential treatment options based on your diagnosis.

Post  an explanation of the differential diagnosis for the patient in the case study that you selected. Describe the role the patient history and physical exam played in the diagnosis. Then, suggest potential treatment options based on your patient diagnosis.

Diagnosing Gastrointestinal Disorders

Evolution Of Long-Term Care Systems

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Evolution Of Long-Term Care Systems

During the 1800s, and well into the 1900s, families took care of their own members whenever possible. Several generations lived together, with the younger generation taking care of the older and vice versa. Post 1900s, the joint family system started disintegrating. Evolution Of Long-Term Care Systems

Interview at least five people of varying ages from different families to know their perspective on disintegration of joint family system. Based on your interview findings and learning from your readings, respond to the following questions:

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  • What factors led to disintegration of the joint family system?
  • What has been the impact of this disintegration on aging people and long-term care?
  • Did disintegration have any benefits for health service organizations? Why or why not?

At the same time this shift occurred in the family structure, health care organizations were experiencing continuous changes in their operating styles. The long-term care system took some time to catch up with the changing nature of businesses. In the 1990s and early 2000s, long-term care was seen to experience several turbulent changes, particularly related to its operations, management, and structure. Research the South University Online Library and the Internet to find information on the changes in the long-term care system in the United States and respond to the following questions:

  • How have the operations, management, and structural changes of the 1990s and early 2000s impacted the long-term care system today?
  • What are the strengths and weaknesses of the present long-term care system in the United States?

Evolution Of Long-Term Care Systems

Integrating PHRs into EHR Platforms

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Integrating PHRs into EHR Platforms

When electronic health records (EHRs) first entered the market, their primary focus was to collect and analyze patient information within health care settings. As technological capabilities grew, so did the interest in making these records available to patients. In addition, many health care professionals saw benefits in allowing the patient to enter his or her own health data into EHR platforms. Though many patients are already utilizing personal health records (PHRs) to manage and track their own health, some believe that an integrated system would provide a better, more comprehensive picture of a patient’s health history. Integrating PHRs into EHR Platforms

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As a result, many EHR platforms are now equipped with a PHR tool. This PHR tool allows patients to enter health information as they would in a stand-alone PHR system. In addition, web-based portals within the EHR allow patients to access information entered by their physicians and health care providers.

Like many emerging trends and technologies, there is much discussion about the potential benefits and challenges of this type of integrated system. While many health care professionals are excited about the empowerment provided to patients, others express significant concerns about access, security, ethics, and other implications.

In this Discussion, you explore how integrating PHRs into EHR platforms could impact you and your patients.

To prepare:

  • Review the media Patient-Centered Technologies, and reflect upon Dr. Simpson’s statements about the ownership of patient data.
  • Review the article,“Dreams and Nightmares: Practice and Ethical Issues for Patients and Physicians Using Personal Health Records” found in this week’s Learning Resources. Consider how PHR capabilities can be integrated into EHR platforms.
  • Examine the “dreams” and the “nightmares” the authors associate with this type of integrated health record. Select one benefit or one challenge of integrating PHRs into EHR platforms. Then, consider its potential impact on health care providers and patients. Why is this considered to be a benefit or challenge for health care professionals and patients?

Integrating PHRs into EHR Platforms

Nursing Research and Evidence-Based Practice

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Nursing Research and Evidence-Based Practice

In your practice as a nurse, you may use procedures and methods that did not necessarily originate in evidence, but instead were derived from informal and unwritten conventions, traditions, and observations. While these techniques may have merit, practices are constantly being updated and contradicted by information from scholarly research studies and professional guidelines. This new information serves as “evidence” for revising practices to improve outcomes across health care.

Based on this evidence, you can formulate a question. In this Discussion, you consider the use of evidence-based practice in your own organization and formulate a question that you will need to answer for your portfolio project. This is called a PICOT question. You will also investigate strategies for overcoming barriers to implementing evidence-based practice (EBP). Nursing Research and Evidence-Based Practice

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To prepare:

  • Consider a recent clinical experience in which you were providing care for a patient.
  • Determine the extent to which the care that you provided was based on evidence and research findings or supported only by your organization’s standard procedures. How do you know if the tasks were based on research?
  • What questions have you thought about in a particular area of care such as a  procedure or policy?
  • Review Chapter 2, pages 36—39 on “Asking Well worded Clinical Questions” in Polit & Beck and consult the resource from the Walden Student Center for Success: Clinical Question Anatomy & examples of PICOT questions (found in this week’s Learning Resources). Formulate your background questions and PICOT question.
  • Reflect on the barriers that might inhibit the implementation of evidence-based practice in your clinical environment.
  • Review the article “Adopting Evidence-Based Practice in Clinical Decision Making” in this week’s Learning Resources. Select one of the barriers described that is evident in your organization and formulate a plan for overcoming this barrier.

 Post an evaluation of the use, or lack thereof, of EBP in a recent clinical experience. Identify which aspects of the care delivered, if any, were based on evidence and provide your rationale. List your background questions and PICOT question about this nursing topic. Critique how the policies, procedures, and culture in your organization may hinder or support the adoption of evidence-based practices. Identify the barrier you selected from the article and explain how this barrier could be overcome within your organization.

Nursing Research and Evidence-Based Practice

Benchmark – Human Experience Across The Health-Illness Continuum

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Benchmark – Human Experience Across The Health-Illness Continuum

Research the health-illness continuum and its relevance to patient care. In a 750-1,000 word paper, discuss the relevance of the continuum to patient care and present a perspective of your current state of health in relation to the wellness spectrum. Include the following: Benchmark – Human Experience Across The Health-Illness Continuum

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  1. Examine the health-illness continuum and discuss why this perspective is important to consider in relation to health and the human experience when caring for patients.
  2. Reflect on your overall state of health. Discuss what behaviors support or detract from your health and well-being. Explain where you currently fall on the health-illness continuum.
  3. Discuss the options and resources available to you to help you move toward wellness on the health-illness spectrum. Describe how these would assist in moving you toward wellness (managing a chronic disease, recovering from an illness, self-actualization, etc.).

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Benchmark – Human Experience Across The Health-Illness Continuum

 

Case Study Advanced Pharmacology

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Case Study Advanced Pharmacology

Use APA 6th Edition Format and support your work with at least 3 peer-reviewed references within 5 years of publication. Remember that you need a cover page and a reference page. All paragraphs need to be cited properly. Please use headers.  All responses must be in a narrative format and each paragraph must have at least 4 sentences. Lastly, you must have at least 2 pages of content, no greater than 4 pages, excluding cover page and reference page. Case Study Advanced Pharmacology

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Case Study 

Chronic Stable Angina

E.H. is a 45-year-old African American man who recently moved to the community from another state. He requests renewal of a prescription for a calcium channel blocker, prescribed by a physician in the former state. He is unemployed and lives with a woman, their son, and the woman’s 2 children. His past medical history is remarkable for asthma and six “heart attacks” that he claims occurred because of a 25-year history of drug use (primarily cocaine). He states that he used drugs as recently as 2 weeks ago. He does not have any prior medical records with him. He claims that he has been having occasional periods of chest pain. He is unable to report the duration or pattern of the pain. Before proceeding, explore the following questions: What further information would you need to diagnose angina (substantiate your answer)? What is the connection between cocaine use and angina? Identify at least three tests that you would order to diagnose angina. Case Study Advanced Pharmacology

Diagnosis: Angina

1. List specific goals of treatment for E.H.

2. What dietary and lifestyle changes should be recommended for this patient?

3. What drug therapy would you prescribe for E.H. and why?

4. How would you monitor for success in E.H.?

5. Describe one or two drug–drug or drug–food interactions for the selected agent.

6. List one or two adverse reactions for the selected agent that would cause you to change therapy.

7. What would be the choice for the second-line therapy?

8. Discuss specific patient education based on the prescribed first-line therapy.

9. What over-the-counter and/or alternative medications would be appropriate for E.H.?

Case Study Advanced Pharmacology

Psychotherapy With Individuals

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Psychotherapy With Individuals

Using the client from your Week 3 Assignment, address the following in a progress note (without violating HIPAA regulations):

  • Treatment modality used and efficacy of approach  Psychotherapy With Individuals
  • Progress and/or lack of progress toward the mutually agreed-upon client goals (reference the Treatment plan—progress toward goals)
  • Modification(s) of the treatment plan that were made based on progress/lack of progress
  • Clinical impressions regarding diagnosis and/or symptoms

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  • Relevant psychosocial information or changes from original assessment (i.e., marriage, separation/divorce, new relationships, move to a new house/apartment, change of job, etc.)
  • Safety issues
  • Clinical emergencies/actions taken
  • Medications used by the patient (even if the nurse psychotherapist was not the one prescribing them)
  • Treatment compliance/lack of compliance
  • Clinical consultations
  • Collaboration with other professionals (i.e., phone consultations with physicians, psychiatrists, marriage/family therapists, etc.)
  • Therapist’s recommendations, including whether the client agreed to the recommendations
  • Referrals made/reasons for making referrals
  • Termination/issues that are relevant to the termination process (i.e., client informed of loss of insurance or refusal of insurance company to pay for continued sessions)
  • Issues related to consent and/or informed consent for treatment
  • Information concerning child abuse, and/or elder or dependent adult abuse, including documentation as to where the abuse was reported
  • Information reflecting the therapist’s exercise of clinical judgment

Psychotherapy With Individuals

Health Policy And Management

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Health Policy And Management

Please answer the following questions with supporting examples and full explanations.

  • Analyze how policies influence the structure and financing of health care, practice, and health outcomes.

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  • Develop institutional, local, state and/or federal policy initiatives.
  • Consider the role of government and various professional organizations in the process of planning and implementing policies at management levels for diverse healthcare environments.
  • Examine the effect of legal, ethical, and regulatory processes on nursing practice (and/or change to providers), healthcare delivery, and outcomes while maintaining balance with administrative and fiscal responsibilities.
  • Interpret research, bringing the nursing perspective, alongside perspectives of their administrative colleagues, for policy makers and stakeholders.
  • Advocate for policies that improve the health of the public and the profession of nursing and health care administration.
  • For each of the learning objectives, provide an analysis of how the course supported each objective.
  • Explain how the material learned in this course, based upon the objectives, will be applicable to professional application.

Reflect back on your journey through this course and answer the following:

  • What was the most valuable thing you learned in this course?

Health Policy And Management

Cancer And The Approach, Using Nursing Process

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Cancer And The Approach, Using Nursing Process

The nursing process is a tool that puts knowledge into practice. By utilizing this systematic problem-solving method, nurses can determine the health care needs of an individual and provide personalized care. Cancer And The Approach, Using Nursing Process

Write a paper (1,750-2,000 words) on cancer and approach to care based on the utilization of the nursing process. Include the following in your paper:

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  1. Describe the diagnosis and staging of cancer.
  2. Describe at least three complications of cancer, the side effects of treatment, and methods to lessen physical and psychological effects.
  3. Discuss what factors contribute to the yearly incidence and mortality rates of various cancers in Americans.
  4. Explain how the American Cancer Society (ACS) might provide education and support. What ACS services would you recommend and why?
  5. Explain how the nursing process is utilized to provide safe and effective care for cancer patients across the life span. Your explanation should include each of the five phases and demonstrate the delivery of holistic and patient-focused care.
  6. Discuss how undergraduate education in liberal arts and science studies contributes to the foundation of nursing knowledge and prepares nurses to work with patients utilizing the nursing process. Consider mathematics, social and physical sciences, and science studies as an interdisciplinary research area. Cancer And The Approach, Using Nursing Process

You are required to cite to a minimum of four sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

RN-BSN

2.1: Incorporate liberal arts and science studies into nursing knowledge.

3.1 Utilize the nursing process to provide safe and effective care for patients across the life span.

Cancer And The Approach, Using Nursing Process