THE TASK IS TWO REPLY WITH A COMMENT TO EACH POST, POST 1 AND POST 2. TWO REFERENCE IS NEED IT PER COMMENT WITH CITATION PER REFERENCE IN APA STYLE ABOVE ABOVE 2013.

POST 1

The Health Insurance Portability and Accountability Act (HIPPA) is one of the acts that guide the practices of a nurse when it comes to Group and Family Therapy. Ethical and legal considerations such as confidential information of a patient as defined by HIPPA is part of what psychiatric mental health nurse practitioner does. Therefore, in this discussion, the primary objective is to provide an explanation of how legal and ethical considerations for group and family therapy differ from individual therapy.  The differences between the considerations significantly affect therapeutic approaches for clients depending on whether the clients are put on group or family therapy (Schiefele et al. 2018)

The differences in legal and ethical considerations for group and family therapy and individual therapy

Group and family therapists face more ethical and legal challenges than individually oriented therapists do. First, in group and family therapy, the ethical consideration is grounded in the foundational premise of the family as a system and therefore, the focus of the therapy is on the relationship. Some of the specific ethical and legal considerations that require special attention on the part of individual and group and family therapists include responsibility, informed consent and confidentiality. The first difference in ethical considerations for group and family therapy and individual therapy based on responsibility (Schiefele et al. 2018). Unlike individual therapy, group and family therapy is associated with the dilemma of multiple clients who are in the same situations and therefore, an intervention that serves one person’s best interests may be counter therapeutic to another. It means that the therapy process must consider an intervention that serves all the parties involved (Gurman & Burton, 2014). In group and family therapy, there are conflicting goals, as well as, the interests of the parties involved. It is unlike individual therapy in which the therapist encourages the client to explore potential ramifications of his or her actions. The group and family therapist is set apart from the individual therapist because of the family therapist’s ethical clear commitment to promoting the welfare of every member involved in the treatment process. It implies that group and family therapist has more responsibility than an individual therapist does for exercising judgment, which must take into account all the individuals (Gurman & Burton, 2014) Discussion: Legal And Ethical Considerations For Group And Family Therapy

ORDER A PLAGIARISM FREE PAPER NOW

When it comes to legal consideration, informed consent is a key difference between group and family therapy and individual therapy. In treating each member’s confidences in-group and family therapy, the therapists should act as though that person were an individual client (Shaw, 2015).  The information got during a private session, or a telephone call from one member is not divulged to other family members. The therapist upholds the individual client’s confidentiality to other family members (Hertlein, Blumer & Mihaloliakos, 2015). When it comes to individual therapy, one obtains only one client’s permission to use information while in the group and family therapy the permission is obtained during the conjoint sessions.

How the differences might affect therapeutic approaches for client’s in-group and family therapy

By considering responsibility as ethical considering in group and family therapy, the therapist must ensure that improvement in the status of one the member in the therapy is not occurring at the expense of another member. As part of ethical consideration, the group and family therapist should be an advocate of the family system during therapeutic process and avoids becoming an agent of any one of the members. When it comes to preservation of confidentiality, therapeutic approaches for clients in group and family therapy is such that the therapists arrange for sessions with individual family members to actively encourage the sharing of “secrets” as part of better understand what is occurring in the group or family (Shaw, 2015). When dealing with clients in group and family therapy, I will ensure that informed consent is obtained from each member in the therapy process before any information is used. If permission is not granted, all information must be kept confidential (Hertlein,  Blumer & Mihaloliakos, 2015)

References

Gurman, A. S., & Burton, M. (2014). Individual Therapy for Couple of Problems: Perspectives and Pitfalls. Journal of Marital and Family Therapy, 40, 4, 470-483.

Hertlein, K. M., Blumer, M. L. C., & Mihaloliakos, J. H. (2015). Marriage and Family Counselors’ Perceived Ethical Issues Related to Online Therapy. The Family Journal, 23, 1, 5-12.

Schiefele, A.-K., Lutz, W., Rubel, J., Barkham, M., Saxon, D., Bohnke, J., Delgadillo, J., … Lambert, M. J. ( 2018). Reliability of Therapist Effects in Practice-Based Psychotherapy Research: A Guide for the Planning of Future Studies. Administration and Policy in Mental Health and Mental Health Services Research, 45, 6, 598-613.

Shaw, E. (2015). Ethical Practice in Couple and Family Therapy: Negotiating Rocky Terrain. Australian and New

POST 2

Psychotherapy is a way to help people with a broad variety of mental illnesses and emotional difficulties. Psychotherapy can help eliminate or control troubling symptoms, so a person can function better and can increase well-being and healing (APA, 2018). There are two major types of therapies which are Individual therapy and group therapy. On individual therapy, the individual expresses his or her freedom and ability to talk to the therapist without fear of anything. Individual therapy involves the patient and the therapist alone while the group or family therapy includes the patient and the family members or another patient in a group therapy. The group and family therapy help to improve the relationship and interaction of the patient with other people in the group or family which leads to an improvement in the patient mental health (Laureate Education (Producer), 2017).

Legal and Ethical Considerations for Group/Family and Individual Therapy

Ethical consideration that is most seen individual therapy versus group and family therapy is the process and content of interactions in individual versus group therapy. In individual therapy, is mostly talk about one particular patient on his or her feeling and the patient privacy is maintained. Group or family therapy involves two or more people where privacy is not maintained and where one individual’s perception may be criticized by another member of the group which makes the patient endorse a feeling that his or her feelings do not count and respected (Nichols, M., 2014). The level of confidentiality in groups is far less secure than it is individual therapy. Although group members are generally instructed that the information and events that occur in the group are to be held confidential and only to be shared with group members during therapy, the potential for a breach of confidentiality is far greater in group therapy (AAC, 2018). Discussion: Legal And Ethical Considerations For Group And Family Therapy

Both the individual and group or family required the therapist to obtain informed consent before the commencement of the therapy. The therapist is expected to explain the dos and don’ts of the sessions, the goals, and the expected outcome of the therapy to his or her clients. In addition to that, the therapist will make sure that the client’s signs form for confidentiality. This will ensure that anything said between any two or more group members at any time is part of the group and is confidential (Breeskin J., 2011).

Impact of the Ethical factors and Strategies for the therapeutic approaches for Clients in Group/Family Therapy

The patient will be educated on the importance of confidentiality and not reveal other patient’s mental health problem to other people. The therapist should use appropriate therapeutic skills when interacting with group therapy.  Ethical issues in group psychotherapy are complex and differ from individual psychotherapy with regard to the types of ethical dilemmas that are encountered. Confidentiality is a special area of concern, given that there are more threats to confidentiality in group therapy than in individual therapy (Klontz B.T., 2004).

Reference

American Addiction Centre, 2018. Group Therapy verses Individual Therapy. Retrieved from https://americanaddictioncenters.org/therapy-treatment/group-individual

American Psychiatric Association, 2018. What is Psychotherapy? Retrieved from https://www.psychiatry.org/patients-families/psychotherapy

Breeskin J., 2011. Procedures and guidelines for group therapy. Retrieved from https://www.apadivisions.org/division-49/publications/newsletter/group-psychologist/2011/04/group-procedures.aspx

Klontz B.T., 2004. Ethical Practice of Group Experiential Psychotherapy. Retrieved from https://www.researchgate.net/publication/232563953_Ethical_Practice_of_Group_Experiential_Psychotherapy

Laureate Education (Producer). (2017). Introduction to psychotherapy with groups and families [Video file]. Baltimore, MD: Author.

Nichols, M. (2014). The essentials of family therapy (6th ed.). Boston, MA: Pearson. Discussion: Legal And Ethical Considerations For Group And Family Therapy

Personality Disorders Discussion Assignment

This module introduced a variety of different personality disorders and the descriptions probably seem to blur together. In this assignment, you will improve this clarity by examining the key points associated with each cluster disorder group (cluster A, cluster B, and cluster C), then identifying and describing 1 disorder from each of the 3 clusters.

Write a 1-2 page paper, using APA format and proper spelling/grammar. For each of the 3 cluster groups (A, B, and C), address the following:

1. summarize the key points of the cluster
2. explain what makes the cluster unique
3. identify and describe 1 disorder associated with the cluster

 

 

• Personality Disorders

 

Personality disorders are a persistent pattern of emotions, cognitions, and behavior that results in enduring emotional distress for the person affected (APA, 2013). A personality disorder may also cause problems with work and relationships. DSM-5 divides the personality disorders into 3 categories or clusters.

• Cluster A Personality Disorders

Cluster A is comprised of those personality disorders for which the central feature is substantial difficulties with interpersonal functioning. These disorders include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder.

Paranoid Personality Disorder

• • The central features of paranoid personality disorder include pervasive feelings of mistrust and suspiciousness that significantly interfere with functioning and act to undermine the important relationships in a person’s life (Barlow & Durand, 2018; APA, 2013). An important qualifier for these symptoms is that the suspicions are unfounded and not grounded in reality (in other words, the person does not have a real reason to feel paranoid). A clinician diagnosing this disorder must also make sure that the paranoid symptoms are not better understood as being due to paranoid schizophrenia (APA, 2013).
  • Another important factor to keep in mind in the context of paranoid personality disorder is the cultural relevance of paranoid feelings. For example, Ridley (1984) points out that feelings of suspiciousness on the part of African Americans toward white clinicians can often be a normal and healthy response to experiences of racism. Ridley refers to this as “cultural paranoia,” and warns that psychologists working with African American clients should not confuse cultural paranoia with the more traditional concept of pathological paranoia.
    

    ORDER A PLAGIARISM FREE PAPER NOW

Schizoid Personality Disorder

• • The essential features of schizoid personality disorder are a pervasive pattern of social withdrawal and detachment from others. People who possess this difficulty do not appear to be particularly interested in fostering meaningful connections with others and usually gravitate toward professions and/or activities that entail solitude and limited social contact. These people are likely to be described by others as “loners.” They appear to be completely disinterested in forming meaningful attachments and interpersonal connections. Personality Disorders Discussion Assignment
  • The interpersonal deficits that characterize schizoid personality disorder can be very similar to those found in cases of high-functioning autism; in fact, autism spectrum is frequently a rule-out diagnosis when considering schizoid personality disorder. It is possible to conceptualize schizoid personality disorder as being at the higher-functioning end of the autistic spectrum. A central difference between schizoid personality disorder and autism is that schizoid personality disorder does not involve cognitive deficits and the interpersonal difficulties seem to be due to a lack of interest rather than any type of organic or developmental impairment (APA, 2013).

Schizotypal Personality Disorder

 

• • The central characteristics of schizotypal personality disorder include a pervasive difficulty maintaining close, satisfying interpersonal relationships that is brought about by significantly eccentric, odd behaviors and cognitive distortions. Here the term, “cognitive distortions,” refers to a highly peculiar, semi-delusional outlook on the world. Such distortions can include magical thinking, ideas of reference, and unusual perceptions.
  • Magical thinking often involves bizarre, unrealistic ideas about cause and effect. For example, a person may truly believe that, if he wears a blue shirt every Wednesday it will mean that he will not miss his bus. Ideas of reference are similar to “delusions of reference” (as described in the lecture reviewing the psychotic disorders). Ideas of reference usually involve a belief that environmental stimuli are personality directed toward the self. For example, a person experiencing an idea of reference may believe that a television personality is speaking specifically to him, or may feel that his favorite sports team lost a big game as a way of punishing him for something he had done. Unusual perceptions, meanwhile, involves illusion-based perceptions that, while strange, are not significant enough to qualify as a delusion or hallucination. Ideas about clairvoyance or having a “sixth sense” are more common examples of unusual perceptions.
  • Additional criteria for the diagnosis of schizotypal personality disorder include an inappropriate or flattened affect, unusual mannerisms or style of dress, suspicious/paranoid feelings, and a lack of close friends and confidants (other than first-degree relatives; APA, 2013). The most important diagnostic determinant in schizotypal personality disorder is that the symptoms do not occur within the context of schizophrenia or another psychotic disorder (APA, 2013). A psychotic disorder is the primary rule-out diagnosis for schizotypal personality disorder. In fact, a significant number of people who are initially diagnosed with schizotypal personality disorder will eventually be identified as suffering from schizophrenia or one of the other psychotic disorders (Green, 2004).
  • Epidemiological research on schizotypal personality disorder has found that people identified with this disorder possess a higher-than-average likelihood of having a relative who has been diagnosed with schizophrenia or another psychotic spectrum disorder (Camisa et al., 2005; Bergman et al., 2000). These findings suggest that there is likely a strong genetic loading or determinant to schizotypal personality disorder (Green, 2004; Bergman et al., 2000). Personality Disorders Discussion Assignment

 

• Cluster B Personality Disorders

The Cluster B personality disorders are comprised of personality syndromes that are based in significant deficits in emotional functioning (Gabbard, 1994). This can range from severe difficulties with emotional regulation (such as in borderline personality disorder) to extreme deficits in the ability to relate to and feel empathy toward others (such as in antisocial personality disorder). The disorders that comprise Cluster B include narcissistic personality disorder, histrionic personality disorder, antisocial personality disorder, and borderline personality disorder.

Narcissistic Personality Disorder

• • Narcissus is a character from Greek mythology that fell in love with his own reflection. The psychological term, narcissism, is derived from this myth and refers to seeing the self in a grandiose and overly-positive fashion that is not completely in-tune with reality. As noted earlier, a certain degree of narcissism is often healthy and a necessary component to self-confidence and a positive sense of self-esteem. It is only when narcissistic traits surpass a particular threshold and begins to interfere with adaptive functioning that they become clinically significant and a possible aspect of a personality disorder.
  • The central features of narcissistic personality disorder include an exaggerated, often arrogant sense of self-importance and entitlement, as well as a sense of preoccupation with the self that interferes with a person’s ability to feel compassion or empathy for others (APA, 2013). A person with a narcissistic personality disorder appears obsessed with his own sense of being special and all of the wonderful things that he is able to do. People identified with this disorder are often quite successful, but when they are not, or when they fail, it is always attributed to being someone else’s fault. The narcissist is not as confident and self-assured as he appears to be and this causes him to be especially sensitive to any form of criticism or personal failures, whether these failures be real or imagined (Kernberg, 1974).

 

Histrionic Personality Disorder

• • The central features of histrionic personality disorder include a pathological need to be at the center of attention and constant behaviors that are directed toward ensuring that the person is being watched, admired and talked about (APA, 2013). People with this disorder can be like ambitious stage actors who are always on, always performing.
  • People identified with histrionic personality disorder are very uncomfortable when they not receiving adequate attention from others; and they will often dress or behave in a manner that ensures that they will receive lots of attention. This can often include overly sexual behaviors, dressing in a highly provocative way, as well as assuming that relationships with other people are much more intimate and close than they actually are. The internet and the advent of “reality TV” has offered people with significant histrionic traits many new ways of trying to gain constant attention.
  • Again, provocative mannerisms and a wish to be the center of attention in and of itself is not necessarily indicative of a personality disorder. It is only when these behaviors become so pervasive that they overwhelm the person’s ability to function and maintain healthy relationships that they enter into the realm of psychopathology.
  • There is a good deal of overlap between histrionic personality disorder and narcissistic personality disorder. A central difference between the two disorders is that histrionic personality disorder does not entail an inflated sense of personal greatness and accomplishment. Many people with histrionic personality disorder may actually be very self-effacing, and will use their feelings of personal inadequacy as a means of remaining at the center of attention.
  • Histrionic personality disorder may also involve exaggerated gender stereotypes. Men with this disorder may act in an overly “macho” way, bragging about their physical prowess and accomplishments. Women with this disorder, meanwhile, may act in an exaggeratedly feminine way, presenting themselves as sexual objects and/or playing up the idea of being “the weaker sex.”

Personality Disorders Discussion Assignment

Antisocial Personality Disorder

• • The primary characteristics of antisocial personality disorder are a severe deficit in the ability to empathize with others and an inability to fully understand how one’s actions may affect others (APA, 2013). People with this disorder were previously often referred to as “sociopaths,” although this term is no longer used in the professional literature. Antisocial personality disorder is often associated with criminal behavior and a disregard for the rules and regulations of society. People with this disorder are frequently self-centered and will do and take what they want with little or no regard for the law or how their actions will affect others.In extreme, exceptionally rare cases, antisocial personality disorder can lead to the inhuman types of behavior associated with serial killers and mass murderers. The predominating theory regarding these serial killers is that a lack of empathy and connectedness with others ultimately causes the person to feel extremely dissatisfied, frustrated, and disconnected with life. The person may end up turning to extremely cruel, murderous behaviors as an effort to feel something, to feel somehow connected to the world (Black & Larson, 1999).There is an ongoing debate regarding the etiological causes of antisocial personality disorder. Some argue that an antisocial personality is formed, or created by way of early life traumas and circumstances that impair the person’s ability to feel compassion and. Others argue that some people are essentially “born bad” and that antisocial traits are derived from genetic deficits and inborn characteristics (Black & Larson, 1999). In all likelihood, the “causes” of this disorder are an intricate combination of these two factors.

 

Borderline Personality Disorder

• • Borderline personality disorder entails a pervasive pattern of instability of interpersonal relationships, self-image, affects, and control over impulses. People with this diagnosis lead tumultuous and chaotic lives — there is a lot of drama here! Because this diagnosis is one of the more common, it will be discussed on its own page later in this module.

 

• Cluster C Personality Disorders

The Cluster C disorders are made up of those personality disorders for which the central feature is severe difficulties with anxiety. These disorders include avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder.

Avoidant Personality Disorder

• • In many ways, the addition of avoidant personality disorder was a response to the criticism over how schizoid personality was being clinically described. Recall that many psychologists had argued that, although people with schizoid personality disorder tend to avoid social contact, many secretly wish to form meaningful attachments with others but do not do so due to overwhelming feelings of anxiety and a fear of rejection (Gabbard, 1994).
  • Keeping this in mind, avoidant personality disorder can be viewed as involving a lack of close relationship where the person very much wants to connect with others. In other words, schizoid personality disorder entails a lack of interpersonal contact that is ego syntonic (or does not cause conscious feelings of psychic pain or sadness), while avoidant personality disorder involves a lack of interpersonal contact that is ego dystonic (or does cause a great deal of psychic pain; Akhtar, 1986).
  • Avoidant personality disorder has a great deal in common with social anxiety disorder. Social anxiety disorder is an anxiety disorder for which the central features are persisting feelings of worry and discomfort in social settings (APA, 2013). Avoidant personality disorder can be seen as an extreme, personality-oriented, version of social anxiety disorder — a version where the worries have become so pervasive that they are an essential component of the individual’s overall personality.

Personality Disorders Discussion Assignment

Obsessive-Compulsive Personality Disorder

• • The final cluster C personality disorder, obsessive-compulsive personality disorder, can be a difficult diagnosis to figure out. Its name makes it seem as though it is a personality disorder based in the symptoms associated with obsessive-compulsive disorder (OCD). This is actually not the case. Whereas people suffering from obsessive-compulsive disorder often debilitating difficulties with intrusive thoughts and compulsive urges, people identified as possessing an obsessive-compulsive personality disorder are not especially troubled by such intrusive thoughts compulsive urges. Instead, these individuals are particularly focused and extremely fastidious — to an extent that the need for perfection interferes with adaptive functioning. The “obsessive-compulsive” part refers to an obsession with perfection and a compulsive attention to detail.
  • Many people identified as possessing obsessive-compulsive personality disorder are extremely well suited for work that requires a greater degree of attention to detail. These people are often successful in professions such as architect and lawyer. At the same time that the need for perfection can be a benefit in these jobs, it can also be a huge, sometimes insurmountable, obstacle. Perfection is not always attainable. A person with obsessive-compulsive personality disorder can work on something, such as a legal brief or document, and never be able to finish it. He will review it and re-review it again and again, constantly editing and re-editing, trying to obtain an unattainable level of perfection.
  • A good artist knows how to start a painting, but it takes a great artist to know when it is finished. This is a quality that very often remains outside of the grasp of a person who suffers from obsessive-compulsive personality disorder. Treatment strategies for people with this disorder frequently focus on the difficult task of living with imperfection.

Dependent Personality Disorder

• • The central features of dependent personality disorder include a pervasive and all-consuming need to be taken care of and deeply involved in close relationships (APA, 2013). Once again, a need to be closely connected with others on its own is not necessarily indicative of pathology. Rather, it is when this need become so pervasive and consuming that it significantly interferes with adaptive functioning that it starts to meet the criteria for a personality disorder.
  • In dependent personality disorder, the need for close connection and the fear of losing such connections frequently leads the person to take on a submissive and overly clingy role in relationships. At times, this can lead a person to become so dependent that she relies on her partner to tell her what clothes to wear, decide what television shows or types of music she likes, or even how she should feel about current events. The connection becomes so dependent that the person comes to feel that he cannot exist, or is somehow incomplete, outside of the relationship.
  • Many of these dependent relationships are romantic in nature. Others, however, can be based around family ties. Some people with dependent personality disorder may be overly dependent on their parents, continue to live at home as adults, and maintain the type of utter dependency that is usually associated with early childhood. Keep in mind, however, that it is important to attend to cultural factors when assessing the possibility of psychopathology in a dependent relationship. Independence and greater autonomy are viewed as important traits in mainstream American culture, but are less important to other cultures. For instance, an adult son or daughter continuing to live with his or her parents is often much more common and acceptable within Asian and Latin American cultural contexts (Paniagua, 1994).
  • The symptoms of dependent personality disorder are often experienced as ego syntonic — that is, they frequently do not cause conscious feelings of pain and anxiety. It is when there is a risk of the person losing the relationship (or has lost the relationship) that he or she experiences overt feelings of distress.
• References

• • Akhtar, S. (1987). Schizoid Personality Disorder: A Synthesis of Developmental, dynamic and Descriptive Features. American Journal of Psychotherapy, Vol. 61, pp. 499-518.
  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing, Inc.
  • Barlow, D.H., & Durand, V.M. (2018). Abnormal Psychology: An Integrated Approach (8th ed.). Belmont, CA: Wadsworth Cengage Learning.
  • Bergman, A.J., Silverman, J.M., Harvey, P.D., Smith, C.J., & Siever, L.J., (2000). Schizotypal Symptoms in the Relatives of Schizophrenic Patents: An Empirical Analysis of the Factor Structure. Schizophrenia Bulletin, Vol. 26(3), pp. 577-586.
  • Black, D.W., & Larson, C.L., (1999). Bad Boys, Bad Men: Confronting Antisocial Personality Disorder. London: Oxford University Press.
  • Camisa, K., Bockbrader, M., Lysker, P., Rea, L., Brenner C., & O’Donnell, B. (2005). Personality Traits in Schizophrenia and Related Personality Disorders. Psychiatric Research, Vol. 133(1), pp. 23-33.
  • Gabbard, G.O. (1994). Psychodynamic Psychiatry in Clinical Practice: The DSM-IV Edition. Washington, DC: American Psychiatric Press.
  • Green, P. (2004). Schizophrenia Revealed: From Neurons to Social Interactions. New York: WW Norton and Co. Press Hashimoto, T., Tayama, M., Murakawa, K., et al., (2005). Development of the Brainstem and Cerebellum in Autistic patients. Journal of Autism and Developmental Disorders, Vol. 25(1), pp. 1-18.
  • Kernberg, O.T. (1984). Severe Personality Disorders: Psychotherapeutic Strategies. New Haven, CT: Yale University Press.
  • Paniagua, F.A. (1994). Assessing and Treating Culturally Diverse Clients: A Practical Guide. Thousand Oaks, CA: Sage.
  • Ridley, C.R. (1984). Clinical Treatment of The Non-Disclosing Black Client. American Psychologist, Vol. 39(11), pp. 1234-1244.

Personality Disorders Discussion Assignment

Gross Vs Fine Motor Skills Assignment

Due date: 2/3/21

 

Pages: 1 page with at least 2 references with citations.

 

Topic: Fine vs. gross motor skills in a pediatric patient, with examples of each skill; at least 3-4 skills for each fine and gross. And explain parallel play; include age, pros, cons, and and examples.

Due date: 2/3/21

 

Pages: 1 page with at least 2 references with citations.

ORDER A PLAGIARISM FREE PAPER NOW

Topic: Fine vs. gross motor skills in a pediatric patient, with examples of each skill; at least 3-4 skills for each fine and gross. And explain parallel play; include age, pros, cons, and and examples.

Due date: 2/3/21

 

Pages: 1 page with at least 2 referen

Due date: 2/3/21

 

Pages: 1 page with at least 2 references with citations. Gross Vs Fine Motor Skills Assignment

 

Topic: Fine vs. gross motor skills in a pediatric patient, with examples of each skill; at least 3-4 skills for each fine and gross. And explain parallel play; include age, pros, cons, and and examples.

 

ces with citations.

 

Topic: Fine vs. gross motor skills in a pediatric patient, with examples of each skill; at least 3-4 skills for each fine and gross. And explain parallel play; include age, pros, cons, and and examples.

Due date: 2/3/21

 

Pages: 1 page with at least 2 references with citations.

 

Topic: Fine vs. gross motor skills in a pediatric patient, with examples of each skill; at least 3-4 skills for each fine and gross. And explain parallel play; include age, pros, cons, and and examples.

Due date: 2/3/21

 

Pages: 1 page with at least 2 references with citations.

 

Topic: Fine vs. gross motor skills in a pediatric patient, with examples of each skill; at least 3-4 skills for each fine and gross. And explain parallel play; include age, pros, cons, and and examples. Gross Vs Fine Motor Skills Assignment

Due date: 2/3/21

 

Pages: 1 page with at least 2 references with citations.

 

Topic: Fine vs. gross motor skills in a pediatric patient, with examples of each skill; at least 3-4 skills for each fine and gross. And explain parallel play; include age, pros, cons, and and examples.

Gross Vs Fine Motor Skills Assignment

Dermatology Case Study Assignment

Anilemys Paneca

2 seconds ago, at 8:32 PM

Top of Form

Dermatology Case Study

According to the Centers for Disease Control and Prevention (CDC) (2020), the first-line medication for onychomycosis is terbinafine (lamsil). The course of treatment is 12 weeks for toenails, while fingernails require 6 weeks of treatment (CDC, 2020). Based on the patient’s symptoms and diagnosis, the recommended dosage for Terbinafine is 250 mg, 1 tablet, PO daily, for 12 weeks.

The labs for baseline when prescribing terbinafine include complete blood count (CBC) and platelet count, which are collected if the patient is immunodeficient, serum creatinine, Alanine Aminotransferase (ALT), and Aspartate Aminotransferase. The protocol for monitoring include baseline labs, the CBC should be repeated after 6 weeks of continuous use of the drug if the patient is immunodeficient, and liver function tests (LFT) every 4-6 weeks, if the patient is at the risk of drug-induced liver injury due to use of hepatotoxic medications or if there are symptoms of liver problems. Baseline laboratory tests are checked before prescribing terbinafine and periodic monitoring of the laboratory results is required for early detection of abnormalities (Stolmeier et al., 2018).

A follow-up would be ordered for E.D. since she has type 2 diabetes mellitus (T2DM). Type 2 diabetes mellitus is associated with the development of nonalcoholic fatty liver disease (Dharmalingam et al., 2018). As such, it would be advisable to do LFT every 4 weeks to 6 weeks on the course of her treatment to monitor her liver function and discontinue the treatment if abnormalities are detected. The follow-up protects the patient from potential harm that could arise from abnormalities.

 

 

 

ORDER A PLAGIARISM FREE PAPER NOW

 

References

Centers for Disease Control and Prevention (CDC). (2020, May 27). Fungal nail infections. https://www.cdc.gov/fungal/nail-infections.html#:~:text=Topical%20antifungal%20agents%20can%20be,and%2012%20weeks%20for%20toenails.&text=Azoles%20can%20also%20be%20used.

Stolmeier, D. A., Stratman, H. B., McIntee, T. J., & Stratman, E. J. (2018). Utility of laboratory test result monitoring in patients taking oral terbinafine or griseofulvin for dermatophyte infections. JAMA Dermatology, 154(12), 1409–1416. https://doi.org/10.1001/jamadermatol.2018.3578 Dermatology Case Study

 

Bottom of Form

Reply

Adelisa Bencomo

36 minutes ago, at 7:56 PM

 

NEW

Top of Form

Onychomycosis Case Study

Question 1

Proximal subungual onychomycosis is a fungal infection that affects the patient’s proximal nail fold from its undersurface. Effective systematic antifungal therapy has been developed in recent years, with options like fluconazole, terbinafine, and itraconazole being more effective than the griseofulvin (Lipner & Scher, 2019). An ideal prescription for the patient, based on the AAFP/CDC guidelines, would be:

RX: Terbinafine

Dispense: 250 mg capsules

PO: Orally once a day

Notes: Take with food

Duration: 12 consecutive weeks

RX: Itraconazole

Dispense: 200 mg capsules

PO: Orally once a day

Notes: Take with food

Duration: 12 consecutive weeks.

The two antifungal medications will be effective in treating the patient’s conditions with careful monitoring. Close monitoring will help identify if the proposed treatment approach is effective, which, when done on time, will ensure that other treatment options are adopted in time, as Mikailov et al. (2016) describe

Question 2

The ideal labs for this patient for the base and follow-up therapy will be determined by the antifungal medication administered and when the medication was prescribed for the treatment plan. According to Tverdek et al. (2016), a complete blood count and a live blood test to determine ALT and AST levels would be recommended. An interval of 5 weeks during the therapy would be recommended for these tests. Similarly, a lab test for itraconazole will be recommended every five weeks as this drug was used as an antifungal agent. Gupta et al. (2016) have noted that these tests are important for this patient, as they will help monitor if the prescribed medications are working to relieve onychomycosis and the symptoms of the condition.

 

References

Gupta, A.K., Stec, N., Summerbell, R.C., Shear, N.H., Piguet, V., Tosti, A., & Piraccini, B.M. (2020). Onychomycosis: A review. Journal of the European Academy of Dermatology and Venereology, 34(9), 1972-1990. https://doi.org/10.1111/jdv.16394

Lipner, S.R., & Scher, R.K. (2019). Onychomycosis: Treatment and prevention of recurrence. Journal of the American Academy of Dermatology, 80(4), 853-867. https://doi.org/10.1016/j.jaad.2018.05.1260 Dermatology Case Study

Mikailov, A., Cohen, J., Joyce, C., & Mostaghimi, A. (2016). Cost-effectiveness of confirmatory testing before treatment of onychomycosis. JAMA Dermatology, 152(3), 276-281. https://doi.org/10.1001/jamadermatol.2015.4190

Tverdek, F.P., Kofteridis, D., & Kontoyiannis, D.P. (2016). Antifungal agents and liver toxicity: A complex interaction. Expert Review of Anti-Infective Therapy, 14(8), 765-776. https://doi.org/10.1080/14787210.2016.1199272

Bottom of Form

Reply

Nayaris Reyes

2 hours ago, at 6:47 PM

 

NEW

Top of Form

 

1. According to the AAFP/CDC Guidelines, what antifungal medication(s) should this patient be prescribed, and for how long? Write her complete prescriptions using the prescription writing format in your textbook.

There are several antifungal drugs that can be prescribed with the purpose of preventing further complications of proximal subungual onychomycosis. There are systemic and topical drugs. Systemic antifungal drugs include:

Fluconazole and itraconazole, both are fungistatics. They function by inhibiting CYP450 thus inhibiting the fungal growth. Their prescription is 200mg/day PO for 12 weeks.

Terbinafine functions by decreasing ergosterol synthesis hence causing cell death. Its prescription is 250mg/day PO for 12 weeks.

Topical antifungal drugs include: tavaborole, its prescription is: it’s applied to the affected toenails qDay for 48weeks. Eficonazole, its prescription, it’s applied to the affected toenail qDay for 48weeks that is done by the use of an integrated applicator brush. Ciclopirox, it’s applied to the affected toenail plate qDay for 4weeks. (Rodgers and Bassler, 2001)

 

2. What labs for baseline and follow-up of therapy would you order for this patient? Give rationale.

Labs for proximal subungual onychomycosis include histopathology, polymerase chain reaction culture, and direct microscopy. There are special stains with GMS or PAS that are used for the fungal forms assessment. This is supported by the presence of neutrophils and serum in the nail that penetrates the nail tissue. Culture is essential as it identifies onychomycosis species; may be negative up to 30% of onychomycosis cases.

The polymerase chain reaction is used for the detection of onychomycosis DNA in the infected toenail. Direct microscopy is used to identify the presence of fungi using a low-power objective lens, however, it cannot identify onychomycosis-associated specific pathogens.it may be negative results up to 10%. Therefore negative results cannot completely rule out onychomycosis.(Elewski, 1996)

References:

Elewski B. E. (1996). Diagnostic techniques for confirming onychomycosis. Journal of the American Academy of Dermatology, 35: S6-S9.

Rodgers P. and Bassler M. (2001). Treating onychomycosis. American family physician, 63: 663.

 

Bottom of Form

Reply Dermatology Case Study

Dania Morejon Torres

2 hours ago, at 6:38 PM

 

NEW

Top of Form

Dermatology Case Study

The 38-year-old Caucasian female is possibly suffering from distal subungual onychomycosis. The most common kind of fungal infection affecting the nails of both children and adults is distal subungual onychomycosis. The patient shows the main symptom of the infection of the great toe to be affected first. Diabetes, nail psoriasis, athlete’s foot, relative with the infection, and weak immune system include risk factors of the patient having subungual onychomycosis. Trichophyton rubrum is the common cause associated with distal subungual onychomycosis. Medical treatment is essential to help in pain-relieving and especially for the patient since she has increased risk factors of diabetes and infection of a family member.

Prescription

The patient should be prescribed oral antifungal therapy. Compared to topical therapy, oral antifungal treatment is regarded as the best therapy because of increased cure rates and little treatment duration for toenail fungus (Lipner & Scher, 2019). The oral medications may be effective for the patient since she had already tried topical medications such as Benadryl and Lotrimin AF cream and never helped the symptoms. Terbinafine (Lamisil) is an effective and safe drug for the patient to take. The patient should take 250 mg of the drug orally once per day. The drug generates few side effects and is taken daily for two and a half months. Fluconazole (Diflucan) is the second type of drug that can be administered to the patient (Lieberman & Curtis, 2018). The patient should take 200 mg orally of Fluconazole once a week within a duration of one year.

 

Follow-Up Therapy

Baseline tests such as cholesterol levels should be recorded to help identify changes and follow-up signs of recovering. Maintaining trimmed and filed nails are one of the best ways to minimize the amount of fungus in the nails. The general hygiene of the feet and nails is essential for the patient to reduce the risk factors of fungal infections such as subungual onychomycosis accumulating in the nails. Trimmed and well-maintained nails also help to get pain relief when swelling nails produce pain. Finally, the patient should eat healthy meals to improve the immune system and help in maintaining good blood sugar levels.

References

Lipner, S. R., & Scher, R. K. (2019). Onychomycosis: treatment and prevention of recurrence. Journal of the American Academy of Dermatology, 80(4), 853-867.

Lieberman, A., & Curtis, L. (2018). Severe Adverse Reactions Following Ketoconazole, Fluconazole, and Environmental Exposures: A Case Report. Drug safety-case reports, 5(1), 1-5. Dermatology Case Study

Bottom of Form

Reply

Laura Rosa Alonso Salido

5 hours ago, at 3:27 PM

 

NEW

Top of Form

According to the AAFP/CDC Guidelines, what antifungal medication(s) should this patient be prescribed, and for how long?

The most prevalent nail problem is onychomycosis, which is caused by fungus such as dermatophytes, no dermatophytes, and candida. When the fungus infects the nail through the proximal nail fold, it is termed as proximal subungual onychomycosis. This kind is prevalent in immunocompromised individuals (HIV, Diabetes), following trauma, and in people with blood circulation disorders, although it is uncommon in healthy people (Lipner & Scher, 2019). Due to the presence of tinea pedis (athlete’s foot), it is critical to examine the rest of the foot, particularly between the toes.

Treatment varies based on the intensity, the organism involved, and concerns regarding drug-drug interactions and adverse effects. Cure measures are used to determine effectiveness such as mycotic (no organism discovered), clinical (with normal morphology in 80-90 percent of nails), and complete (all of the above). Oral azoles and allylamines, topical analgesics, and physical treatments have all been tried in the past. It’s a time-consuming treatment that can take months or even a year to work, causing dissatisfaction among those who are affected.

 

Prescriptions must be written on a preprinted prescription pad that includes the prescriber’s name, address, phone number, and NPI number. The patient’s name and date of birth must also be supplied. When it comes to children, weight is important.

The following can be used :-

Terbinafine 250 mg po once a day for 12weeks Dx. Onychomycosis.

Itraconazole 200 mg po once a day for 12weeks Dx. Onychomycosis.

 

Dermatology Case Study

Itraconazole 200 mg po dose for one week each month, repeated for two to four months, has also been recommended in conjunction with a pulse treatment. If you have tinea pedis, it’s a good idea to use a topical antifungal ointment. Information on good foot care is vital as part of the treatment, as is wearing breathable shoes, 100 percent cotton socks, and keeping feet dry. Trimming and debridement are advised as physical therapy (Alqahtani et al., 2022) We can also utilize the following local agent:

 

8 percent ciclopirox solution (nail lacquer) At night, put one layer over the nail and surrounding region for 48 weeks. Onychomycosis is the diagnosis.

*Daily applications should me made over the previous coat after which it is removed with alcohol every seven days.

 

What labs for baseline and follow up of therapy would you order for this patient? Give rationale.

The identification of the causative agent by direct microscopy utilizing periodic acid Schiff stain (PAS) and methenamine silver stains is required for a positive diagnosis of onychomycosis. Fungal culture is another scientific approach that requires at least 10 days to see colonies grow in a culture foundation. The use of a real-time polymerase chain reaction (PCR) technology to detect the agent has been made possible thanks to advances in modern science. This approach is quicker, and studies have shown that it is reliable (Watanabe & Ishida, 2017). To maximize the chances of a correct diagnosis, the sample collection site must be carefully chosen and the collection technique must be precise.

Before starting continued therapy, the liver enzymes and function must be checked, as well as every four to six weeks throughout oral treatment. This is due to the possibility of toxicity and liver damage associated with antifungal medication metabolism (Jazdarehee et al., 2022). This approach is not recommended when pulse therapy is utilized because the danger of injury is lower. A complete blood count is often advised to establish a baseline and rule out other infectious disorders.

 

 

References

Alqahtani, A., Raut, B., Khan, S., Mohamed, J. M., Fatease, A. A., Alqahtani, T., Alamri, A., Ahmad, F., & Krishnaraju, V. (2022). The unique carboxymethyl fenugreek gum gel loaded itraconazole self-emulsifying nanovesicles for topical onychomycosis treatment. Polymers, 14(2), 325. https://doi.org/10.3390/polym14020325

Jazdarehee, A., Malekafzali, L., Lee, J., Lewis, R., & Mukovozov, I. (2022). Transmission of onychomycosis and dermatophytosis between household members: A scoping review. Journal of Fungi, 8(1), 60. https://doi.org/10.3390/jof8010060

Lipner, S. R., & Scher, R. K. (2019). Onychomycosis. Journal of the American Academy of Dermatology, 80(4), 853–867. https://doi.org/10.1016/j.jaad.2018.05.1260

 

Watanabe, S., & Ishida, K. (2017). Molecular Diagnostic Techniques for Onychomycosis: Validity and Potential Application. American Journal of Clinical Dermatology, 18(2), 281–286. https://doi.org/10.1007/s40257-016-0248-7

Bottom of Form

Reply

 

Dermatology Case Study

Joscelyne Lastra

8 hours ago, at 12:46 PM

 

NEW

Top of Form

Dermatology Case Study 

 

The best antifungal medication for the patient is Terbinafine. Precisely, the patient should be prescribed a terbinafine drug known as Lamisil. The prescription should be Lamisil 250 mg to be taken oral once a day for 12 weeks.  According to Leung et al. (2020), Lamisil is 76% effective in treating proximal subungual onychomycosis compared to other Terbinafine drugs, which are Sporanox with an effectiveness of 69%, and Diflucan with an effectiveness of 48% (Leung et al., 2020). In addition to that, Lamisil is safe for use by patients living with type 2 diabetes mellitus (Leung et al., 2020). As such, the most appropriate treatment for the patient based on AAFP/CDC guidelines is Lamisil.

The baseline labs I would recommend for the patient are LFTs (Liver function test) and CBC (complete blood count). The reason for this is that Lamisil is associated with a high risk of hepatotoxicity in most patients with or without liver disease. Accordingly, the patient must take pretreatment serum transaminase examinations before starting the medication. Accordingly, LFTs are necessary to continually examine toxicity levels to eliminate the threat of liver disease that may result from hepatotoxicity of Lamisil. According to Heymann (2019), LFTs should be initiated in patients who present disease indicators that include pale stools, dark urine, anorexia, jaundice, vomiting, and nausea, as they point to a high risk of impaired liver function (Heymann, 2019). The purpose of CBC is to examine the presence of a secondary infection if the indications presented by the patient continue to manifest past 12 weeks of drug administration (Heymann, 2019). Through LFTs, severe side effects of Lamisil can be detected early, thus minimizing the risk of liver damage (Wang & Lipner, 2021). Apart from that, LFTs can inform follow-up therapy through a change of the patient’s medication if severe side effects are detected (Heymann, 2019). Through CBC, additional treatment approaches can be employed if a diagnosis of a secondary infection is confirmed.

 

 

References

Heymann, W. (2019). Breaking the terbinafine laboratory habit for onychomycosis. Retrieved February 02, 2022, from https://www.aad.org/dw/dw-insights-and-inquiries/2019-archive/may/breaking-the-terbinafine-laboratory-habit-for-onychomycosis

Leung, A. K., Lam, J. M., Leong, K. F., Hon, K. L., Barankin, B., Leung, A. A., & Wong, A. H. (2020). Onychomycosis: An updated review. Recent Patents on Inflammation & Allergy Drug Discovery, 14(1), 32-45. doi:10.2174/1872213×13666191026090713

Wang, Y., & Lipner, S. R. (2021). Retrospective analysis of laboratory abnormalities in patients with preexisting liver and hematologic diseases prescribed terbinafine for onychomycosis. Journal of the American Academy of Dermatology, 84(1), 220-221. doi:10.1016/j.jaad.2020.09.004

Bottom of Form

Dermatology Case Study

Telephonic Nursing Discussion Assignment

Discussion Question:

• Based on your research, what conclusions have you been able to draw related to your final presentation topic? ( Telephonic Nursing )
• Please describe your final presentation topic and the conclusions you have drawn from the literature you have researched.
• Are practice changes recommended for your current practice? Why or why not?
• Initial 400 words. Make up 2 replies to 2 students with 200 words each
  

  ORDER A PLAGIARISM FREE PAPER NOW

   

  Discussion Question:

  • Based on your research, what conclusions have you been able to draw related to your final presentation topic? ( Telephonic Nursing )
  • Please describe your final presentation topic and the conclusions you have drawn from the literature you have researched.
  • Are practice changes recommended for your current practice? Why or why not?
  • Initial 400 words. Make up 2 replies to 2 students with 200 words each

Discussion Question:

• Based on your research, what conclusions have you been able to draw related to your final presentation topic? ( Telephonic Nursing )
• Please describe your final presentation topic and the conclusions you have drawn from the literature you have researched.
• Are practice changes recommended for your current practice? Why or why not?
• Initial 400 words. Make up 2 replies to 2 students with 200 words each Telephonic Nursing Discussion Assignment

Discussion Question:

• Based on your research, what conclusions have you been able to draw related to your final presentation topic? ( Telephonic Nursing )
• Please describe your final presentation topic and the conclusions you have drawn from the literature you have researched.
• Are practice changes recommended for your current practice? Why or why not?
• Initial 400 words. Make up 2 replies to 2 students with 200 words each

Discussion Question:

• Based on your research, what conclusions have you been able to draw related to your final presentation topic? ( Telephonic Nursing )
• Please describe your final presentation topic and the conclusions you have drawn from the literature you have researched.
• Are practice changes recommended for your current practice? Why or why not?
• Initial 400 words. Make up 2 replies to 2 students with 200 words  each Telephonic Nursing Discussion Assignment