No Plagiarism please, assignment will be checked with Turnitin. 

Will need 4 full pages,  double spaced all throughout the page for the case study, APA Style, Times New Roman, font 12, Title Page and a Reference page. 

Case Study 1:   Structure and Function of the Respiratory System

Brad is 45 years old and has been working as a coal cutter in a mine for the last 25 years. He likes the job because it pays well and the same mine had employed his father. Like many of his colleagues, Brad has had problems with a chronic cough. He has avoided his annual checkups for fear that he will be told he has “black lung,” or coal worker’s pneumoconiosis. The disease causes fibrosis, decreased diffusing capacity, and permanent small airway dilation. In later stages, pulmonary capillaries, alveoli, and airways are destroyed. Structure and Function of the Respiratory System 

Make sure all of the topics in the case study have been answered.

1.) How can the disease described above create a mismatch between ventilation and perfusion?  Use your understanding of alveolar dead space and physiologic shunt to explain your answer.

2.) Individuals with chronic obstructive pulmonary disease have more difficulty exhaling than inhaling.  Why is this so? 

3.) In general terms, what mechanisms in lung disease can affect diffusing capacity across alveolar membranes?  Use the Fick law to explain your answer.

Cite at least 3 References; journal articles, textbooks, or evidenced-based websites to support the content. 3.

All sources must be within five years (2012-2017) Structure and Function of the Respiratory System.

Case Study: A System Approach Review the case study in the article, Texas Health Harris Methodist-Cleburne: A System Approach to Surgical Improvement (Links to an external site.)Links to an external site.. After reviewing the case study, construct a written paper that addresses the following: •Explain organizational theories evidenced in this case study. •Analyze how Texas Health Harris Methodist-Cleburne is a learning organization. •Explain the organizational structure displayed in this case study. •Describe the leaders involved in this case study. •Discusses the role of the leaders in this case study. Including an introduction and conclusion paragraph, your paper must be three to five double-spaced pages (excluding title and reference pages) and formatted according to APA style as outlined in the Ashford Writing Center (Links to an external site.)Links to an external site.. Including the textbook, utilize a minimum of three (one of which is the case study article used for review) scholarly and/or peer-reviewed sources from the Ashford University Library that were published within the last five years. Document all references in APA style as outlined in the Ashford Writing Center APA Checklist (Links to an external site.)Links to an external site.. it is do tomorrow at midnight. Can you please let me know. I will appreciate your help.

                                                 Assgn 2 – WK10 (C)

Practicum: Decision Tree

Childhood psychosis is extremely rare; however, children that present with psychosis must be carefully assessed and evaluated with appropriate interviewing of parent, child, and use of assessment tools.

For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with early onset schizophrenia.

The Assignment:

Examine Case 3. You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment. 

(N: B. A CASE STUDY WITH ANSWER SAMPLE IS ATTACHED WITH THIS ASSIGNMENT)

At each Decision Point, stop to complete the following:

                                          · Decision #1: Differential Diagnosis

o Which Decision did you select?

o Why did you select this Decision? Support your response with evidence and 

     references to the Learning Resources.

o What were you hoping to achieve by making this Decision? Support your 

    response with evidence and references to the Learning Resources.

o Explain any difference between what you expected to achieve with Decision #1 

    and the results of the Decision. Why were they different?

                      · Decision #2: Treatment Plan for Psychotherapy

o Why did you select this Decision? Support your response with evidence and 

    references to the Learning Resources.

o What were you hoping to achieve by making this Decision? Support your 

    response with evidence and references to the Learning Resources.

o Explain any difference between what you expected to achieve with Decision #2 

    and the results of the Decision. Why were they different?

                  · Decision #3: Treatment Plan for Psychopharmacology

o Why did you select this Decision? Support your response with evidence and 

    references to the Learning Resources.

o What were you hoping to achieve by making this Decision? Support your 

    response with evidence and references to the Learning Resources.

o 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 and their families.

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.

                                                                      Case #3
A young girl with strange behaviors

BACKGROUND

            Carrie is a 13-year-old Hispanic female who is brought to your office today by her mother and father. They report that they were referred to you by their primary care provider after seeking her advice because Carrie’s behavior has been difficult to manage, and they don’t know what to do.

SUBJECTIVE

            Carrie’s parents report that they have concerns about her behavior, which they describe as sometimes “not normal for a 13-year-old.” They notice that she talks to people who aren’t real. Her behavior is calm and “passive.” Her parents noted that when she was younger, she was irritable at times, but have noticed that this has given way to passivity. Her parents state that they understand that it’s normal for younger children to have “imaginary friends,” but they feel that at    

           Carrie’s age, she should have grown out of these behaviors. Carrie’s parents report that she has friends that are half-cat and half-human, and “spirits” who speak with her “in her head.” She also reports that the people on television know when she is home and that they have certain shows “just for her.”

           Carrie’s parents report that they have taken her to her pediatrician who has given her a “clean bill of health.” Carrie’s parents note that they had some early concerns as she was lagging in meeting developmental milestones. Initially, when she first started school, Carrie managed to keep up with her peers in terms of academic performance, but she was noticed by her teachers to be isolative. It was also noted by her teachers and guidance counselor that Carrie’s social skills do not seem to match what they see in other children her age. Initially the school counselor suspected that Carrie may have been suffering from attention deficit hyperactivity disorder (primarily inattentive type), but now is not certain and has recommended a psychiatric evaluation. Her grades were “ok” in school up until last year when she left junior high school, and entered high school, where the academic demands began to increase. Carrie’s teachers had wanted to hold her back a grade, but her parents acknowledge that they were “insistent” that this did not happen. Now they are describing some regrets over this as Carrie seems “more lost than ever” in her schoolwork. Carrie’s mother produced a copy of a paper that Carrie had to submit as a homework assignment. You attempt to read the assignment, but there does not appear to be any clarity to the work, and it can best be described as a hodge-podge of thoughts and ideas.

           Carrie’s parents want you to know that although they are concerned about Carrie, they are opposed to giving her medications that would turn her “into a zombie.” Carrie’s mother also confides that her husband’s grandfather spent “a few years in the nut house.” When you probe further, she began crying and said, “He was schizophrenic … what if Carrie is schizophrenic?”

            During your interview with Carrie, she seems pleasant, but somewhat distant. When you ask her about her friends at school, she shrugs her shoulders and says, “I don’t really have any. I don’t like those people.” You inquire if she is sad or upset that she doesn’t like them, to which she states “no, why should I be? I guess they would be friends with me if I asked, but I’m not interested. I could make them be my friends if I wanted, but I don’t … but if I wanted them to, all that I have to do is make up my mind that they will be my friend and they would have to.” When you ask Carrie if she believes that she can control the thoughts of others with her mind, she puts her index finger up to her mouth and looks toward the door. “My mom gets upset when I talk about these things. I try not to think about them either because if she is close enough, she could read my thoughts and they upset her. She may think that I’m into witchcraft or something.”

When you ask Carrie about the homework assignment that you read, she explains that her teacher “is just miserable. She doesn’t understand how I think—I think high, she just can’t get it.”

OBJECTIVE

            The client is a 13-year-old Hispanic female client who appears appropriately developed for her age. She is dressed appropriately for the current weather and ambulates with a steady upright gait. She does not appear to be demonstrating any noteworthy mannerisms, gestures, or tics. No psychomotor agitation/retardation apparent.

MENTAL STATUS EXAM

            Carries is alert and oriented × 4 spheres. Her speech is clear, coherent, goal directed, and spontaneous. Carrie self-reports her mood as “good.” However, her affect does appear somewhat constricted. Her eye contact is minimal throughout the clinical interview and at times, Carrie seems preoccupied. Carrie is oriented to person, place, and time. She endorses hearing and seeing strange “things that I talk to. They don’t scare me; they come to see me from another world.” No overt paranoia is appreciated. She does report delusions of reference (she believes that the people on TV play programs “just for her” and at times, television commercials were designed to tell her what to do), as well as other delusional thoughts (as described above). Carrie denies any suicidal or homicidal ideation.

At this point, please discuss any additional diagnostic tests you would perform on Carrie.

                                                     Decision Point One

BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PSYCHIATRIC/MENTAL HEALTH NURSE PRACTITIONER (PMHNP) GIVE TO CARRIE?

In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.

Early Onset Schizophrenia

Schizoaffective Disorder

Schizotypal Personality Disorder

                                                        Answer Chosen:  

Early Onset Schizophrenia

                                                   Decision Point Two

BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS:

Refer for psychological testing

Begin Clozaril 100 mg orally daily

Begin psychotherapy using a psychodynamic approach

                                               Answer Chosen:

Refer for psychological testing

RESULTS OF DECISION POINT TWO

·  Client returns to clinic in four weeks

·  Although there are no specific psychometric tests available for schizophrenia, the consulting psychologist administered a comprehensive psychological battery of tests in order to assess personality and cognitive functioning as well as to identify any underlying intellectual disabilities that could account for the difficulty Carrie is having in school. Tests administered included the Minnesota Multiphasic Personality Inventory; Kaufman Adolescent and Adult Intelligence Test; Rorschach test; Whitaker Index of Schizophrenic Thinking (WIST) test; Wide Range Achievement Test – 4th Edition (WRAT-4); and the Millon Adolescent Clinical Inventory (MACI). The consulting psychologist opined that early-onset schizophrenia was strongly suspected in this client.

                                                           Decision Point Three

BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.

Begin Clozapine 100 mg orally daily

Begin family interventions

Begin Lurasidone 40 mg orally daily

                                               Answer Chosen

Begin Lurasidone 40 mg orally daily

Guidance to Student 

           It is not always necessary to procure a consult with a psychologist. However, psychologists by virtue of their advanced training and licensure are able to conduct comprehensive psychological testing on clients more advanced than those tests that could be conducted by the psychiatric/mental health nurse practitioner. In this case, we would like to know if the poor academic performance was the result of an intellectual disability, versus poor premorbid intellectual functioning that is often seen in schizophrenia.

            In terms of treatment decisions, Clozapine is FDA-approved for treatment-resistant schizophrenia. Since the child has not yet been treated with any agent, we have no way of knowing if her schizophrenia is treatment resistant. Additionally, if we were to use Clozapine, the starting dose is approximately 25 mg in adults (perhaps 12.5 mg in a child, depending on body weight). Clozapine 100 mg would most likely cause significant side effects that both the child and parents would find objectionable, thus making compliance an issue.

Although not FDA-approved for use in children, Lurasidone is used as an off-label drug in this population. There are no legal prohibitions against any prescriber using drugs “off-label”; however, attention must be given to the concept of informed consent. When working with children/adolescents, the PMHNP must explain pros/cons, discuss therapeutic endpoints/goals of treatment, etc. The parent/guardian must have all of the information needed to make an informed consent. Therefore, Lurasidone would be the best choice. Additionally, Lurasidone may be the preferred antipsychotic, as it appears to have the least impact on body weight and lipid profile.

           Recall that with any antipsychotic medication, you should determine fasting plasma glucose levels, monitor weight and BMI during treatment, as well as blood pressure and fasting triglycerides.

            Family interventions are important as well, as they do have a positive benefit on symptom relapse and admission/readmission to the hospital. Family interventions should include teaching about the disease, medications, and anticipatory guidance.

                                                                Learning Resources

Required Readings

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

• Chapter      31, “Child Psychiatry” (pp. 1268–1283)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

• “Schizophrenia Spectrum and Other Psychotic Disorders”

McClellan, J., & Stock, S. (2013). Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. Journal of the American Academy of Child & Adolescent Psychiatry, 52(9), 976–990. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00112-3/pdf

Giles, L. L., & Martini, D. R. (2016). Challenges and promises of pediatric psychopharmacology. Academic Pediatrics, 16(6), 508–518. doi:10.1016/j.acap.2016.03.011

Hargrave, T. M., & Arthur, M. E. (2015). Teaching child psychiatric assessment skills: Using pediatric mental health screening tools. International Journal of Psychiatry in Medicine, 50(1), 60–72. Retrieved from http://search.proquest.com.ezp.waldenulibrary.org/docview/1702699596?accountid=14872

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press. 

Required Media

Laureate Education (Producer). (2017b). A young girl with strange behaviors [Multimedia file]. Baltimore, MD: Author. (THE ATTACHED CASE STUDY IS THE MEDIA)

PLEASE PART OF THE CONTRACT IS TO HAVE IT DONE IN 12 HOURS. THANKS

Instructions

Art as Revolution

This week, we have studied works of art produced in the eighteenth and nineteenth centuries that reflected, or in some cases, incited, social change or even revolution.

Carefully examine the following works, and read about each one in your textbook, course and video lectures, and through reliable internet resources: Events or social factors may have influenced the creation or interpretation of painting

• Hogarth, The Marriage Contract, from Marriage à la Mode, 1743-45
• David, Death of Marat, 1793
• Delacroix ,Liberty Leading the People, 1830
• Goya, Third of May, 1808, 1814-15
• Courbet, The Stone Breakers, 1849

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In an essay of 5-7 well-developed paragraphs, address the following questions, making specific references to the five paintings listed above:

1. How did each painting reflect or inspire social change or revolution? What was the social or revolutionary context of the painting?
2. What additional historical events or social factors may have influenced the creation or interpretation of each painting?
3. Explain how the style and specific visual characteristics of each painting contributed to or reflected its overall content or meaning.
4. Do these paintings have the same impact or meaning to audiences today? Why or why not?

Include details about the visual characteristics and content of each painting in your response. Provide proper citations for any information from outside sources included in your essay.

Objectives of this assignment are to:

Apply the theoretical knowledge about medical surgical disorders and the drug treatment to actual clinical practice.

Compare and contrast expected presentations of the disorder and use of pharma-cotherapeutics with the disease and the drug treatment used in an actual client case.

Critically analyze the pathophysiologic and pharmacotherapeutic components of an actual clinical case presentation.

Synthesize knowledge gained about disease and the drug treatment by creating an appropriate case study of a selected disease process and drug treatment.

Improve critical thinking and communication skills through writing and developing a case study.

Guidelines for writing a case study: This must be done individually

Choose 1 area studied in this course from weeks 1 and two, write a case study based on an actual client you cared for during the adult health clinical rotation, or base it on a disease topic discussed in class.

You must protect client confidentiality in the case study. Names or initials will not be used, nor will other identifying information such as the health care facility or city, among others. Client’s age, gender, and race may be included.

The case study must be submitted through the course shell in the Drop Box labeled, “Missed Clinical Assignments”on or before the due date. NO EXCEPTIONS. The course coordinator will determine the due date for the case study.

Students are required to support research material with appropriate citations using current APA format. Resources must include at least 3 nursing journals .

Include a title page, table of contents, an abstract, and a reference page.

The case study will include the following components:

Demographic data (protecting confidentiality)

Pertinent past medical history and current diagnosis

Clinical presentation: Signs/symptoms, physical findings upon assessment

Description of medical diagnosis (including pathophysiology & nursing needs)

Lab and diagnostic test results with rationale

Pharmacotherapeutic treatment with rationale

A table listing expected and actual presentation findings, lab/diagnostic studies, drug treatment based on pertinent past medical history and current diagnosis.

3 care plans which include:

Prioritized nursing diagnoses (one diagnosis on each care plan; one must be psychosocial)

Goal statements (short term and long term)

Minimum of 6 nursing interventions with rationale statements

Evaluation statement of short term goal

A minimum of 5-typed pages is required. This does not include the title page, table of contents, abstract, or reference page.

If this assignment is not turned in by the due date or is incomplete, a clinical Unsatisfactory /“U” will be given and this may result in a clinical failure.

A Satisfactory / “S” grade must be obtained to meet clinical competency for the day.

Grading Rubric for Clinical Make-Up Assignment

	Satisfactory	Unsatisfactory
Content: Clear presentation of Case Study
Demographic data
Pertinent past medical history and current diagnosis
Clinical presentation: signs and symptoms, physical findings
Description of medical diagnosis (including pathophysiology and nursing needs)
Lab and diagnostic test results with rationales
Pharmacotherapy treatment with rationale
Table comparing expected and actual presentation findings
3 Care plans which include: nursing diagnoses (one psychosocial), goal (short term and long term), minimum of 6 nursing interventions with rationale statements, evaluation statement of short term goal
Mechanics
·         Minimum of 5 pages typed. ·         The paper, including tables and graphs, headings, title page, abstract, appendices, and reference page are consistent with current APA formatting guidelines.·         The introduction provides sufficient background on the topic and previews major points.·         Intellectual property is recognized with in-text citations and a reference page.·         The paper presents with effective use of level headings, font styles, and space.·         Rules of grammar, usage, and punctuation are followed; spelling is correct.·         Conclusion is logical, flows, and reviews the major points.
Grade

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