Diagnosing and Managing Common Cardiovascular and Neurologic Conditions

Cardiovascular and neurologic conditions are among the leading causes of death and hospitalization of women in the United States (Centers for Disease Control and Prevention, 2008a). As an advanced practice nurse, you must routinely monitor patients at risk of these conditions and recommend the appropriate health screenings and preventive services. When assessing patients for these conditions, it is important to keep in mind that while some female patients might present with typical signs and symptoms, others might present with atypical signs and symptoms that are unique to women. For this Discussion, consider signs and symptoms presented by the women in the following case studies and develop differential diagnoses:

                                                      Case Study 2: Due  10.30.17

You are seeing a 63-year-old African American female for a two-week history of intermittent chest pain. The pain varies in intensity and resolves with rest. She does not believe it has increased over time. She is a nonsmoker with a history of hypertension treated with Lisinopril 10 mg once daily. She had an exercise stress test one year ago that was within normal limits. Her physical exam findings are as follows: HR–90, BP–150/92, R–22, O2Sat 98% RA; lungs: clear to auscultation bilaterally; cardiovascular: apical pulse of 90 RRR, no rubs, murmurs, or gallops. Chest wall mildly tender to palpation that reproduces her complaint of pain. Extremities include no clubbing, cyanosis, or edema. The remainder of the exam is within normal limits.

To prepare:

· Review Chapter 8 of the Tharpe et al. text and the McSweeney et al. article in this week’s Learning Resources.

· Analyze the patient information on case study # 2

· Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.

· Reflect on the appropriate clinical guidelines.

· Think about a treatment and management plan for the patient. 

· Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.

· Consider strategies for educating patients on the treatment and management of the disorder you identified as your primary diagnosis.

Post an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Then, based on the appropriate clinical guidelines, explain a treatment and management plan for the patient, including proper dosages for any recommended treatments. Finally, explain strategies for educating patients on the disorder.

                                             Please use these resources/references:

Required Readings

Tharpe, N. L., Farley, C., & Jordan, R. G. (2017). Clinical practice guidelines for midwifery & women’s health (5th  ed.). Burlington, MA: Jones & Bartlett Publishers.

Chapter 8, “Primary Care in Women’s Health” (pp. 457-616)
This chapter explores health promotion and disease prevention in women’s health. It also describes the presentation, assessment, diagnosis, and management of various systemic conditions, including cardiovascular and neurologic conditions.

McSweeney, J. C., Pettey, C. M., Souder, E., & Rhoads, S. (2011). Disparities in Women’s cardiovascular health. Journal of Obstetric, Gynecologic & Neonatal Nursing, 40(3), 362–371.
Note: Retrieved from the Walden Library databases.

This article explores health disparities in cardiovascular disease, including gender and racial disparities related to the diagnosis, treatment, and outcomes of patients with this disease.

Department of Health and Human Services, National Institutes of Health, & National Heart, Lung, and Blood Institute. (n.d.). Women’s Health Initiative: WHI background and overview. Retrieved March 20, 2013, from http://www.nhlbi.nih.gov/whi/background.htm

This website outlines details of the Women’s Health Initiative (WHI) and introduces the various health issues addressed by the WHI.

Optional Resources

Centers for Disease Control and Prevention. (2012b). Women’s health. Retrieved from http://www.cdc.gov/women/

National Institutes of Health. (2012). Office of Research on Women’s Health (ORWH). Retrieved from http://orwh.od.nih.gov/

U.S. Department of Health and Human Services. (2012a). Womenshealth.gov. Retrieved from http://www.womenshealth.gov/

Conceptual Basis for Policymaking

The policy process consists of a series of actions, each critical to resolving a problem through analysis and formulation of solutions and can involve many organizations and individuals as well as requiring multiple steps. Two models from political scientists are relevant to nurses’ understanding of the policy process. The purpose of reviewing these models is to provide two different yet complementary approaches for readers to see how the seemingly chaotic policymaking process has a form, rhythm, and predictability.

Longest’s Policy Cycle Model

Health policy is a cyclical process. Longest (2010) mapped out an interrelated model to capture how U.S. policymaking works. It is a continuous, highly dynamic cycle that captures the incremen­talism inherent in U.S. governmental decision making (Figure 7-1). In its simplest form, there are three phases to the policy process: a policy formulation phase, an implementation phase, and a policy modification phase. Each phase contains a set of actions and activities that produce outcomes or products that influence the next stage. Although simple in design, this model is deceptively complex. Defining the policy problem with adequate clarity so that it gains the attention of policymakers and stakeholders is challenging; each policy problem has many solutions and competitors seeking a place on the policy agenda. Although policymaking is dependent on good data and evidence about what works, data and evidence may not be enough to outweigh the influence of the political environment.

FIGURE 7-1 Longest’s Policy Framework. (Redrawn from Longest, B. [2010]. Health policymaking in the United States [5th ed.]. Chicago: Health Administration Press.)

Policy formulation includes all of the activities that are involved in policy design, including those activities which inform the legislators. It is in this phase that nurses can serve as a knowledge source to legislators in helping frame the problem and bringing nursing stories and patient narratives to illustrate how health problems play out with individual constituents/populations. The most effective 66time to influence legislation is before it is drafted, so that nurses can help frame the issues to align with their desire for policy outcomes that are patient-centered.

Policy implementation comprises the rule-making phase of policy development. The legislative branch passes the law to the executive branch which is charged with implementation. This includes adding specificity to the law and may also include, for example, defining the provider to include advanced practice nurses. The writing of rules after legislation is passed is a crucial and often overlooked aspect of policymaking. At this juncture, nurses with appropriate expertise can monitor and influence how the rules are written. Once written, federal regulations are published in the daily Federal Register for 60 days to receive public comment. States also have regulation processes that provide designated times for public input.

Stakeholder groups can exert enormous influence during the implementation phase (Regulations.gov, 2013). When strong letter-writing campaigns are employed, the rulemaking agency may be forced to publish those comments and make adjustments according to their volume and scientific rigor. It is not unusual for the intent of a policy to get lost in the translation to program development. This rule-making phase is an important leverage point for nurses to closely monitor and respond to regulations through grassroots campaigns.

Two important aspects of American democracy are at play during the public comment phase: (1) informed citizenry: the democratic process only works if its citizenry is informed; and (2) government is not all-knowing: the government acknowledges it does not hold all of the expertise, it must solicit that expertise from the public (Regulations.gov, 2013). An example of rule making that limited nursing occurred when the Georgia legislature revised its scope of practice law for nurses. The law had many benefits for APNs, but the executive branch of the Georgia state government made the rules and regulations more restrictive than they were before the legislation was passed. The restrictions caused many APNs to avoid practicing under the new scope of practice but to continue to work under the old scope of practice that is still in effect as it is less restrictive (Center to Champion Nursing in America, 2010).

Policy modification allows all previous decisions to be revisited and modified. Polices that are wholly pertinent at one time may, over time, become inappropriate. Almost all policies have unintended consequences which is why many stakeholders seek to modify policies continuously.

Research methods of assessing quality and techniques for improving quality and safety Instructions

Unit outcomes addressed in this Assignment: • Assess quality and techniques for improving quality and safety. Course outcome addressed in this Assignment: HA540-3: Research methods of assessing quality and techniques for improving quality and safety Instructions: In this assignment, you will be researching dimensions of quality and safety in healthcare, specifically long-term care, and how various industries can apply these concepts to improve operations. ● Using the Medicare Nursing Home Compare website, research one nursing home that displays a low level of quality as indicated by their Five Star Rating* ○ The nursing home should display a low level of quality (-2 star rating) ○ The nursing home should display a low level of safety ● Provide a general overview of the nursing home (e.g., name, location, bed size, ownership, etc.) ● Discuss the quality performance of the nursing home as evident by its most recent health care inspection (e.g., deficiencies, citations, financial penalties, etc.). This can be accomplished by thoroughly reading the nursing home’s statement of deficiencies and plan of action to correct quality deficiencies (CMS Form 2567). ● Discuss the safety performance of the nursing home as evident by its most recent life safety inspection (e.g., life safety citations, financial penalties, etc.). This can be accomplished by thoroughly reading the nursing home’s life safety code statement of deficiencies and plan of action. ● Discuss appropriate techniques that you would use to improve quality in the nursing home. ● Discuss appropriate techniques that you would use to improve safety in the nursing home. ● Be sure to include details about the deficiencies that you found. ● Report your findings by using one (1) of the methods below: ○ 3-4 page paper excluding front and back matter (APA standards apply). ○ Internal organizational memorandum. ○ Infographic 2 Kaplan University School of Health Sciences HA540 Unit 7 Assignment COURSE # ○ Power Point presentation for a Board of Directors (10-12 slides; speaker notes as needed to support assertions). ○ 7-10 minute public service announcement (using a free online voice recorder such as vocaroo.com) ○ Video newscast (using a free online video recorder such as YouTube.com)(e.g., entertainment talk show, television commentary, interview-style, news reporting, etc.). ○ The use of first person is permitted for this assignment (excluding option 1). ● APA formatting (e.g., title page, conclusion, reference page, etc.) should not be used. •You can select any nursing home published on the Medicare Hospital Compare website. To narrow your selection, consider researching nursing homes in your community, previous places of residence, employers, competitors, or even a nursing home you would like to network with someday. References: http://www.medicare.gov/nursinghomecompare/search. html https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/cms2567.pdfhttp://www.cdc.gov/nchs/nnhs.htm Submitting your work: Submit your Assignment to the appropriate Dropbox. For instructions on submitting your work, view the Dropbox Guide located under Academic Tools at the top of your unit page. Please be sure to download the file “Writing Center Resources” from Doc Sharing to assist you with meeting APA expectations for written Assignments.

Nursing Finances

Throughout this course, you’ve examined the importance of anticipating financial fluctuations that may impact your organization’s ability to provide services. While financial managers have no time machines or crystal balls, they do have expense forecasts. Expense forecasting is one of the preeminent tools that financial managers can use to prepare their organizations for future fiscal turbulence. In this Assignment, you will examine a scenario and generate a corresponding expense forecast in Excel.

Before pursuing an opportunity or making a major purchase, financial decision makers must first ascertain if the expenditures are justified. Determining whether a new process, system, or purchase will yield worthwhile returns is no easy task. However, managers have a variety of tools to help them decide whether the new expenditure is warranted. Analyzing a venture’s benefit/cost ratio, marginal profit and loss statement, and break-even points enable nurse managers to make educated decisions about how they choose to commit their funds.

Note: For those Assignments in this course that require you to perform calculations you must:Use the Excel spreadsheet template for the Week 3 assignment

Show all your calculations and formulas in the spreadsheet.

Answer any questions included with the problems (as text in the Excel spreadsheet).

Expense Forecasting

In this Application Assignment you calculate scenarios focusing on benefit/cost ratio analysis, marginal profit and loss statements, and break-even analysis. For these scenarios, you will utilize the provided figures to perform calculations and then make recommendations about the viability of the investment opportunities

Expense Forecasting Scenario

Your department has performed 20,000 procedures during the first six months (January–June) of 20X1. Spending during that period of time was $210,000 for fixed expense items and $1,200,000 for variable expense items. Of those amounts, $50,000 of fixed expense money was spent on preparing for a Joint Commission survey. Volume is anticipated to be 10% higher in the second half of the year. On November 1st, two new procedure technicians will begin work. The salary and fringe benefit costs for each are $96,000/year. Based on the information provided, prepare an expense forecast for 20X1.

Annualization for Fixed: (Adjusted Total for Year to Date Expense/6) * 12 =Total Annualized Amounts

Annualization for Variable (Adjusted Total for Year to Date Expense/ 20,000) * 40,000 =Total Annualized Amounts.

Financial Analysis Cycle

Marginal Profit and Loss Statement Scenario

You are examining a proposal for a new business opportunity – a new procedure for which demand is expected to be 1,400 units the first year, growing by 600 units a year thereafter. The price charged per procedure is $1,000. The collection rate is anticipated to be 80%. Each procedure consumes $300 of supplies. Salary cost is estimated to cost $540,000 each year, fringe benefits are 25% of salaries, rent for the facility is $55,000/yr and operating cost are $120,000/yr.

Questions:

Develop a marginal profit and loss statement for this business opportunity.Based on that analysis, should this opportunity be pursued?

Break-Even Analysis Scenario

You can charge $1,075 for a new service. Demand is anticipated to be 8,000 units a year. Your business is able to handle up to 16,500 units annually, so capacity should not be a problem. The average collection rate is 80%. The new service has annual fixed costs of $4,700,000. Variable cost per unit of service is $420.

Question: Use break-even analysis to determine if this new service is financially viable. If the business is not financially viable, what steps could you take to make a case to proceed with implementation? Explain your decision.

Benefit/Cost Ratio Analysis Scenario

You are considering the acquisition of a new piece of equipment with a useful life of five years. This new technology will make your clinical operation more efficient and allow for a reduction of 10 FTEs. The equipment purchase price is $4,500,000 plus 10% installation fee. The purchase price includes service for the first year, an item that has an annual cost of $10,000. There is a potential for additional volume of 150,000 units in the first year, growing by 30,000 each year thereafter. The price charged per unit is $15.00 with a 50% collection rate. The staff being eliminated are paid $12.50 per hour. The fringe benefits rate is 20%. The hurdle rate is 7.5%.

Questions: After reviewing Dr. Ward’s Video and the calculations below, please answer the following questions:

What is meant by benefit/cost ratio, average payback period and ROI and why are the all important to understand when purchasing new equipment?

Based on this information, would you pursue this opportunity?

Explain your decision in 250-500 words in the text box below.

References:

Baker, J. J., Baker, R. W., & Dworkin, N. R. (2018). Health care finance: Basic tools for nonfinancial managers (5th ed.). Burlington, MA: Jones and Bartlett Learning.

Chapter 14, “Trend Analysis, Common Sizing, and Forecasted Data” (pp. 149-160)

The focus of this chapter is the use of trend analysis and forecasting to develop future budgets and make financial decisions about capital purchases, programs, and personnel.

Chapter 15, “Using Comparative Data” (pp. 161-173)

In this chapter, you are introduced to the criteria for identifying other health care organizations that are comparable to your own. Data from these organizations can then be used to evaluate your own organizational performance.

Chapter 19, “Estimates, Benchmarking, and Other Measurement Tools” (pp. 223-231)

In this chapter, you continue exploring the concept of financial benchmarking. The chapter focuses on the importance of benchmarking for identifying performance gaps.

Zelman, W., McCue, M., & Glick, N. (2009). Financial management of health care organizations: An introduction to fundamental tools, concepts, and applications (3rd ed.). Hoboken, NJ: Jossey-Bass.

Retrieved from the Walden Library databases.

Chapter 5, “Working Capital Management” (pp. 187–231)

This chapter examines the concept of working capital. The authors explore the specifics of current assets and the management of the working capital cycle.

Chapter 11, “Responsibility Accounting” (pp. 468–497)

Review: This chapter explores the trend toward the decentralization of health care organizations and the challenges this presents. This chapter also describes responsibility centers, or organizational units intended to achieve specific tasks.

Mulva, S., & Dai, J. (2009) Health care facility benchmarking. HERD, 3(1), 28–37.

Reprinted by permission of Sage Publications via the Copyright Clearance Center.

This article describes a national health care facility’s benchmarking program. It is designed to compare measures of capital project performance.

Agency for Healthcare Research and Quality. (2013). Measuring and benchmarking clinical performance

Overview and Outcomes Ethical Self-Awareness in the Role of an Advanced Practice Nurse

10/23/17, 9*12 AMSample Content Topic

Page 1 of 1file:///Users/OrlandoHayaCuan/Downloads/Unit%202%20Overview%20and%20Outcomes.html

Unit 2 Overview and Outcomes Ethical Self-Awareness in the Role of an Advanced Practice Nurse

In this unit, you will have the opportunity to explore beliefs and question the ethics of those foundations. The National Council of State Boards of Nursing (2009) has set boundaries that must be maintained among patients, families, and practitioners. You will evaluate ethical theories and models that can be used to decide an ethical dilemma. You will choose an ethical dilemma to develop into a paper that is due in Unit 4. The dilemma you choose may deal with death and dying, transplant issues, HIV, informed consent, confidentiality, dealing with minors, education, teaching, or leadership dilemmas to name a few. The dilemma you choose maybe something you have encountered in your practice and wish to explore. Ethical models and theories provide a way to evaluate ethics, morality, and your own personal philosophy about what is right and what is wrong. Ethics are a part of the art of being a nursing leader.

Reflect on the following:

Do you have a moral compass grounded in emotional intelligence that guides your practice or do you react without reflection, causing conflict and chaos using a model of incivility? Does pride prevent you from doing the right thing? Decide what is right for the subject(s) of the dilemma? What is the right thing and how can law, ethics, and morals help you?

References

The National Council of State Boards of Nursing. (Producer). (2014). Professional boundaries in nursing . Available from https://www.ncsbn.org/464.htm

After completing this unit, you should be able to:

Explain how ethics, morality, and philosophies affect ethical and legal decision-making. Evaluate ethical models and theories and how they apply to ethical dilemmas. Present an ethical dilemma to your institution’s ethics committee.

Class 6 Unit 2

Community, Culture, and Nursing

Week 1 Discussion

Previous  Next 

Community, Culture, and Nursing

The discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered.

By the due date assigned, post a response to one of the two discussion topics below, using information from the lectures, reading assignments, library resources, and Internet resources. All responses should be posted to the appropriate topic in the Discussion Area.

Topic 1: Community-Based Nursing

Nursing services play an important role in caring for patients and families in the community and providing them the support they need. For patients with problems ranging from chronic health conditions to need of elder care, nursing has proved itself an important part of the healthcare team. In fact, many people now prefer sending their elderly parents to a daycare for nursing, rather than to a long-term care facility.

For this topic, interview a community-based nurse or nurse practitioner who sees individuals in the home setting. Ask the following questions:

  • What are your job responsibilities?
  • Does a correlation exist between your job description and your practice?
  • Are you involved in policy formulation that affects client services?
  • Do you belong to a professional organization related to your current job position?

Topic 2: Culturally Competent Care

A broad range of cultures exists in the world today. Nursing professionals often interact with people from cultural backgrounds that differ from their own.

  • Share an experience where you cared for a patient in the healthcare setting who was from a culture different from your own. How did you accommodate this patient’s needs? How would you apply the Purnell Model to future cultural encounters?
  • Which one of the twelve domains of culture from the Purnell Model do you feel is most important? Why?

Citations should conform to APA guidelines. You may use this APA Citation Helper as a convenient reference for properly citing resources or connect to the APA Style website through the APA icon below.

Before the end of the week, comment on at least two of your peers’ responses. You can ask questions or respond generally to the overall experience. Be objective, clear, and concise. Always use constructive language, even in criticism, to work toward the goal of positive progress. All comments should be posted to the appropriate topic in the Discussion Area.

Practicum – Assessing Client Progress

Assignment Instructions. Please read carefully to the end before starting

Assignment 2: Practicum – Assessing Client Progress

To prepare:

· Reflect on the client you selected for the Week 3 (See the attached case study for client selected in week 3) Practicum Assignment.

· Review the Cameron and Turtle-Song (2002) article in this week’s Learning Resources for guidance on writing case notes using the SOAP format (See attached resource).

The Assignment

Part 1: Progress Note

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

Treatment modality used and efficacy of approach

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

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

Note:  Be sure to exclude any information that should not be found in a discoverable progress note.

Part 2: Privileged Note

Based on this week’s readings, prepare a privileged psychotherapy note that you would use to document your impressions of therapeutic progress/therapy sessions for your client from the Week 3 Practicum Assignment.

The privileged note should include items that you would not typically include in a note as part of the clinical record.

Explain why the items you included in the privileged note would not be included in the client’s progress note.

Explain whether your preceptor uses privileged notes, and if so, describe the type of information he or she might include. If not, explain why.

References

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

· Chapter 5, “Supportive and Psychodynamic Psychotherapy” (pp. 238–242)

· Chapter 9, “Interpersonal Psychotherapy” (pp. 347–368)

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

Note: You will access this text from the Walden Library databases.

Abeles, N., & Koocher, G. P. (2011). Ethics in psychotherapy. In J. C. Norcross, G. R. VandenBos, D. K. Freedheim, J. C. Norcross, G. R. VandenBos, & D. K. Freedheim (Eds.), History of psychotherapy: Continuity and change (pp. 723–740). Washington, DC: American Psychological Association. doi:10.1037/12353-048

Note: You will access this resource from the Walden Library databases.

Cameron, S., & Turtle-Song, I. (2002). Learning to write case notes using the SOAP format. Journal of Counseling and Development, 80(3), 286–292. Retrieved from the Academic Search Complete database. (Accession No. 7164780)

Note: You will access this article from the Walden Library databases.

Nicholson, R. (2002). The dilemma of psychotherapy notes and HIPAA. Journal of AHIMA, 73(2), 38–39. Retrieved from http://library.ahima.org/doc?oid=58162#.V5J0__krLZ4http://library.ahima.org/doc?oid=58162#.V5J0__krLZ4

U.S. Department of Health & Human Services. (n.d.). HIPAA privacy rule and sharing information related to mental health. Retrieved from http://www.hhs.gov/hipaa/for-professionals/special-topics/mental-health/

Required Media

Sommers-Flanagan, J., & Sommers-Flanagan, R. (2013). Counseling and psychotherapy theories in context and practice [Video file]. Mill Valley, CA: Psychotherapy.net.

Personal leadership philosophy that reflects what you think are characteristics of a good leader

Many of us can think of leaders we have come to admire, be they historical figures, pillars of the industry we work in, or leaders we know personally. The leadership of individuals such as Abraham Lincoln and Margaret Thatcher has been studied and discussed repeatedly. However, you may have interacted with leaders you feel demonstrated equally competent leadership without ever having a book written about their approaches.

What makes great leaders great? Every leader is different, of course, but one area of commonality is the leadership philosophy that great leaders develop and practice. A leadership philosophy is basically an attitude held by leaders that acts as a guiding principle for their behavior. While formal theories on leadership continue to evolve over time, great leaders seem to adhere to an overarching philosophy that steers their actions.

What is your leadership philosophy? In this Assignment, you will explore what guides your own leadership. 

To Prepare:

· Identify two to three scholarly resources, in addition to this Module’s readings, that evaluate the impact of leadership behaviors in creating healthy work environments.

· Reflect on the leadership behaviors presented in the three resources that you selected for review.

· Reflect on your results of the Clifton Strengths Assessment, and consider how the results relate to your leadership traits.

The Assignment (2-3 pages):

Personal Leadership Philosophies

Develop and submit a personal leadership philosophy that reflects what you think are characteristics of a good leader. Use the scholarly resources on leadership you selected to support your philosophy statement. Your personal leadership philosophy should include the following:

· A description of your core values

· A personal mission/vision statement

· An analysis of your Clifton Strengths Assessment summarizing the results of your profile

· A description of two key behaviors that you wish to strengthen

· A development plan that explains how you plan to improve upon the two key behaviors you selected and an explanation of how you plan to achieve your personal vision. Be specific and provide examples.

· Be sure to incorporate your colleagues’ feedback on your Clifton Strengths Assessment from this Module’s Discussion 2.

Resources

https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-015-0891-3
https://walden.gallup.com/
https://class.waldenu.edu/bbcswebdav/institution/USW1/201970_27/MS_NURS/NURS_6053_WC/artifacts/SQOS_Student%20Long%20Guide.pdf
https://class.waldenu.edu/bbcswebdav/institution/USW1/201970_27/MS_NURS/NURS_6053_WC/artifacts/SQOS_Student%20Short%20Guide_.pdf

Clifton strengths results

RANK

STRENGTH

1

Empathy

LEARN MORE

RELATIONSHIP BUILDING

People who are especially talented in the Empathy theme can sense the feelings of other people by imagining themselves in others’ lives or others’ situations.

2

Positivity

LEARN MORE

RELATIONSHIP BUILDING

People who are especially talented in the Positivity theme have an enthusiasm that is contagious. They are upbeat and can get others excited about what they are going to do.

3

Developer

LEARN MORE

RELATIONSHIP BUILDING

People who are especially talented in the Developer theme recognize and cultivate the potential in others. They spot the signs of each small improvement and derive satisfaction from these improvements.

4

Discipline

LEARN MORE

EXECUTING

People who are especially talented in the Discipline theme enjoy routine and structure. Their world is best described by the order they create.

5

Connectedness

LEARN MORE

RELATIONSHIP BUILDING

People who are especially talented in the Connectedness theme have faith in the links between all things. They believe there are few coincidences and that almost every event has a reason.

Making decisions about how to assess and treat clients

For this Assignment, you examine the client case study in this week’s Learning Resources. Consider how you might assess and treat pediatric clients presenting with symptoms noted in the case.

Note:  For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients.

                                                              The Assignment:

Examine Case 1. 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.

A Young Girl With ADHD

                                                          Case #1
A young girl with difficulties in school

                                                                               BACKGROUND

In psychopharmacology you met Katie, an 8-year-old Caucasian female, who was brought to your office by her mother (age 47) and father (age 49). You worked through the case by recommending possible ADHD medications. As you progress in your PMHNP program, the cases will involve more information for you to sort through.

For this case, you see Katie and her parents again. The parents have reported that the medication given to Katie does not seem to be helping. This has prompted you to reconsider the diagnosis of ADHD. You will consider other differential diagnoses and determine what information you need to accurately assess the DSM-5 criteria to make the diagnosis of ADHD or another disorder with similar diagnostic features.

When parents bring their child to your office, they may have read symptoms on the internet or they may have been told by the school “your child has ADHD”. Your diagnosis will either confirm or refute that diagnosis.

Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine a differential diagnosis and to begin medication, if indicated. The PMHNP makes this diagnostic decision based on interviews and observations of the child, her parents, and the assessment of the parents and teacher.

To start, consider what assessment tools you might need to evaluate Katie.

· Child Behavior Check List

· Conners’ Teacher Rating Scale

The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised” (Available at: http://www.doctorrudy.com/files/teacher_add_adhd_short.pdf). This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, makes careless mistakes in her schoolwork, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. She has difficulty interacting with peers in the classroom and likes to play by herself at recess.

When interviewing Katie’s parents, you ask about pre- and post-natal history and you note that Katie is the first born with parents who were close to 40 years old when she was born. She had a low 5 minute Apgar score. The parents say that she met normal developmental milestones and possibly had some difficulty with sleep during the pre-school years. They notice that Katie has difficulty socializing with peers, she is quiet at home and spends a lot of time watching TV.

                                                      SUBJECTIVE

You observe Katie in the office and she is not able to sit still during the interview. She is constantly interrupting both you and her parents. Katie reports that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds some subjects boring or too difficult, and sometimes hard because she feels “lost”. She admits that her mind does wander during class. “Sometimes” Katie reports “I will just be thinking about something else and not looking at the teacher or other students in the class.”

Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. She offers no other concerns at this time.

Katie’s parents appear somewhat anxious about their daughter’s problems. You notice the mother is fidgeting with her rings and watch while you are talking. The father is tapping his foot. Other than that, they seem attentive and straight forward in the interview process.

                                                                  MENTAL STATUS EXAM

The client is an 8-year-old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. Affect is neutral. Katie says that she doesn’t hear any ‘voices’ in her head but does admit to having an imaginary friend, ‘Audrey’. No reports of delusional or paranoid thought processes. Attention and concentration are somewhat limited based on Katie’s short answers to your questions.

                                                       Decision Point One

BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHAT IS YOUR DIAGNOSIS FOR KATIE?

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.

299.00 Autism Spectrum Disorder (ASD), mild and co-occurring; 300.23 Social Anxiety Disorder

315.0 Specific Learning Disorder with Impairment in Reading and 315.1 Impairment in Mathematics

314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation

ANSWER CHOOSEN: Attention Deficit Hyperactivity Disorder, 

predominantly inattentive presentation 314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation

                                           RESULTS OF DECISION POINT ONE

·  Client returns to clinic in four weeks

·  You selected Attention deficit hyperactivity disorder, predominantly inattentive presentation. Based on this choice, outline the remainder of the diagnostic evaluation that you will conduct on this child and their parents. Be sure to include standardized assessment instruments that you would administer

                                                                   · Decision Point Two

· BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.
 
https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6660/03/mm/decision_tree/img/pill-red.png

· Wellbutrin 75 mg orally daily

· 

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· Strattera 25 mg orally daily

· 

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6660/03/mm/decision_tree/img/pill-yellow.png

· Adderall XR 10 mg orally daily

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ANSWER CHOOSEN: Adderall XR 10 mg orally daily

                                          RESULTS OF DECISION POINT TWO

·  Client returns to clinic in four weeks

·  Katie’s parents seem absolutely delighted upon their return stating that Katie is paying more attention in school, but note that there is still room for improvement, particularly in the afternoon

·  They report that Katie’s teacher has reported that Katie is able to maintain her attention throughout the morning classes but come afternoon, she “daydreams.”

·  Katie’s parents are also concerned about her decrease in appetite since starting the medication.

                                                     Decision Point Three

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

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Katie’s parents that weight loss is common with stimulant medications 

          used to treat ADHD

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medication with family thearpy

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a small dose of immediate release Adderall in the early afternoon

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ANSWER CHOOSEN: Add a small dose of immediate release Adderall in the 

                                                         early afternoon

                                             Guidance to Student

Whereas weight loss is common with stimulant medication, this option does not address Katie’s parents’ concerns about the return of symptoms in the afternoon.

Augmentation with family therapy is also a good idea as it can help Katie with her symptoms and further help her parents to understand the unique challenges that Katie experiences, as well as ways that they can help her with symptoms, however, this option does not address the return of inattentive symptoms in the afternoon.

Adding a small dose of immediate relate Adderall in the afternoon can help Katie to maintain attention throughout the afternoon and into the early evening when she must do homework. This would be the best option.

                                                  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 3, “Contributions of the Sociocultural      Sciences” (pp. 131–150)
  • Chapter      31, “Child Psychiatry” (pp. 1152–1181, 1244–1253)

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

  • “Neurodevelopmental Disorders”

o “Intellectual Disabilities”

o “Communication Disorders”

  • “Disruptive, Impulse-Control, and Conduct Disorders”

Volkmar, F., Siegel, M., Woodbury-Smith, M., King, B., McCracken, J., & State, M. (2014). Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 53(2), 237–257. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00819-8/pdf 

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 difficulties in school [Multimedia file]. Baltimore, MD: Author. (SEE THE ATTACHED CASE STUDY SAMPLE WITH ANSWER)

                                               Optional Resources

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell. 

  • Chapter      51, “Autism Spectrum Disorder” (pp. 665–682)

Exploring the rate of seasonal pattern depression in an Inuit community

W 2 Assignment 1 Discussion

The discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered.

For this assignment, make sure you post your initial response to the Discussion Area by Wednesday, October 19, 2016.

To support your work, use your course and text readings and articles from the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

To learn more about qualitative designs, please go to the following website:
http://health.prenhall.com/nieswiadomy/pdf/NIESWIADOMY10.pdf

For quantitative designs, please go to the websites:
https://explorable.com/research-designs 
http://www.researchproposalsforhealthprofessionals.com

Workforce Issues on Patient Safety

In this assignment, you will consider how workforce issues impact patient safety.

Based on your research, respond to one of the following discussion questions.

Discussion Question 1

Identify the methodology, design, and rationale of the following titles.

  1. Exploring the rate of seasonal pattern depression in an Inuit community
  2. Democracy in America
  3. The relationship between compassion fatigue and burnout among critical care nurses
  4. Two drugs for Alzheimer’s show promise
  5. Evaluating technology with student success
  6. Factors that influence weight control among women
  7. The meaning of living with brain injury and stroke 10 years after the injury
  8. Exploring the beliefs of healing among Aborigines

Discussion Question 2

Using the South University Online Library, research workforce issues and patient safety.

Based on your research, complete the following tasks:

  • Identify and describe the research problems, purpose, objectives, and hypothesis of the research.
  • Evaluate the credibility and validity of the study.

Suggested References:

Shisana, O., Rice, K., Zungu, N., & Zuma, K. (2010). Gender and poverty in South
           Africa in the era of HIV/AIDS: A quantitative study. Journal of Women’s
           Health (15409996)19(1), 39–46.

Ko, E., Nelson-Becker, H., Park, Y., & Shin, M. (2013). End-of-Life decision making
           in older Korean adults: Concerns, preferences, and expectations.Educational
           Gerontology39(2), 71–81.

Witzke, J., Rhone, R., Backhaus, D., & Shaver, N. (2008). How sweet the sound:
           Research evidence for the use of music in Alzheimer’s dementia. Journal of
           Gerontological Nursing34(10), 45–52.

Sandvik, A., Melender, H., Jonsén, E., Jönsson, G., Salmu, M., & Hilli, Y. (2012).
           Nursing students’ experiences of the first clinical education: A nordic
           quantitative study. Nordic Journal of Nursing Research & Clinical Studies /
           Vård I Norden32(3), 20–25.

Cooper, C., Taft, L., & Thelen, M. (2004). Examining the role of technology in
           learning: An evaluation of online clinical conferencing. Journal of
           Professional Nursing20(3), 160–166.

Roulston, A., Bickerstaff, D., Haynes, T., Rutherford, L., & Jones, L. (2012). A pilot
           study to evaluate an outpatient service for people with advanced lung cancer.
           International Journal of Palliative Nursing18(5), 225–233.