NR 507 Week 2 Discussion

PART No. 1:

A five-month-old Caucasian female is brought into the clinic as the parent complain that she has been having ongoing foul-smelling , greasy diarrhea. She seems to be small for her age and a bit sickly but, her parent’s state that she has a huge appetite. Upon examination you find that the patient is wheezing and you observe her coughing.

· Write a differential diagnosis of at least three (3) disorders and explain why each might be a possibility and any potential weaknesses of each differential.

· Why is it that the later in age this disease manifest itself, the less severe the disease is?

· What tests would you run to clarify your differential and potentially come to a definitive diagnosis?

· If the same child was African in ancestry would this change your initial differential? Why or why not?

PART No. 2:

Tammy is a 33-year-old who presents for evaluation of a cough. She reports that about 3 weeks ago she developed a “really bad cold” with rhinorrhea. The cold seemed to go away but then she developed a profound, deep, mucus-producing cough. Now, there is no rhinorrhea or rhinitis—the primary problem is the cough. She develops these coughing fits that are prolonged, very deep, and productive of a lot of green sputum. She hasn’t had any fever but does have a scratchy throat. Tammy has tried over-the-counter cough medicines but has not had much relief. The cough keeps her awake at night and sometimes gets so bad that she gags and dry heaves.

· Write a differential of at least three (3) possible diagnosis’s and explain how each may be a possible answer to the clinical presentation above. Remember, to list the differential in the order of most likely to less likely.

· Based upon what you have at the top of the differential how would you treat this patient?

· Suppose now, the patient has a fever of 100.4 and complains of foul smelling mucous and breath. Indeed, she complains of producing cups of mucous some days. She has some trouble breathing on moderate exertion but this is only a minor complaint to her. How does this change your differential and why? à Bronchiectasis p. 1256 can happen after an infection

PART No. 3:

A nursing student comes into your office because they are struggling with the concept of pulmonary function. They know you as an experienced FNP and so they are comfortable asking if you could clarify the terms residual volume (RV), functional reserve capacity (FRC), total lung capacity (TLC) inspiratory reserve volume (IRV), and expiratory reserve volume (ERV).

1. Give her a definition of each?

2. List three (3) disorders that can alter the residual volume and explain how they do so?

NR 507 Week 2 Quiz (CH 3, 34-36 + 8 – 13 from week 1)

1. At the arterial end of capillaries, fluid moves from the intravascular space into the interstitial space because the (Points : 2)

2. Physiologic pH is maintained around 7.4 because bicarbonate (HCO3) and carbonic acid (H2CO3) exist in a ratio of (Points : 2)

3. When thirst is experienced, how are osmoreceptors activated? (Points : 2)

4. Chvostek sign and Trousseau sign indicate (Points : 2)

5. Which are indications of dehydration? (Points : 2)

6. In hyperkalemia, cardiac rhythm changes are a direct result of (Points : 2)

7. Water movement between the intracellular fluid compartment and the extracellular compartment is primarily a function of (Points : 2)

8. In tuberculosis, the body walls off the bacilli in a tubercle by stimulating (Points : 2)

9. Pulmonary edema usually begins at a pulmonary capillary wedge pressure or left atrial pressure of _____ mm Hg. (Points : 2)

10. Which inflammatory mediators are produced in asthma? (Points : 2)

11. The most successful treatment for chronic asthma begins with (Points : 2)

12. Which pleural abnormality involves a site of pleural rupture that act as a one-way valve, permitting air to enter on inspiration but preventing its escape by closing during expiration? (Points : 2)

13. _____ is a fulminant form of respiratory failure characterized by acute lung inflammation and diffuse alveolocapillary injury. (Points : 2)

14. In ARDS, alveoli and respiratory bronchioles fill with fluid as a result of the (Points : 2)

15. Clinical manifestations that include unexplained weight loss, dyspnea on exertion, use of accessory muscles, and tachypnea with prolonged expiration are indicative of (Points : 2)

16. Clinical manifestations of pulmonary hypertension include (Points : 2)

17. Dyspnea is not a result of (Points : 2)

18. High altitudes may produce hypoxemia through (Points : 2)

19. Chest wall compliance in infants is _____ in adults. (Points : 2)

20. What is the primary cause of RDS of the newborn? (Points : 2)

21. An accurate description of childhood asthma is that it is a(n) (Points : 2)

22. Cystic fibrosis (CF) is caused by a(n) (Points : 2)

23. Which of the following statements about the advances in the treatment of RDS of the newborn is incorrect? (Points : 2)

24. Which of the following types of croup is most common? (Points : 2)

25. Which immunoglobulin is present in childhood asthma? (Points : 2)

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IOM Report

Review the Institute of Medicine’s 2010 report “The Future of Nursing: Leading Change, Advancing Health.” Write a 750-1500 word paper discussing the influence of the IOM report on nursing practice. Include the following:

1. Summarize the four messages outlined in the IOM report and explain why these are significant to nursing practice.
2. Discuss the direct influence the IOM report has on nursing education and nursing leadership. Describe the benefits and opportunities for BSN-prepared nurses.
3. Explain why it is important that a nurse’s role and education evolve to meet the needs of an aging and increasingly diverse population.
4. Discuss the significance of professional development, or lifelong learning, and its relevance in caring for diverse populations across the life span and within the health-illness continuum.
5. Discuss how nurses can assist in effectively managing patient care within an evolving health care system.

Prepare this assignment according to the guidelines found in the APA Style Guide

NO PLAGIARISM, 4 REFERENCE IN APA FORMAT

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Rhetorical Analysis Essay Assignment

ENGL 1020: Composition/Analysis

University of Memphis

Rhetorical Analysis Essay Assignment

Purpose: 

The purpose of your rhetorical analysis is to analyze another writer’s argument.  Of course, your essay should address what the writer has written, but the emphasis of your rhetorical analysis essay should be a close examination of how the writer has presented an argument. Your purpose is not to argue with (or state your agreement with) the writer’s position. Your primary purpose is to analyze the strategies and features another writer has used to be persuasive. Do not be diverted from your primary task: to demonstrate that you have uncovered interesting, important things about the way the author’s argument has been presented.

Process:

First, you need to choose an article to analyze. Consider the following options from Writing Memphis:

• “The Soul of Memphis” by Jamie Katz, pp. 19-39
• “The Education of Dasmine Cathey” by Brad Wolverton, pp. 143-162
• “Memphis Burning” by Preston Lauterbach, pp. 183-201
• “The Resistance: Memphis Activism Sprouts Everywhere” by Flyer Staff, pp. 83-91

You may also find an argument about Memphis from another source, but if you choose this route then you must get the article approved by me before you begin writing.

You do not need to agree with the argument to analyze it, but you should be careful to choose an argument that you can approach objectively, as you will not be critiquing the argument; you will be analyzing it. Your analysis should be no less than four pages long. 

What Should Be Analyzed?

Listed below are the sorts of things your rhetorical analysis should consider. This list is neither a checklist nor an outline, and not every question will apply to every article.

•  Purpose (What is the writer trying to accomplish with the essay?)

•  Audience (To whom does the writer try to appeal?  How does the writer try to connect with that audience?)

•  Organization (How has the writer structured and presented the argument?)

•  Nods to the Opposition (How does the writer anticipate and address arguments that might be made against his/her position?)

•  Definition (How does the writer define key terms used in the argument?)

•  Examples (What sort of examples/analogies does the writer use as evidence?)

•  Appeals to Authority (How does the writer use other sources, experts, statistics, etc.?)

•  Ethos (How does the writer present him/herself to the reader?)

•  Logos (How does the writer appeal to the reader’s sense of logical reasoning?)

•  Pathos (How does the writer appeal to the reader’s emotions, beliefs, and values?)

•  Kairos (How has the author made use of an opportune moment or place?)

•  Tone (What is the writer’s attitude towards the subject?)

•  Diction and Imagery (What are the effects of the writer’s word choices?)

Submission: You will submit your paper digitally, via ecourseware. If you choose to analyze an article that we did not read in class, then you will also have to submit that article as an appendix. MLA citation and format are required. For specifics about format please see the course syllabus.

Requirements: 

• Four full pages (not including works cited page)
• MLA citation and format
• Submitted digitally to the Dropbox
• Avoid summary (beyond a brief introductory summary of your source)

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Assessing The Genitalia And Rectum

Assessing The Genitalia And Rectum

Assessing The Genitalia And Rectum

Assessing The Genitalia And Rectum

Assessing The Genitalia And Rectum

Assessing The Genitalia And Rectum

Assessing The Genitalia And Rectum

For this assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions. Please remember to pretend that this is an actual patient and gives as much detail as possible!

Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal GENITALIA ASSESSMENT

Subjective: • CC: “I have bumps on my bottom that I want to have checked out.” • HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner during the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.

• PMH: Asthma •

Medications: Symbicort 160/4.5mcg •

Allergies: NKDA •

FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD •

Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

Objective: • VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs •

Heart: RRR, no murmurs • Lungs: CTA, chest wall symmetrical • Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia • Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, negMcBurney •

Diagnostics: HSV specimen obtained

Assessment: • Chancre

PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

• Based on the Episodic note case study:
  • Review this week’s Learning Resources, and consider the insights they provide about the case study. Refer to Chapter 3 of the Sullivan resource to guide you as you complete your Lab Assignment.
  • Search the Walden library or the Internet for evidence-based resources to support your answers to the questions provided.
  • Consider what history would be necessary to collect from the patient in the case study.
  • Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
  • Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

The Lab Assignment

Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature.

• Analyze the subjective portion of the note. List additional information that should be included in the documentation.
• Analyze the objective portion of the note. List additional information that should be included in the documentation.
• Is the assessment supported by the subjective and objective information? Why or why not?
• Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?
• Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.

Rubric:

With regard to the SOAP note case study provided and using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature:

·   Analyze the subjective portion of the note. List additional information that should be included in the documentation. 

Analyze the objective portion of the note. List additional information that should be included in the documentation. 

·  Is the assessment supported by the subjective and objective information? Why or why not? 

 What diagnostic tests would be appropriate for this case, and how would the results be used to make a diagnosis? 

 Would you reject or accept the current diagnosis? Why or why not?
·   Identify three possible conditions that may be considered as a differenial diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature. 

 Would you reject or accept the current diagnosis? Why or why not?
·   Identify three possible conditions that may be considered as a differenial diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature. 

Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation 

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list.

Presentation For Faculty Review And Feedback & Reflective Journal

Review And Feedback & Reflective Journal

PAPER 1

Capstone Project   Change Proposal Presentation for Faculty Review and Feedback 

Create a professional presentation of your evidence-based intervention and change proposal to be disseminated to an interprofessional audience of leaders and stakeholders. Include the intervention, evidence-based literature, objectives, resources needed, anticipated measurable outcomes, and how the intervention would be evaluated. Submit the presentation in LoudCloud for feedback from the instructor.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

You are not required to submit this assignment to LopesWrite.

PAPER 2

Professional   Capstone and Practicum Reflective Journal 

Students are required to submit weekly reflective narratives throughout the course that will culminate in a final, course-long reflective journal due in Topic 10. The narratives help students integrate leadership and inquiry into current practice.

This reflection journal also allows students to outline what they have discovered about their professional practice, personal strengths and weaknesses, and additional resources that could be introduced in a given situation to influence optimal outcomes. Each week students should also explain how they met a course competency or course objective(s).

In each week’s entry, students should reflect on the personal knowledge and skills gained throughout the course. Journal entries should address one or more of the areas stated below.  In the Topic 10 graded submission, each of the areas below should be addressed as part of the summary submission.

1. New      practice approaches
2. Interprofessional      collaboration
3. Health      care delivery and clinical systems
4. Ethical      considerations in health care
5. Practices      of culturally sensitive care
6. Ensuring      the integrity of human dignity in the care of all patients
7. Population      health concerns
8. The      role of technology in improving health care outcomes
9. Health      policy
10. Leadership      and economic models
11. Health      disparities

While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

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

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Capstone Project Change Proposal Presentation

Review the feedback on the change proposal professional presentation and make required adjustments to the presentation. Present your evidence-based intervention and change proposal to an interprofessional audience of leaders and stakeholders. Be prepared to answer questions and accept feedback.

After presenting your capstone project change proposal, write a 250-350 word summary of the presentation. Include a description of the changes that were suggested by your preceptor before your presentation and how you incorporated that feedback. Describe how this interprofessional collaboration improved the effectiveness of your presentation. Include a description of the feedback and questions from your audience after your presentation, and how this experience will affect your professional practice in the future.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

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We will process your orders through multiple stages and checks to ensure that what we are delivering to you, in the end, is something that is precise as you envisioned it. All of our essay writing service products are 100% original, ensuring that there is no plagiarism in them. The sources are well-researched and cited so that it is interesting. Our goal is to help as many students as possible with their assignments, i.e. our prices are affordable and services premium.

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Week3 Discuss 6050

Melissa Hinkhouse

Week 3-Original Post

NURS 6050: Policy and Advocacy for Improving Population Health

Walden University

In 2010 The Affordable Care Act (ACA) was enacted; the hope was to expand access to medical care, make coverage more affordable, and decrease the number of people without medical insurance. The Affordable Care Act (ACA) expanded and improved health insurance coverage in two primary ways. First, the number of individuals receiving insurance coverage grown by increasing access to coverage through Medicaid expansion and providing subsidies to purchase private insurance on the health care exchanges. Second, the ACA upgraded the quality and scope of coverage by improving benefit design, including implementing the essential health benefits (Willison & Singer, 2017). People who did not have coverage through their employer or Medicaid were required to purchase insurance through the Marketplace. The Marketplace was created as a one-stop-shop for people to view multiple plans and purchase insurance. Just because you have access to health care insurance does not mean you are going to receive quality health care (Teitelbaum, 2018).

Both parties have asked that the ACA be repealed or replaced for multiple reasons. Every Republican presidential candidate for 2016 has called for the repeal of the ACA. Some, but not all, Republican candidates have proposed health policies that they would like to put in place after repeal, but there is no broad agreement on a replacement for the ACA (Buettgens & Blumberg, 2016). The federal government would spend $90.9 billion less on health care for the nonelderly in 2021 if the ACA were repealed (Buettgens & Blumberg, 2016). State governments as a whole would spend $5.2 billion more on health care for the nonelderly in 2021 if the ACA were repealed (Buettgens & Blumberg, 2016). Healthcare is a priority to many Americans for obvious reasons; it was more costly for those with preexisting conditions before the ACA to obtain Medical Insurance. With the ACA the income guidelines for Medicaid where changed so additional people qualified that didn’t prior. As a Behavioral Health Nurse, I am a fan of anyone and everyone having access to Healthcare Services. I have seen to many times my patient not have the money for their medications because insurance was canceled so they go off their medications, they become unstable and ended up in the Emergency Department and admitted Inpatient, costing more money, hurting themselves and their loved ones.

Politicians are aware that election time is the best time to play the tug of war game with the heavy ticket items to capture someone votes. Republicans ran hard on promises to get rid of the law in every election since it passed in 2010. But when the GOP finally got control of the House, the Senate and the White House in 2017, Republicans found they could not reach agreement on how to “repeal and replace” the law (Kaiser Health News, 2018). And political strategists say that, when the dust clears after voting, the numbers in the Senate may not be much different, so change could be hard there too. Republicans, even with a small majority last year, could not pass a repeal bill there (Kaiser Health News, 2018). When it comes to voting, it is hard for some to know the different facts from fiction, political talk, and actual context that can be followed through. It can be frustrating but needed to research why a candidate is saying something and if he has the means to make a change. It can be time consuming to research through the political propaganda, but worth it for the issues at hand.

References

Buettgens, M., Blumberg, L. J., Holahan, J., & Ndwandwe, S. (2016, June). The Cost of

ACA Repeal. Urban Institute | Social and Economic Policy Research. /orders/www.urban.org/sites/default/files/publication/81296/2000806-The-Cost-of-the-ACA-Repeal.pdf

Kaiser Health News. (2018, November 2). The election’s impact on health care: Some bellwether

races to watch. Health Leaders. /orders/www.healthleadersmedia.com/elections-impact-health-care-some-bellwether-races-watch

Laureate Education (Producer). (2018). Introduction to Health Policy and Law with Joel

 Teitelbaum [Video file]. Baltimore, MD: Author.

Willison, C. E., & Singer, P. M. (2017, August). Repealing the Affordable Care Act essential

health benefits: Threats and obstacles. PubMed Central (PMC). /orders/www.ncbi.nlm.nih.gov/pmc/articles/PMC5508159/

Lilia Roy

Discussion Week 3 

Repeal or Replace the Affordable Care Act

Affordable care has been a topic that has a long history of wishing that we can all have medical insurance and be able to have great doctors and excellent services for very little money.  The cost of Medicaid in the United States continues to rise every day.  Many people cannot afford not to have medical insurance, but many cannot afford medical insurance.  The fact that there are so many people that live in poverty lines and must accommodate the use of medical insurance is either by state services such as Medicaid, which has been a good thing since 1960 (Milstead & Short, 2019).  The Obama Administration has tried to implement a reform of insurance for the past eight years of his presidency. Still, many think it was just an expansion to Medicaid services, which many people did not like the idea that they lost their doctors that they wanted.  He promised that people would keep the same plan and doctor, which he did not factor in that many doctors were not going to accept the proposal he offered.  Many doctors left their private sectors due because of this.  They were going to have to see more patients for less money. Another thing it put pressure on small businesses that they had to aid their employees to have medical insurance, which many can pick packages that were not good if they wanted the cost to below so they could stay in business.  Providing this insurance for employees created an extra expense for small companies, and many had to reduce their personal.  What studies saw it was that even people with insurance did not seek medical care which was not what they wanted to see

Politics plays a huge role in selling a need and targets the idea for elections and for them to win. The Obama administration sold the plan of care for all with no evidence data, which millions of Americans enrolled for insurance for the first time in history.  Obama stated that the republicans have not idea how to repeal the ACA with no plan to replace the health care issue (Obama, 2017).  The Trump administration has good intentions, but no plan on how to implement the ideas due to the people that will benefit is business and the wealthy that will not have a problem with the yearly cost of health care.  Trump wants to be able for people to choose their coverage, and some of the same things, such as preexisting medical care, will not be punished or pay more.  His goal is to create a patient health care system that promotes choice and quality (Glied & Jackson, 2017).   They also will keep kids covered until the age of 26, which they complete school.  Most of the repeal is going to cost billions of dollars to replace.  It is going to leave millions of people without insurance and health care.  It’s going to increase the national debt, and we all still have no clue how to fix it.  The idea of creating a socialist system of health care might work, but people that would lose their choice of care providers, doctors, hospitals, and patient care.  We are going to see the care that will diminish due to no incentive if a doctor sees three patients or ten per day he or she will be earning the same amount of money.  I see this in the Tricare system many providers do not perform the same volume of surgeries due to he is going to get the same amount of money he is not paid per case he is paid per salary.  I have both care systems I have Tricare, and I purchase my health care. I have both many people tell me why, but I have to.  My daughter has many needs that sometimes Tricare will not cover or will not have my choice of a doctor, so I prefer to have options for her due to she requires nothing but the best care for her Autism.  I do not want her just to see someone once a month. She needs individual attention to weekly providers such as speech pathology and occupational therapy.  I do not see anything resolved is such a huge debate of who is right and what is fair.

References

Glied, S., & Jackson, A. (2017). The future of the affordable care act and insurance coverage. American Journal of Public Health, 107(4), 538–540. Retrieved June 15, 2020, from /orders/doi.org/10.2105/ajph.2017.303665

Milstead, J. A., & Short, N. M. (2019). Health Policy and Politics (6th ed.). Jones and Barlett Learning books.

Obama, B. H. (2017). Repealing the ACA without a replacement—the risks to American health care. Obstetrical & Gynecological Survey, 72(5), 263–264. Retrieved June 15, 2020, from /orders/doi.org/10.1097/ogx.0000000000000447

MN577 Pregnancy Chart

No plagiarism will be checked with turnitin.

Assignment Directions:  Case: Jane

For this Assignment, using the case information and best evidence, complete the chart below. Make sure to address all columns in the chart.

Case #1: Jane

Jane is a 42-year-old G4P2103. Jane is divorced and works long, hard hours as a real estate agent. Jane was having irregular and heavy menses for 6 months, and then they abruptly stopped 3 months ago.

Jane has been having nausea and vomiting for 6 weeks but attributed it to having the flu recently. She also admits to gaining about 10 pounds in the last few months and experiencing breast tenderness.

Jane comes to the clinic today to discuss menopause symptoms and treatment. During the visit, a urine pregnancy test came back positive. During the exam, you palpate a 16-week-size uterus and get fetal heart tones of 165. Jane is in disbelief.

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The 8-Year-Old Girl Who Was Naughty

The 8-Year-Old Girl Who Was Naughty

The 8-Year-Old Girl Who Was Naughty

The 8-Year-Old Girl Who Was Naughty

The 8-Year-Old Girl Who Was Naughty

The 8-Year-Old Girl Who Was Naughty

The 8-Year-Old Girl Who Was Naughty

The 8-Year-Old Girl Who Was Naughty

Main Question Post.

NURS 6630N-08: Therapy for Clients with Sleep/Wake Disorders.

Week 7

Case 1: Volume 2, Case #16: The woman who liked the late-night TV

The 70-year-old woman shows several signs and symptoms related to mental illness such as depression. She is often sad due to her loneliness. Her husband died years ago, and the son no longer lives with her. Also, she experiences several unexplained pains and aches in different parts of her body. Her movement is substantially limited thus denying her a chance to join other people in society and participate in communal activities. Besides losing interest in doing things that she previously liked, she is also experiencing insomnia. She also admitted having experienced symptoms of Major Depression Disorder; thus indicating that she had historical family depression. Her mother suffered from the disease, despite the external family having the issues of Alcohol Use Disorder. The recent development of the hearing problem due to Major Depression Disorder (MDD) for both of her ears has dramatically affected her ability to communicate and interact with others. MDD has contributed to her sadness and the choice to remain alone rather than in a crowd (Stahl, 2013).

Questions and Rationales

Given the explanation of the signs experienced by the woman, the following are some of the questions the psychiatric mental health nurse practitioner (PMHNP) would consider asking patient as a way of establishing the cause and extent of her illness.

1. Have you been diagnosed with depression before? This way, it is easy to conclude whether the woman has a mental disorder or not (Ball, Dains, Flynn, Solomon, & Stewart, 2015).

2. Any other member of the family, apart from your mother, both nuclear and extended suffering or who have ever suffered from depression? The question is to help establish if the disease is genetic or not. Again, it would be the best way to develop the most effective medication to give to the patient, probably those that might have worked for the family members before. For instance, in the case of Major Depression Disorder (MDD), treatment is likely to be based on the medication that seemed useful for the family (Dains, Baumann, & Scheibel, 2016).

3. Do you suffer from any drug abuse? The family has a history of continued drug use disorder that might influence the development of depression due to inability to access the drugs (Ball et al., 2015). Therefore, it will be easy to draw a base and ground from which one can help uplift her spirit on awful days.

People in Patient’s Life to Give a Feedback

The first person that the psychiatric mental health nurse practitioner (PMHNP) would consider to reach and ask questions about the patient is the son (Stahl, 2013). Despite not being around his mother on a daily basis, he is the only family support that she has. Therefore, it is possible that he knows his mother’s condition in-depth. Again, he always accompanies her to her regular clinics for checkups. What this means is that the doctor keeps him updated on the improving or deteriorating state of his mother. He is a reliable source as the mother is also unlikely to hide any kind of pain and discomfort that she feels. The specific question to ask the son will be, when did you first notice a change in behavior in mother? The rationale is to establish a time frame of illness and to determine if the mother is an excellent historian and if what she said tallies with what happened. Another question will be what do you think may have triggered this behavior? Rationale, to assess if the trauma of losing her spouse engendered current illness and do you notice at any time if your mother used or is using street drugs or abusing any other substance? The reason is to rule our substance induced illness. Tell the PMHNP more about your mother? An open-ended question and answer that is free-flowing may reveal truths that the PMHNP may never have thought of asking (Ball et al., 2015). Another credible person as well is the home caretaker who takes care of the patient. He/she is responsible for catering to all the needs of the patient, thus understanding the progress of the woman regarding the mental sickness. The helper can also assist in identifying other psychological symptoms that the patient might have forgotten to mention. The PMHNP, without violating patient’s privacy will ask the caretaker, at any point in your care of the patient have you ever stumbled across any paraphernalia suggesting substance use by the patient? The PMHNP is still in search of the cause of patient’s illness to know how to assist client further. What does patient do during in her leisure time if any? The PMHNP want to gain insight into the patient’s daily behavior to determine the intensity of depression (Dains et al., 2016). The last individual the PMHNP will approach as he tries to understand the problems of the woman is the personal therapists who help her to fight against the mental disorder. Specific questions like what are the things you two talk about that change the patient’s mood from sad to happiness? There is a possibility of indicating activities and topics that they consider enjoyable to engage in that may be helpful to the PMHNP come up with a successful care plan. Also as the being the healthcare provider who has been caring for the patient, the therapist might be aware of the issues that might be considered to trigger the problem or even a medication that can help diagnose the further diseases. The progress of her illness is also essential since the therapist is always in constant communication with the patient. Therefore, the therapist might know more than anyone else could. People tend to be open with their health care providers because they tend to understand them better than all others (Davidson, 2016).

Physical Exams and Diagnostic Tests

The PMHNP will recommend for in-depth scrutiny of the patient’s well-being. Patient’s continued fatigue, especially in the morning, has not yet been established (Stahl, 2013). Therefore, it is difficult to prescribe any medication to her without the accurate medical information. In this case, the patient needs to be investigated in the affairs of obstructive sleep apnea. Lack of adequate sleep may result in patient always exhausted. Other examples like snoring and day-time sleeping are among the obstructive sleep apnea (OSA) that she experiences. Although there are high chances of concluding that she was suffering from the disease, there is a need for the physicians to conduct in-depth research on the same (Stahl, 2013).

Also, there should be implantation of the cochlear implant to help in depressing the major depression disorder (MDD). The confusion is stated to have not been under medication, thus the eternal suffering as a result of the illness. The use of the implant will help to regulate the level and impact of the disorder the patient experiences from time to time (Stahl, 2013).

The introduction of the Actigraphy to measure the movements made by the patient may also be an excellent way to monitor her sleep and wake cycles (Ancoli-Israel, Cole, Alessi, Chambers, Moorcroft, & Pollak, 2003). The device, worn on the wrist, records all the activities including the physical movement of the patient. It will show the resting and activity cycle of the patient. For that reason, it will be easy to assess the severity of insomnia (Stahl, 2013). Lastly, Polysomnography test (sleep study) should be conducted to establish the advancement of the sleeping disorder (Ancoli-Israel et al., 2003). The equipment is used to measure and record the brain activities that influence the sleeping ability of individual and other issues in the body such as breathing. The study examines the availability of oxygen in the body, heart rate, eye movement, as well as leg movement (Ancoli-Israel et al., 2003). With the study on the sleep patterns and cycles, it will be possible to establish the further cause of sleeplessness in the patient.

Differentiates Diagnoses

1. Major Depressive Disorder, Recurrent Episode severe (American Psychiatric Association, 2013; DSM-5, 2018).

2. Generalized Anxiety Disorder (American Psychiatric Association, 2013; DSM-5, 2018).

3. Obstructive Sleep Apnea (OSA) (American Psychiatric Association, 2013; DSM-5, 2018).

From the review of the case study, there are two significant illnesses. First, the patient is suffering from the major depression disorder (MDD) specified under the DSM-5 (American Psychiatric Association, 2013). People were suffering from the condition exhibit the symptoms of both mania and depression. For a patient who experiences mixed features, she needs to be diagnosed and treated with an antidepressant to suppress the disorder (Stahl, 2014b). In addition to the antidepressant that might work or not work on its own, there is a need to accompany the medication with more drugs. Typical antipsychotics such as Saphris, Latuda, Zyprexa, and Seroquel can help to effectively bring down the effects of the depression that is running in her family (Stahl, 2014b). Another reason for deciding to combine the medication is due to the (tenacity) stubbornness of the illness towards common drugs. Mood stabilizers like lithium and Depakote should be used to ensure that it sustains the spirit of the patient thus dealing with the issues of sadness and frequent cries. It should minimize the down periods and instead promote happiness from a few things that they enjoy doing.

Further diagnosis will be Generalized Anxiety Disorder (GAD) (DSM-5, 2018). Stillness and spending times all alone were the causes of anxiety and stress which later became the depression. Valium, a sedative will be used to help her with the sleep (Stahl, 2014b). Despite the previous medication being effective in promoting sleep, she still cannot help sleeping early. Therefore, she needs to use sleeping pills to encourage more rest.

Patient Medication

The use of the Citalopram (Celexa), an SSRI, 10 mg/d to suppress the depression symptoms have been quite successful (Stahl, 2014b). Although she has not started sleeping completely, the rate of sadness in her has reduced implying that it is useful in suppressing the mood instability (Stahl, 2014b). Increasing the amount of the SSRI intake would help improve the status of the patient even more (Stahl, 2014b). Replacing the drug with another medication has a high likelihood of causing a relapse on the user. During a decline, the condition of the patient goes back to the original status or even worse. Stopping the generation of the chemical in the body means that the antibodies responsible for the well-being will be defeated. The inclusion of the noradrenergic or dopaminergic to the antidepressant would help to treat the fatigue she experienced (Stahl, 2014b). Hypnotic drugs will be used to treat the lack of sleep which the SSRI failed to address (Drugbank, 2018). Also, the auto-titrating continuous positive airway pressure (CPAP) will also enhance the ability to curb the sleep disorder. Therefore, the goal is that the patient will experience fewer occurrences of insomnia. Continued use of the Zaleplon (Sonata) 5 mg will supplement the ability of the rest of the drugs in curbing lack of sleep (Stahl, 2014b).

Posttest

Ramelteon and doxepin are the hypnotic drugs that are considered to have no effects on the functionality of the psychomotor, the respiratory process or even become addictive. The two belong to the class of tricyclic antidepressants which increases the brain level of serotonin and norepinephrine. The two are the neurotransmitters used to transmit messages in the brain (Davidson, 2016). They are positive allosteric modulators (PAMs) used to relieve muscle spasm as well as providing medical sedation before performing medical procedures. Either of the two is an excellent choice to give the patient to stimulate sleeping cycles during the night. Unlike other drugs, the users are not expected to experience any after use adverse effects. Therefore, one will be sure on the treatment of the actual disease without side effects that tend to affect people differently. Augmenting the two drugs with the medications previously given the patient will help to increase her chances of sleeping. As a result, she will gain relief from the leg pain.

Check Points

The case study indicated positive responses to facsimiles received back and forth with the therapist (Stahl, 2013). In enhancing patient’s ability to associate with people and engage in everyday activities, cochlear implantation is necessary so the patient can hear others easily hence ending her frustration. Patient ability to hear will further motivate her to engage with others in different activities with peers along with pharmacologic and non-pharmacologic intervention (Sadock, 2015).

Lessons learned

The PMHNP knows that in this patient, the use of anti-stimulant is contraindicated. Instead, hypnotics augmented with SSRIs SNRIs may be prescribed. Additionally, for the neuropathic pain, gabapentin may be prescribed. The PMHNP due diligence in prescribing right drugs and making changes in medication where and when necessary will result in a patient living a more healthier, productive and fruitful life.

References

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

Ancoli-Israel, S., Cole, R., Alessi, C., Chambers, M., Moorcroft, W., Pollak, C. P. (2003). The role of actigraphy in the study of sleep and circadian rhythms. American Academy of Sleep Medicine Review Paper. SLEEP 2003;26(3):342-92.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby

Davidson, J. (2016). Pharmacotherapy of post-traumatic stress disorder: Going beyond the guidelines. British Journal of Psychiatry, 2(6), e16-e18. i:10.1192/bjpo.bp.116.003707. Retrieved from http://bjpo.rcpsych.org/content/2/6/e16

Drugbank. (2018). Hypnotics medications. Retrieved from /orders/www.drugbank.ca/drugs/DB00402

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia: Wolters Kluwer.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

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Academic Resources And Strategies

1. Clearly identify and accurately describe in detail at least three academic resources or strategies that can be applied to the Masters Nursing MSN program.  2. Clearly identify and accurately describe in detail at least three professional resources that can be applied to success in the nursing practice in general or in a specialty.                                                                                                                                                                   3. Clearly and thoroughly explain in detail how you intend to use these resources, and how they might benefit you academically and professionally.

Remember to include an introduction paragraph which contains a clear and comprehensive purpose statement which delineates all required criteria, and end the assignment Part with a conclusion paragraph. 

Academic Resource/Strategy 1

Academic Resource/Strategy 2

Academic Resource/Strategy 3

Professional Resource/Strategy 1

Professional Resource/Strategy 2

Professional Resource/Strategy 3

ADDITIONAL RESOURCES/STRATEGIES

We will process your orders through multiple stages and checks to ensure that what we are delivering to you, in the end, is something that is precise as you envisioned it. All of our essay writing service products are 100% original, ensuring that there is no plagiarism in them. The sources are well-researched and cited so that it is interesting. Our goal is to help as many students as possible with their assignments, i.e. our prices are affordable and services premium.

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