Week 9: Group Therapy For Addiction

Anxiety Disorders, PTSD, and Related Disorders

Week 6 Discussion: Treatment of Anxiety Disorders due to another Medical Condition

Post:

An Overview of Anxiety Disorder Due to another Medical Condition

Explain the difference between an adjustment disorder and Anxiety Disorder Due to Another Medical Condition. Provide examples to illustrate your rationale.

Explain the diagnostic criteria for Anxiety Disorder Due to Another Medical Condition.

Explain the evidenced-based psychotherapy and psychopharmacologic treatment for Anxiety Disorder Due to Another Medical Condition. Support your rationale with references to the Learning Resources or other academic resource.

Learning Resources

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 9, “Anxiety Disorders” (pp. 387–417)

· Chapter 11, “Trauma- and Stressor-Related Disorders” (pp. 437–451)

Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.

· Chapter 16, “Panic Disorder”

· Chapter 18, “Social Anxiety Disorder (Social Phobia)”

· Chapter 19, “Generalized Anxiety Disorder”

· Chapter 20, “Specific Phobia”

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

· “Anxiety Disorders”

· “Trauma- and Stressor-Related Disorders”

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

Note: All Stahl resources can be accessed through the Walden Library using the link below. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear. http://ezp.waldenulibrary.org/login?url=http://stahlonline.cambridge.org/

To access information on specific medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication.

Maples-Keller, J. L., Price, M., Rauch, S., Gerardi, M., & Rothbaum, B. O. (2017). Investigating relationships between PTSD symptom clusters within virtual reality exposure therapy for OEF/OIF veterans. Behavior Therapy, 48(2), 147–155. doi:10.1016/j.beth.2016.02.011

Hayes, J. P., Logue, M. W., Reagan, A., Salat, D., Wolf, E. J., Sadeh, N., & … Miller, M. W. (2017). COMT Val158Met polymorphism moderates the association between PTSD symptom severity and hippocampal volume. Journal of Psychiatry & Neuroscience: JPN, 42(2), 95–102. doi:10.1503/jpn.150339

Quinn, B. L., & Peters, A. (2017). Strategies to reduce nursing student test anxiety: A literature review. Journal of Nursing Education, 56(3), 145–151. doi:10.3928/01484834-20170222-05

Required Media

Wolpe, J. (Producer). (n.d.). Joseph Wolpe on systematic desensitization [Video file]. Mill Valley, CA: Psychotherapy.net

Note: The approximate length of this media piece is 59 minutes. You will access this video from the Walden Library databases

Acosta, M. C., Possemato, K., Maisto, S. A., Marsch, L. A., Barrie, K., Lantinga, L., . . . Rosenblum, A. (2017). Web-delivered CBT reduces heavy drinking in OEF-OIF veterans in primary care with symptomatic substance use and PTSD. Behavior Therapy, 48(2), 262-–276. doi:10.1016/j.beth.2016.09.001

Substance Abuse and Mental Health Services Association (SAMHSA). (2014). TIP 57: Trauma-informed care in behavioral health services. Retrieved from: http://store.samhsa.gov/product/TIP-57-Trauma-Informed-Care-in-Behavioral-Health-Services/SMA14-4816

Note: This document is available as a free download.

CASE STUDY

Details:

Based on “Case Study: Fetal Abnormality” and other required topic study materials, write a 750-1,000-word reflection that answers the following questions:

1. What is the Christian view of the nature of human persons, and which theory of moral status is it compatible with? How is this related to the intrinsic human value and dignity?
2. Which theory or theories are being used by Jessica, Marco, Maria, and Dr. Wilson to determine the moral status of the fetus? What from the case study specifically leads you to believe that they hold the theory you selected?
3. How does the theory determine or influence each of their recommendations for action?
4. What theory do you agree with? Why? How would that theory determine or influence the recommendation for action?

Remember to support your responses with the topic study materials.

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.

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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COMMUNITY SETTING AND COMMUNITY HEALTH NURSING ROLES

Purpose

The purpose of this paper is to describe the community health nursing role of the home health nursing in the community setting of your choice. Health promotion nursing interventions and a professional nursing organization related to this role will also be examined.

Course Outcomes

This assignment enables the student to meet the following Course Outcomes.

· CO5: Analyze the nursing roles in providing comprehensive care in a variety of community health settings. (PO 1)

· CO6: Utilize a systems-based and collaborative approach to address factors that influence the health of a community and population health problems. (PO 2)

Directions

Community Health Nursing Roles assignment.

This APA paper is expected to be no more than four pages in length (not including the title page and reference list). Below are the requirements for successful completion of this paper.

1. The role for this paper must be on Home Health Nursing (not  including hospice).

2.  The template is formatted with the appropriate running head, title page, page numbers, paragraph formatting, and most of the headings. Please edit the headers and title page with your specific information. You are also encouraged to view the Week 4 assignment tutorial found at the end of the Academic Integrity Reminder.

3. Read the chapter of your textbook on the role and take notes based on the outline below.

4. Locate and read at least one scholarly peer-reviewed journal article that is not assigned in the course related to a nurse’s role in health promotion in this setting. Search peer reviewed journals to find a scholarly article on this topic. The article must be less than 10 years old (less than 5 years is best).

5. Thoroughly address the following categories using the APA Template that is provided.

· Introduction (one paragraph):

o  The introduction should be interesting and capture the reader’s attention.

o  Introduce the assigned community health nurse role and a community setting where this nurse may work.

o  Introduce your community and where/how this CHN role is utilized in your community

o  Identify population(s) served by this role in your community

o  Include a purpose statement

· Community Setting (two to three paragraphs)

o  Describe a practice setting for the assigned CHN role.

o  Describe the population(s) served in this setting.

o  Discuss three health services provided by the assigned CHN role in this setting.

o  You may use your textbook or an outside scholarly source to address these sub-points.

· Health Promotion Nursing Intervention (two to three paragraphs) 

o  Describe in detail health promotion intervention(s) of the assigned CHN role specific to the community setting identified.

o  Identify people/organizations/community members this CHN role may collaborate with in health promotion interventions.

o  Include one peer-reviewed journal article discussed that clearly relates to nursing health promotion intervention.

· Professional Nursing Organization (two paragraphs)

o  Provide a detailed description of a professional nursing organization that supports nurses in this role in your own words. Search the text, your article, or the Internet for one professional organization that supports nurses in this role. If you can’t find an organization specific to this group, search the American Nurses Association (ANA) website for information on this role. Cite the organization in the body of the text with (organization name, year), and include a complete reference on the reference page.

o  Discuss one professional issue that this organization is addressing related to this CHN role.

· Summary (one paragraph)

The summary reiterates key points about:

o  The CHN role and community setting

o  Health promotion intervention

o  Professional organization

o  Includes a concluding statement.

· Reference Page:The reference page should start on a new page (insert a page break). All references should be cited within the body of the paper as (author or organization, year), and the full reference should be included in APA format on the reference page.

The setting for this paper must be on Home Health Nursing (Not including hospice).

· Use only the assigned CHN role

· Cite all sources within the paper as well as on the reference page.

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NURS 6640 Week 11 Final Exam

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1. A PMHNP is using Gestalt therapy to communicate with a 50-year-old patient who is going through a divorce. As he is calmly sharing the details of his divorce, the PMHNP notices that Dave is tapping his fingers on his legs. What is an appropriate response by the PMHNP using the technique of focusing?
2. A 25-year-old female states, “I really need to lose weight. I know I’m the cause of our problems,  if I could just lose weight he might be more attracted to me. Then we could start a family and we would be happy. I’m sure of it, right, we would definitely be happy!” Which statement shows the PMHNP’s ability to apply “summarizing”?
3. As part of the PMHNP’s role in the clinic, the PMHNP oversees students that gain clinical experience at the agency. The student is instructed to use the supportive psychodynamic therapy approach with the patient. Which action made by the student causes the PMHNP to intervene, after observing the student interacting with the patient?
4. A PMHNP is using motivational interviewing (MI) with a 50-year-old patient named Dave to commit to a healthy drug-free lifestyle. By using “change talk,” the PMHNP hopes to help the patient build self-esteem and hope.
   True or false: If Dave is resisting change, the PMHNP should challenge his resistance in order for MI to be successful.
5. The PMHNP is actively listening to Ms. Thomas who is detoxing from alcohol. Ms. Thomas is currently discussing with the PMHNP the reasons why she feels guilty about her drinking. Ms. Thomas tearfully states, “I have driven my family and friends away with this terrible habit. I have no one left. I had more than enough chances and now my children won’t even talk to me.” Which of the following statements demonstrate a simple reflection?
6. A PMHNP is using Gestalt therapy to communicate with a 42-year-old patient who is upset with her mother. She says, “I want to tell her how hurt I feel when she doesn’t call me, but I don’t want to upset her.” What technique can the PMHNP use to help Sasha express herself?
7. The PMHNP is meeting with an older, female adult patient and her daughter. The patient has early onset dementia. The daughter expresses concern, saying, “I don’t want you to just stick my mother in a home and give her medicine. I’m worried that’s what people are going to want to do.” What is the best response by the PMHNP to the daughter?
8. The PMHNP meets with a 31-year-old woman who reports feeling as though she is “at her breaking point” with work. The PMHNP learns that the woman works 12-hour days, including one day on the weekend, because she is nervous about company layoffs. “I feel like I need to work myself to death in order to prove that I am valuable to the organization,” the woman says. Using the supportive psychodynamic therapy approach, how does the PMHNP respond?
9. When preparing to terminate a patient, what does the PMHNP do to organize thoughts about the patient’s progress made during treatment?
10. Linda is a 65-year-old patient who has completed initial treatment for alcohol addiction and anxiety problems. She is motivated to continue her treatment gains and have a healthy lifestyle. How would the PMHNP apply a mindfulness approach to this case?
11. The PMHNP is caring for a young adult patient with whom the PMHNP decides to use a dynamic supportive therapy approach in addition to pharmacological intervention. Which therapeutic action will the PMHNP take to employ the strategy of holding and containing the patient?
12. The PMHNP is caring for an adult male patient whose wife left him several months ago. He recently learned that his ex-wife is dating someone much younger. The man feels belittled, sad, and lonely. He talks about trying to meet other women, but says, “I can’t compete with the younger guys these days, with the cool clothes and the vegan diets. I’m bald and overweight, and what woman is going to want to be with me?” How does the PMHNP help raise the man’s self-esteem?
13. A 43-year-old single mother is seeing the PMHNP at the request of her sister. “My sister thinks I need to come here to talk about my feelings,” the patient reports. The PMHNP learns that the patient has three children from three different men, but is unable to collect appropriate child support payments from any of the biological fathers. Additionally, the woman is barely able to afford her apartment or utilities payments. What is the appropriate response from the PMHNP when using the psychodynamic psychotherapy technique?
14. The PMHNP has been providing interpersonal psychotherapy (IPT) for a patient who the PMHNP observes implementing new ways of being, such as interacting more with peers and being less isolated in social scenarios. The PMHNP understands that the patient is approaching termination. How does the PMHNP address termination with this patient?
15. A PMHNP has been treating a 14-year-old patient using interpersonal psychotherapy. The patient has been depressed since the death of his grandmother. To help the patient recover, the PMHNP has told the parents:
16. In the planning phase of change, a 42-year-old male client who struggles with gambling discusses how he plans to abstain from gambling. He tells the PMHNP, “I am no longer going to carry cash to the casino because you can’t spend what you don’t have.” The PMHNP uses an affirming communication skill when she states:
17. The PMHNP is assessing a patient who has been receiving months of outpatient psychotherapy. According to the PMHNP’s assessment, the patient is nearing the termination phase of their therapeutic relationship because the patient’s symptoms have improved, and the patient shows progress managing behaviors and decision-making abilities according to the diagnosis. How does the PMHNP approach termination with this patient?
18. The PMHNP is caring for a patient who is histrionic. Using the supportive psychodynamic therapy model, what is the best statement made by the PMHNP?
19. A cocaine-addicted female patient is entering residential treatment for substance abuse. Using the 10 guiding principles of recovery, an appropriate step by the PMHNP is to ______________.
20. A PMHNP is assessing a 40-year-old patient named Sarah who has a severe cocaine addiction and mild depression. Using the four-quadrant model, what would be the most appropriate setting to help the patient
21. A 21-year-old patient has been having trouble adjusting to college life. She tells the PMHNP that she had five alcoholic drinks at a party this past weekend. She also acknowledges that she drank the same amount of alcohol at a party the previous month. Based on this information, what would the PMHNP most likely recommend?
22. A PMHNP is using emotion-focused therapy to help a 38-year-old patient who says, “I’ve been feeling angry lately, but I’m not sure why.” The first attempt by the PMHNP is to say:
23. The PMHNP uses the Adult Attachment Interview (AAI) with a male patient who reports having had a difficult time being separated from his parents during his childhood. He explains that going to school or visiting his relatives without his parents was troublesome. The PMHNP characterizes the patient as unresolved/disorganized, according to his outcomes on the AAI. What does the PMHNP anticipate from the patient?
24. The PMHNP is interviewing a patient who is in the process of successfully completing a substance abuse program. During the interview, the patient states, “I wish I was strong enough to keep the same friends I had before I came here for treatment. I’m really afraid of being discharged because I’ll probably run into my old friends again.” The PMHNP offers a complex reflection when she states the following:
25. A PMHNP is using interpersonal psychotherapy with a 40-year-old patient having relationship problems with his extended family. The patient shares that he has been using the strategies they identified to reduce his distress, but they have not been helping. He is frustrated and is considering stopping treatment. What would be an appropriate step by the PMHNP?
26. An 8-year-old has been having trouble making friends at school. His parents initiated treatment when he also started acting out at home. Which is the most appropriate step that the PMHNP takes during the assessment process when using an integrated approach?
27. The PMHNP is treating an older adult patient who reports symptoms of late-life anxiety. What type of treatment(s) will the PMHNP consider?
28. The PMHNP is assessing a patient who requires cognitive behavioral therapy (CBT). Which of the following statements made by the PMHNP approach the termination phase for this patient?
29. A patient’s depression is affecting her relationship with her spouse. What might the PMHNP ask during the initial sessions of interpersonal psychotherapy treatment?
30. A PMHNP is treating a 10-year-old boy who is exhibiting signs of aggression and attention problems. What type of intervention will the PMHNP consider using a common elements approach?
31. The PMHNP who practices motivational interviewing understands its relationship to patient behaviors and/or outcomes to mean which of the following?
32. A PMHNP is treating a 12-year-old girl who witnessed the physical abuse of her sibling. She has been anxious and irritable since the experience. After speaking with the PMHNP, the patient says she keeps having anxiety-causing thoughts about the experience. Using the PRACTICE technique, which skill will best help the patient interrupt these negative thoughts?
33. The PMHNP is working with a patient who describes having a painful and traumatic childhood experience, which causes her to have anxiety as an adult. When asked how she manages her anxiety, the patient dismisses it and denies that it is a problem. Using the supportive psychotherapy approach, the PMHNP will do which of the following when assessing the patient’s ego strength?
34. The PMHNP uses therapeutic communication skills while ensuring that the patient understands that he has choices. The PMHNP comprehends and practices motivational interviewing. This is best understood as which of the following?
35. While assessing a patient using a humanistic-existential approach, a patient tells the PMHNP, “For the past few weeks, I’ve felt anxious almost every single day.” What would be an appropriate next step by the PMHNP?
36. The PMHNP is meeting with a patient who has been diagnosed with depression. The patient is having trouble adjusting to her new job and hasn’t made any new friends there. What would an appropriate response be by the PMHNP using the interpersonal psychotherapy approach?
37. A 38-year-old patient tells the PMHNP that her father went to jail for selling drugs when she was a child. The patient is visibly upset when discussing what happened. Using a humanistic-existential approach to psychotherapy, which of the following is the most appropriate response by the PMHNP?
38. The PMHNP is assessing an older adult male patient with depression and comorbidities. According to the medical chart, the patient takes medication to manage joint and bone pain. The patient reports feeling “forgetful” and complains that he has a hard time remembering where he puts things. What is the primary action by the PMHNP?
39. A 35-year-old male patient is being treated for alcohol addiction. He asks for the PMHNP’s cell phone number to use in case of an emergency. When the PMHNP responds that giving her number would be against therapeutic rules, the patient threatens an act of violence to the therapist. What would be the most appropriate response by the PMHNP?
40. The PMHNP is caring for a geriatric patient who expresses symptoms of gastrointestinal problems, aches and pains, and loss of appetite. The patient reports feeling lonely, as more of his friends have been passing away over the recent months and years. The PMHNP focuses on which therapeutic approach for this patient?
41. A 12-year-old girl was referred for treatment after witnessing the physical abuse of her sibling by their mother. The patient has been anxious and irritable since the experience. What evidence-based treatment would be most appropriate for the PMHNP to use?
42. The PMHNP uses the cognitive behavioral therapy model with Gerald, an older adult patient who is being treated for depression and mood disorder. What will the PMHNP do with the patient during the first three sessions?
43. The PMHNP is initiating a plan of care for a patient who requires comprehensive psychotherapy to manage his depression and mood disorder. Throughout the initial sessions, the patient reports feeling as though he cannot be helped. The PMHNP is concerned about premature termination initiated by the patient. What strategy can the PMHNP employ to prevent or reduce premature termination?
44. How does the PMHNP approach termination with the patient who has been receiving intermittent therapy?
45. A PMHNP is treating a 25-year-old patient who has a compulsive urge to exercise to excess. When asked to describe why she does so much exercise, she says, “I like the compliments I receive from others on my new level of fitness, and the excitement of getting more attention.” The PMHNP can use feeling-state therapy to help Monique ___________.
46. The PMHNP is assessing a 30-year-old client who reports feeling stressed out due to his current employment situation. When asked about how he manages this work-related stress, the patient says that exercise helps him feel less anxious, so he often spends 2 or more hours at the gym each night. After completing the patient assessment, the PMHNP has determined that an existential psychotherapy approach may best benefit this client. What is the PMHNP’s goal in employing this treatment approach?
47. The PMHNP is interviewing a patient with a history of substance abuse. He has attempted to stop abusing drugs three times before. He states to the PMHNP, “I just cannot change. How can you help me?!” As it applies to change, the PMHNP understands the principle of evocation to mean:
48. A PMHNP has been working with a 50-year-old patient who has a stressful job and goes to the casino on weekends to play poker with his friends, which he says relieves his stress. Tim admits that he sometimes misses work on Monday when he stays out too late at the casino on Sunday nights. In addition, he once was an avid runner, and has given up running to spend more time gambling.
    True or false: According to the PMHNP, the desired goal after treatment is not complete abstinence from gambling, but reaching a healthy level of the behavior.
49. The PMHNP is caring for a patient who experiences depression caused by the traumatic experience of her dog passing away. She reports not being able to eat or sleep, and sometimes doesn’t want to leave the house at all. Which statement is most appropriate for the PMHNP to maximize the patient’s adaptive coping mechanisms?
50. A 13-year-old patient and his parents are meeting with a PMHNP. When the PMHNP says hello, the boy just nods. His parents tell the PMHNP that he didn’t want to come to the session, but they insisted. They explain that their son has been moody and depressed at home, but is still getting good grades at school. Which of the following would be the best response by the PMHNP?
51. The PMHNP is initiating a plan of care for Holly, a 73-year-old female patient who has late-life bipolar disorder and reports consuming alcoholic beverages four times per week. What is the focus of Holly’s therapy going to be?
52. The PMHNP continues to meet with Gerald, who is the patient with depression and mood disorder. The PMHNP uses the CBT approach. Gerald is now meeting with the PMHNP for his fifth session and feels comfortable with how the therapy works. What does the PMHNP plan to do with Gerald over the course of the next several sessions?
53. Mia is a 75-year-old patient who has completed initial treatment for depression. What might a PMHNP ask Mia when using a solution-focused therapy approach?

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Differential Diagnosis For Skin Conditions

Properly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms, and incrementally narrow them down until one diagnosis is determined as the most likely cause.

In this Lab Assignment, you will examine several visual representations of various skin conditions, describe your observations, and use the techniques of differential diagnosis to determine the most likely condition.

To Prepare

Review the Skin Conditions document provided in this week’s Learning Resources, and select one condition to closely examine for this Lab Assignment.

Consider the abnormal physical characteristics you observe in the graphic you selected. How would you describe the characteristics using clinical terminologies?

Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.

Consider which of the conditions is most likely to be the correct diagnosis, and why.

Search the Walden library for one evidence-based practice, peer-reviewed article based on the skin condition you chose for this Lab Assignment.

Review the Comprehensive SOAP Exemplar found in this week’s Learning Resources to guide you as you prepare your SOAP note.

Download the SOAP Template found in this week’s Learning Resources, and use this template to complete this Lab Assignment.

The Lab Assignment

Choose one skin condition graphic (identify by number in your Chief Complaint) to document your assignment in the SOAP (Subjective, Objective, Assessment, and Plan) note format rather than the traditional narrative style. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.

Use clinical terminologies to explain the physical characteristics featured in the graphic. Formulate a differential diagnosis of three to five possible conditions for the skin graphic that you chose. Determine which is most likely to be the correct diagnosis and explain your reasoning using at least three different references, one reference from current evidence-based literature from your search and two different references from this week’s Learning Resources.

REQUIRED READINGS

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Chapter 9, “Skin, Hair, and Nails”

This chapter reviews the basic anatomy and physiology of skin, hair, and nails. The chapter also describes guidelines for proper skin, hair, and nails assessments.

Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.

Credit Line: Advanced practice nursing procedures, 1st Edition by Colyar, M. R. Copyright 2015 by F. A. Davis Company. Reprinted by permission of F. A. Davis Company via the Copyright Clearance Center.

This section explains the procedural knowledge needed prior to performing various dermatological procedures.

Chapter 1, “Punch Biopsy”

Chapter 2, “Skin Biopsy”

Chapter 10, “Nail Removal”

Chapter 15, “Skin Lesion Removals: Keloids, Moles, Corns, Calluses”

Chapter 16, “Skin Tag (Acrochordon) Removal”

Chapter 22, “Suture Insertion”

Chapter 24, “Suture Removal”

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

Chapter 28, “Rashes and Skin Lesions”

This chapter explains the steps in an initial examination of someone with dermatological problems, including the type of information that needs to be gathered and assessed.

Note: Download and use the Student Checklist and the Key Points when you conduct your assessment of the skin, hair, and nails in this Week’s Lab Assignment.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Skin, hair, and nails: Student checklist. In Seidel’s guide to physical examination (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Skin, hair, and nails: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.

Chapter 2, “The Comprehensive History and Physical Exam” (Previously read in Weeks 1 and 3)

VisualDx. (n.d.). Clinical decision support. Retrieved June 11, 2019, from http://www.skinsight.com/info/for_professionals

This interactive website allows you to explore skin conditions according to age, gender, and area of the body.

Clothier, A. (2014). Assessing and managing skin tears in older people. Nurse Prescribing, 12(6), 278–282.

This document contains five images of different skin conditions. You will use this information in this week’s Discussion.

Document: Comprehensive SOAP Exemplar (Word document)

DQ1 Please Read The Instructions

Please read the instruction. ( citation, references, 250 words ) see the picture below for instructions.
The answer has to be in a table.

Describe the characteristics of the aging process. Explain how some of the characteristics may lead to elder abuse (memory issues, vulnerability, etc.). Discuss the types of consideration a nurse must be mindful of while performing a health assessment on a geriatric patient as compared to a middle-aged adult.

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Assignment Mod #3

Professional Development

Professional Development

Professional Development

Professional Development Assignment Description:

There are 4 parts to the assignment. Please place all four assignments into one paper. The different parts should be clearly marked so your professor knows which question you are addressing.

Rewrite the following essays. Correct all errors in capitalization, spelling, and punctuation. Divide the passage into appropriate paragraphs.

Essay #1:

When my husband Joe had cancer surgery five years ago, each of his family members responded just as I knew they would. John, his father, decided to organize the family’s calls. Because, of course, everything would run so much more smoothly. Thus Jane, Matt, and Jim received detailed sheets of instructions in the mail. Telling them which days to telephone r.j. smith hospital to talk to Joe and what presents to send. Jane, enraged, promptly threw a tantrum. Calling Matt and me to complain about her father’s overbearing behavior. “I,” she yelled, “am a Psychiatrist who knows how to handle these situations, i am not still a child.” Matt also responded predictably. By avoiding the situation. He threw himself into his work. Normally a late sleeper, Matt took to leaving at 5:00 a.m., driving on the deserted expressway and arriving at work before six a.m. In addition, he didn’t return until 11:00 p.m. When he would fall into bed so exhausted that he couldn’t worry about Joe. Jim, too, responded predictably. He fumed inside for weeks, ignored John’s instructions, and sent cartons of books to Joe. So that he would never be bored. The books were funny. Because Jim had read Norman Cousins’ book about the healing power of laughter. Within a few months, Joe recovered from the surgery-in spite of his family

Essay #2:

Treatment of atrial septal defect depends upon the size and symptoms and therefore is individualized an atrial septal defect of less than 3mm usually closes spontaneously (The Merck Manual, 2006). When the defect is between 3mm and 8mm it closes spontaneously in eighty percent of cases by the age of eighteen months, however, atrial septal defects located in the anteroinferior aspect of the septum (ostium primum) or in the posterior aspect of the septum near the superior vena cava or inferior vena cava (sinus venosus) don’t close spontaneously. If the defect is very small does not close spontaneously and the patient is asymptomatic. The treatment may be simply too monitor via an annual echocardiogram. Of course their is a risk of patients’ becoming symptomatic.

Moderate-sized atrial septal defects or larger or patients’ who are symptomatic require closure of the shunt this is usually done between the ages of 2 and 6 years. A catheter-delivered closure device, such as Amplatzer Septal Occluder or Cardio-Seal device. May be used for closure of atrial septal defects less than 13mm in size, except than primum or sinus venosus defects. If the defect is greater than thirteen milimeters or located near important structures. Surgical repair becomes necessary. If the atrial septal defect is repaired during childhood there mortality rates approach 0 and the patient’s life expectancy approaches that of the general population prior to surgical repair, patients may need to be treated with diuretics; digoxin; ACE inhibitor; or beta blockers to prevent congestive heart failure (Moser & Riegel, 2007). Following surgical repair patience will receive aspirin to prevent clots, and be monitored closely for dysrhythmias and pulmonary hypertension. Oxygen and nitric oxide therapy have proven to be beneficial in treating postoperative pulmonary hypertension. Also patients who have primum atrial septal defect will need endocarditis prophylaxis.

Guided writing exercise:

Think about a recent experience you have had that required you to use critical thinking skills. Set a timer for five minutes. Write about your experience. Do not worry about grammar, punctuation, or spelling. Just write, but stop at five minutes. Now go back and write your experience with correct grammar, punctuation, and spelling. Submit both written pieces. Add a concluding paragraph that answers the follows questions: How was the formal writing experience different from the timed writing experience? What did you do differently? Was there any difference in the time it took you? How did you ensure your spelling, grammar, and punctuation were correct?

Describe when the following words would be used in a scholarly essay (define each word). Then, use those that are appropriate to a scholarly essay in a sentence.

Their, there, they’re

Affect, effect

Its, it’s

your, you’re

then, than

accept, except

Describe the use of apostrophes in writing in general. When should apostrophes be used in formal writing? When should apostrophes be avoided in formal writing?

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CONVERSATION RECAP

INTRODUCTION

Communication requires both parties to make choices. These choices determine if the conversation will create value or create waste. These choices mostly consist of recognizing when a bioreaction occurs, how it impacts listening, and being aware of listening differently.

REQUIREMENTS

Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course. 

Select a conversation where you had a disagreement that had an impact on you and triggered a bioreaction. The conversation could have been a long time ago or recently.

A.  Explain what happened during the disagreement by answering the following questions:

•  Describe the situation that led to the conversation.

•  When did you realize that there was a disagreement during the conversation?

•  Describe a bioreaction(s) that was experienced during the disagreement.

•  How did the conversation end?
B.  Analyze the conversation by answering the following questions:

•  Using the four levels of the conversation meter, what level were you listening at, and what level was the other person listening at?

•  Give examples of two factors that describe how you and they were listening in at these levels in the conversation meter: feelings, behaviors, language, or tone.

•  What were your points of alignment or disagreement?
C.  Reflect on how the conversation encouraged you to listen differently by answering the following questions:

•  How could you have listened differently moving up the conversation meter, and what effect would that have had on the disagreement?

•  How could you incorporate listening for needs, purpose, or concern to create value in the conversation (including describing what that would look like)?

•  What have you learned about accuracy and authenticity that could be used to improve the conversation?
D.  Demonstrate professional communication in the content and presentation of your submission.

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 Health History Paper

Health History

Health History

Health History

Health History

Health History

Health History

Chamberlain University College of Nursing

Health Assessment 2

Dr. Christina Johnson

Assignment Due Date:

Well Woman Check-up

Demographic Data

Mrs. R.K.B, a female African American aged 25, visited the hospital at Sugarland for her yearly well-woman visit on September 21st, 2020. A happily married woman who decided to go back to school as a full-time student. She is a mother of two children, a male, and a female.

Past Medical History

She stated, and her medical record shows she had completed her tetanus, hepatitis, chickenpox, and MMR earlier as a child. She had no records of surgeries or any hospitalization history. The patient has never had a blood transfusion. Mrs. R.K.B has been diagnosed with strep throat in the past.

Present Medication

She is currently on prescribed medication like Ibuprofen 400mg PRN for pains. She is also on Calcium Acetate 667mg once daily for bone formation. She also takes vitamin C 500mg once a day to boost her immune system.

Perception of Health

Mrs. R.K.B’s perception of her health condition is good as she feels she is healthy and good. Compared to the regular African Americans who struggle with high blood pressure, diabetes, and high cholesterol due to their sedentary lifestyle. Also, most African America the same age as Mrs. R.K.B do not take the time to visit the hospital because of a lack of insurance, or they feel they are healthy so, they do not need to visit the hospital. The patient has an allergic reaction to chloroquine, she stated it irritates her skin, and she swells around her eyes.

Present Illness

Mrs. R.K.B engages in vigorous exercise 4 times a week for 30 mins, and she tries to keep fit to be able to care for her family. Her last well-woman checkup was okay, which the nurse educator encouraged her to continue performing this checkup to prevent and review her reproductive health from time to time (Jarvis & Eckhardt, 2020). The patient currently is a nursing student so, she is aware of the implication of an unhealthy diet, and her salt intake is medium because she is knowledgeable of what a high intake of sodium can do to people mostly, African Americans. So, at this time of the visit, the patient has no illness.

Family Medical History

Her mother was diagnosed with high blood pressure at the age of 38, which motives her to try to live a healthy lifestyle to avoid high blood pressure. Her father has been diagnosed with a cataract of the eyes, which he is yet to perform surgery to remove the cataract, and her siblings have no significant health problems. Her mental health states she is stressed, and she stated schoolwork and trying to take care of her immediate family’s day-to-day activities was putting a lot of stress on her because she has two children.

Reason for Care

Mrs. R.K.B stated, she started her menstrual cycle at the age of 13, which is an ideal age. Her last menstruation was on September 19th, 2020. She states her period is every 24 days, and she had never had a rectal examination. The reason for her visit was for a well-woman checkup. I asked her if she would want a Pap smear done today, and she wanted to know what a Pap smear was? I explained, “it is a procedure to test for cervical cancer in women” (Pap smear – Mayo Clinic, 2019). And she accepted the Pap smear screening since her main aim for her visit was for a good woman checkup. Mrs. R.K.B was taking her health as her optimum priority.

Cultural Consideration

Due to her cultural belief, she stated she does not take alcoholic beverages, and at some period of the year, due to her religious beliefs, she fast. She explained she was a catholic, and during Lent, she avoids eating meat on Ash Wednesday and all the Fridays of Lent, and I documented that information in the system.

Review of Systems

When I went through the system, it stated she had been diagnosed with strep throat in the past. It was treated with some antibiotics, after which she was better. She has never had strep throat after the first incident.

Developmental Consideration

During the assessment, the patient weight, height, and size were appropriate for her age. Going through her records on the system, Mrs. R.K.B started her first menstrual cycle was at the age of 13 years, which is within the right age of development.

Psychosocial Consideration

Mrs. R.K.B, a mother of 2 children, talked about how much she loved spending time with her family. She talked about how her husband and the children supported her decision by going back to school.

HEENT (Head, Eyes, Ears, Nose, and Throat)

Before I got all the necessary information from Mrs. R.K.B, I started my assessment by first introducing myself to the patient. I verified with the patient if she was aware of what brought her to the hospital, which she was alert and oriented to the place and situation. Inspecting her face and it is symmetry with facial structures, her head is normocephalic without any lesions or infections noted. Patient two eyes are symmetrically placed, there are no infections to the eyebrows, eyelids, or eyelashes, there are no discharge, redness, or drainage noted. The patient has two ears, and they are both symmetrically placed looking at the patient ear. There is no redness, drainage, or discharge looking behind the ear. The patient nose is symmetric to other facial features, there are no wounds rash, or lesions noted. When I checked with the light, there is no foreign body, no inflammation or deformity noted. When inspecting the patient’s throat with a tongue blade, the uvula rises and falls at the midline.

Neck

When I inspected the neck for symmetry, I ensured Mrs. R.K.B’s neck was in the midline. I assessed her neck range of motion, palpated the lymph nodes, and I used a gentle circular motion to palpate the lymph nodes in front of the ear and, within the neck, I also palpated the thyroid gland for any abnormal findings, and everything was okay.

Respiratory

When inspecting Mrs. R.K.B, she is not using any accessory muscles. When I auscultated her anterior and posterior lung, it was clear to auscultation bilaterally. She has no scoliosis, Kyphosis, Lordosis, or no crackle sounds. The A/P diameter is less than transverse.

Cardiovascular System

When I placed the bell side to listen to her carotid artery, the carotid pulses one at a time was 2+ and no bruits noted, no jugular vein distension. Right Aortic intercostal space and the left intercostal space pulmonic S2 is greater than S1, Erb’s point S1 was greater than S2, the Tricuspid and Mitral were S1 greater than S2 which was within the normal range.

Neurological System

I began Mrs. R.K.B’s neurological assessment by assessing her level of consciousness. I assessed if she was alert, awake, and aware of the environment. She was oriented to person, time, situation, and place. Her facial expression, speech, and general mood and affect were appropriate to the situation. I assessed her appearance, posture, dressing, and grooming and it was appropriate.

Gastrointestinal System

The contour is flat, and the abdomen is symmetrical. She has an even skin color, and it is appropriate for the patient’s race. (Epigastric, Umbilical, and Suprapubic Areas) No bruits were auscultated to the epigastric, umbilical, and suprapubic areas. Her bowel sounds are normoactive in all four quadrants.

Musculoskeletal System

When assessing Mrs. R.K.B’s musculoskeletal system, I began with the inspection. I inspected the corresponding joints, structure, and function of each joint to determine if a full range of motion is present. I palpated the joint and skin to note temperature, musculoskeletal or muscular deformation, and it was okay. I assessed her range of movement by asking her to do an active range of motion like flexion, extension, abduction, adduction, and pronation, which she was able to perform.

Peripheral Vascular System

In this part of the assessment, I inspected and palpated her arms. I noted the color of her skin and nail beds, the temperature, texture, and turgor of the skin, and assessed for any lesions and edema. I assessed the patient for a capillary refill, and it was less than two seconds, I inspected and palpated her legs, and there was no swelling or lesions noted.

Needs Assessment

Going through her family health history, and as an African American, Mrs. R.K.B has a great chance of developing hypertension later in life. Her mother was diagnosed with high blood pressure at the age of 45 years. One health educational need for Mrs. R.K.B is to always monitor her blood pressure and to avoid smoking cigarettes or secondhand smoking. It states, “hypertension is the leading cause of death and disability-adjusted life-years worldwide. In the United States, hypertension accounts for more cardiovascular disease (CVD) deaths than any other modifiable risk factor which are second only to cigarette smoking as a preventable cause of death for any reason” (Carey & Whelton, 2018).

Mrs. R.K.B belongs to a nuclear family, which consists of her husband and two children, and that makes her very connected.

Conclusion

Mrs. R.K.B, at 25 years of age, was making the right decision of taking charge of her health and life, which most people her age would not take important, which makes her wise at that age.

Reflection

When Mrs. R.K.B arrived at the hospital at Sugarland for her well-woman check-up on September the 21st, 2020. Before starting with the interview with her, I made sure the environment was well lightening and quiet, with comfortable room temperature to make sure my patient was relaxed and able to trust I could provide her with proper care. When I began with the interview, she answered politely and calmly. She demonstrated high-level respect during the communication process. I interviewed her using an open-ended question which, enabled her to be open to discuss her health concerns and asked questions when needed. She was so comfortable discussing why she wanted to take charge of her health to be around and healthy for her family. “Driven by the patient’s reason for seeking care, history and symptoms, the process of targeting the physical assessment from the outset foregrounds inductive reasoning and clinical judgement” (Douglas et al., 2016). I also used therapeutic communication means to get tangible information from the patient, and the idea was to provide maximum healthcare for the patient, which made her trust me more. I noticed she sometimes avoided eye contact with me, and I asked if everything was okay. She made me understand her parent migrated to the United States from West Africa, the culture growing up as a child which she learned it was rude to look at anyone straight to the face. And I asked her what she preferred me to do during the interview process, and she stated nicely the way I conducted the interview was okay. I was happy she was comfortable explaining her cultural expression, and the interview process went well.

References

Jarvis, C., & Eckhardt, A. (2020). Physical examination & health assessment (8th ed.). St. Louis, MO: Elsevier.

Pap smear – Mayo Clinic. Mayoclinic.org. (2019). Retrieved 27 September 2020, from

/orders/www.mayoclinic.org/tests-procedures/pap-smear/about/pac-20394841.

Douglas, C., Booker, C., Fox, R., Windsor, C., Osborne, S., & Gardner, G. (2016). Nursing

physical assessment for patient safety in general wards: reaching consensus on core skills. Journal of Clinical Nursing, 25(13-14), 1890-1900. /orders/doi.org/10.1111/jocn.13201

Carey, R., & Whelton, P. (2018). Prevention, Detection, Evaluation, and Management of High

Blood Pressure in Adults: Synopsis of the 2017 American College of Cardiology/American Heart Association Hypertension Guideline. Annals of Internal Medicine, 168(5), 351. /orders/doi.org/10.7326/m17-3203

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Assignment: Off-Label Drug Use In Pediatrics

PLEASE FOLLOW THE INSTRUCTIONS AS INDICATED BELOW

1). ZERO (0) PLAGIARISM

2). ATLEAST 5 REFERENCES, NO MORE THAN 5 YEARS (WITHIN 5YRS, OR LESS THAN 5YRS)

3).  PLEASE SEE THE ATTACHMENT FOR RUBRIC DETAILS AND RECOMMENDED WRITING TEMPLATE AND APA 7 STYLE.

4). Please review and follow the grading rubric details, and include each component in the assignment as required. Also, follow the APA writing rules and style, Title page, summary, Conclusion, References. 

5) Please, Include the Title page, Introduction, purpose statement, Literature Review, conclusion, and reference page. 

Thank you very much.

The unapproved use of approved drugs, also called off-label use, with children is quite common. This is because pediatric dosage guidelines are typically unavailable, since very few drugs have been specifically researched and tested with children.

When treating children, prescribers often adjust dosages approved for adults to accommodate a child’s weight. However, children are not just “smaller” adults. Adults and children process and respond to drugs differently in their absorption, distribution, metabolism, and excretion.

Children even respond differently during stages from infancy to adolescence. This poses potential safety concerns when prescribing drugs to pediatric patients. As an advanced practice nurse, you have to be aware of the safety implications of the off-label use of drugs with this patient group.

To Prepare

• Review the interactive media piece in this week’s Resources and reflect on the types of drugs used to treat pediatric patients with mood disorders.
• Reflect on situations in which children should be prescribed drugs for off-label use.
• Think about strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Consider specific off-label drugs that you think require extra care and attention when used in pediatrics.

Write a 1-page narrative in APA format that addresses the following:

• Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples.
• Describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.

Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression

BACKGROUND INFORMATION

The client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression.

• Client complained of feeling “sad”
• Mother reports that teacher said child is withdrawn from peers in class
• Mother notes decreased appetite and occasional periods of irritation
• Client reached all developmental landmarks at appropriate ages
• Physical exam unremarkable
• Laboratory studies WNL
• Child referred to psychiatry for evaluation

MENTAL STATUS EXAM

Alert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation, but does admit that he often thinks about himself being dead and what it would be like to be dead.

You administer the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression)

RESOURCES

§ Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.

PLEASE NOTE BELOW:

I have provided all the decision points about the drugs. Decisions point one is to pick one medication to begin, either Zoloft, Paxil, or Wellbutrin. I provided all decision points under each drug to follow if any changes are to be made.

For Zoloft:

Decision Point One

Begin Zoloft 25 mg orally daily

RESULTS OF DECISION POINT ONE

• Client returns to clinic in four weeks
• No change in depressive symptoms at all

Decision Point Two

Increase dose to Zoloft 50 mg orally daily

RESULTS OF DECISION POINT TWO

• Client returns to clinic in four weeks
• Depressive symptoms decrease by 50%. Client tolerating well

Decision Point Three

Maintain current dose

Guidance to Student
At this point, sufficient symptom reduction has been achieved. This is considered a “response” to therapy. Can continue with current dose for additional 4 week to see if any further reductions in depressive symptoms are noted. An increase in dose may be warranted since this is not “full” remission- Discuss pros/cons of increasing drug dose with client at this time and empower the client to be part of the decision. There is no indication that the drug therapy should be changed to an SNRI at this point as the client is clearly responding to this therapy.

For Paxil:

Decision Point One

Begin Paxil 10 mg orally daily

RESULTS OF DECISION POINT ONE

• Client returns to clinic in four weeks
• Reduction in The Children’s Depression Rating Scale by 5 points overall, but with complaints of nausea, vomiting, and diarrhea

Decision Point Two

Change to Prozac 10 mg orally daily

RESULTS OF DECISION POINT TWO

• Client returns to clinic in four weeks
• There is a 25% reduction in symptoms, client’s side effects of nausea, vomiting, and diarrhea have resolved. Client reports that he is feeling a “little bit better”

Decision Point Three

Continue current dose

Guidance to Student
You have two equally compelling choices at this point. The client has only been taking the current drug at its current dose for 4 weeks. It would be appropriate to continue at current dose. Additionally, you could also increase the dose to 20 mg orally daily. A discussion of risk/benefits should be had with the childs guardian regarding this and collaborative decision making should occur. There is no indication at this point that augmentation agents are required as the child is showing a partial response to therapy.

For  Wellbutrin:

Decision Point One

Begin Wellbutrin 75 mg orally BID

RESULTS OF DECISION POINT ONE

• Client returns to clinic in four weeks
• Child is unable to fall asleep at night

Decision Point Two

Change to Lexapro 10 mg orally daily

RESULTS OF DECISION POINT TWO

• Client returns to clinic in four weeks
• Child is tolerating Lexapro, and is sleeping at night. There is a 40% reduction in symptoms

Decision Point Three

Continue current dose

Guidance to Student
At this point, there is no indicating that you should change back to Wellbutrin as the child is tolerating the current medication without mention of side effects. Also, the child is experiencing a reduction in symptoms. You could also increase the dose to 15 mg orally daily, but the child has only been taking the drug for 4 weeks at this point. It may be more prudent to give the current therapy an additional 4 weeks before making any decisions to change current dose.

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• Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses.

• Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

• APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

• Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source.

• LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

• Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

• Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

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