Public Health

Public Health

Part 1

From the readings and your own research, discuss the evolution of epidemiology in public health. Choose 1 of the following key pioneers in the field, and discuss his influence and contribution to epidemiology in public health:

  • Hippocrates
  • John Graunt
  • Edward Jenner
  • Lemuel Shattuck
  • Edwin Chadwick
  • John Snow
  • Louis Pasteur
  • Robert Koch

Respond to other students who chose a pioneer different from the one you chose, and discuss how the contributions of both relate to each other. Show either how one paved the way or how one built on the work of those before him.

Part 2

Choose a disease or health condition Determine a local jurisdiction on which you would like to concentrate (city, township, county, or state). Examine the epidemiology of the chosen disease, reviewing its history and trend, comparing the national trend to the chosen local jurisdiction. Describe the local jurisdiction (population and demographics). This will be the introduction

2–3 pages in length and APA-formatted with in-text citations and references

A component of your final project is to complete a needs assessment of your target population pertaining to the disease or health issue for which you are proposing the need for an intervention or prevention program. A component of the needs assessment is to describe the disease or health issue to demonstrate the need.  Using the epidemiologic triad of people, time, and place, provide a descriptive analysis of the health issue and the impacted population.

For data on your chosen disease or health issue, review the following data sources:

Describe the disease in terms of the following:

  • People: Demographics of those impacted (age, race/ethnicity, gender)
  • Time: The time period of the data you are reviewing (5–10 years, 1 year, etc.)
  • Place: Built environment and other environmental factors

Represent the data in graphs, charts, and tables as relevant, accompanied by a brief explanation.

Describe the morbidity, mortality, incidence, and prevalence rates of the data. Describe differences in terms of age, race/ethnicity, and gender. Which age group, race, or gender seems to be most impacted by the morbidity and mortality data? What were the morbidity and mortality trends for the time period observed (5 or 10 years depending on the data)?

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Pathways Mental

Pathways Mental Health

Psychiatric Patient Evaluation

     
Identifying Information   Identification was verified by stating of their name and date of birth. Time spent for evaluation: 0900am-0957am
Chief Complaint   “My other provider retired. I don’t think I’m doing so well.”
HPI   25 yo Russian female evaluated for psychiatric evaluation referred from her retiring practitioner for PTSD, ADHD, Stimulant Use Disorder, in remission. She is currently prescribed fluoxetine 20mg po daily for PTSD, atomoxetine 80mg po daily for ADHD. Today, client denied symptoms of depression, denied anergia, anhedonia, amotivation, no anxiety, denied frequent worry, reports feeling restlessness, no reported panic symptoms, no reported obsessive/compulsive behaviors. Client denies active SI/HI ideations, plans or intent. There is no evidence of psychosis or delusional thinking. Client denied past episodes of hypomania, hyperactivity, erratic/excessive spending, involvement in dangerous activities, self-inflated ego, grandiosity, or promiscuity. Client reports increased irritability and easily frustrated, loses things easily, makes mistakes, hard time focusing and concentrating, affecting her job. Has low frustration tolerance, sleeping 5–6 hrs/24hrs reports nightmares of previous rape, isolates, fearful to go outside, has missed several days of work, appetite decreased. She has somatic concerns with GI upset and headaches. Client denied any current binging/purging behaviors, denied withholding food from self or engaging in anorexic behaviors. No self-mutilation behaviors.
Diagnostic Screening Results   Screen of symptoms in the past 2 weeks:  PHQ 9 = 0 with symptoms rated as no difficulty in functioning  Interpretation of Total Score  Total Score Depression Severity 1-4 Minimal depression 5-9 Mild depression 10-14 Moderate depression 15-19 Moderately severe depression 20-27 Severe depression  GAD 7 = 2 with symptoms rated as no difficulty in functioning  Interpreting the Total Score:  Total Score Interpretation ≥10 Possible diagnosis of GAD; confirm by further evaluation 5 Mild Anxiety 10 Moderate anxiety 15 Severe anxiety  MDQ screen negative PCL-5 Screen 32
Past Psychiatric and Substance Use Treatment   Entered mental health system when she was age 19 after raped by a stranger during a house burglary. Previous Psychiatric Hospitalizations:  denied Previous Detox/Residential treatments: one for abuse of stimulants and cocaine in 2015 Previous psychotropic medication trials: sertraline (became suicidal), trazodone (worsened nightmares), bupropion (became suicidal), Adderall (began abusing) Previous mental health diagnosis per client/medical record: GAD, Unspecified Trauma, PTSD, Stimulant use disorder, ADHD confirmed by school records
Substance Use History   Have you used/abused any of the following (include frequency/amt/last use): Substance Y/N Frequency/Last Use Tobacco products Y ½ ETOH Y last drink 2 weeks ago, reports drinks 1-2 times monthly one drink socially  Cannabis N Cocaine Y last use 2015 Prescription stimulants Y last use 2015 Methamphetamine N Inhalants N Sedative/sleeping pills N Hallucinogens N Street Opioids N Prescription opioids N Other: specify (spice, K2, bath salts, etc.) Y reports one-time ecstasy use in 2015 Any history of substance related:  Blackouts: +  Tremors:   – DUI: –  D/T’s: – Seizures: –  Longest sobriety reported since 2015—stayed sober maintaining sponsor, sober friends, and meetings
Psychosocial History   Client was raised by adoptive parents since age 6; from Russian orphanage. She has unknown siblings. She is single; has no children. Employed at local tanning bed salon Education: High School Diploma Denied current legal issues.
Suicide / HOmicide Risk Assessment   RISK FACTORS FOR SUICIDE: Suicidal Ideas or plans – no Suicide gestures in past – no Psychiatric diagnosis – yes Physical Illness (chronic, medical) – no Childhood trauma – yes Cognition not intact – no Support system – yes Unemployment – no Stressful life events – yes Physical abuse – yes Sexual abuse – yes Family history of suicide – unknown Family history of mental illness – unknown Hopelessness – no Gender – female Marital status – single White race Access to means Substance abuse – in remission PROTECTIVE FACTORS FOR SUICIDE: Absence of psychosis – yes Access to adequate health care – yes Advice & help seeking – yes Resourcefulness/Survival skills – yes Children – no Sense of responsibility – yes Pregnancy – no; last menses one week ago, has Norplant Spirituality – yes Life satisfaction – “fair amount” Positive coping skills – yes Positive social support – yes Positive therapeutic relationship – yes Future oriented – yes Suicide Inquiry: Denies active suicidal ideations, intentions, or plans. Denies recent self-harm behavior. Talks futuristically. Denied history of suicidal/homicidal ideation/gestures; denied history of self-mutilation behaviors Global Suicide Risk Assessment: The client is found to be at low risk of suicide or violence, however, risk of lethality increased under context of drugs/alcohol. No required SAFETY PLAN related to low risk
Mental Status Examination   She is a 25 yo Russian female who looks her stated age. She is cooperative with examiner. She is neatly groomed and clean, dressed appropriately. There is mild psychomotor restlessness. Her speech is clear, coherent, normal in volume and tone, has strong cultural accent. Her thought process is ruminative. There is no evidence of looseness of association or flight of ideas. Her mood is anxious, mildly irritable, and her affect appropriate to her mood. She was smiling at times in an appropriate manner. She denies any auditory or visual hallucinations. There is no evidence of any delusional thinking. She denies any current suicidal or homicidal ideation. Cognitively, She is alert and oriented to all spheres. Her recent and remote memory is intact. Her concentration is fair. Her insight is good.
Clinical Impression   Client is a 25 yo Russian female who presents with history of treatment for PTSD, ADHD, Stimulant use Disorder, in remission. Moods are anxious and irritable. She has ongoing reported symptoms of re-experiencing, avoidance, and hyperarousal of her past trauma experiences; ongoing subsyndromal symptoms related to her past ADHD diagnosis and exacerbated by her PTSD diagnosis. She denied vegetative symptoms of depression, no evident mania/hypomania, no psychosis, denied anxiety symptoms. Denied current cravings for drugs/alcohol, exhibits no withdrawal symptoms, has somatic concerns of GI upset and headaches. At the time of disposition, the client adamantly denies SI/HI ideations, plans or intent and has the ability to determine right from wrong, and can anticipate the potential consequences of behaviors and actions. She is a low risk for self-harm based on her current clinical presentation and her risk and protective factors.
Diagnostic Impression   [Student to provide DSM-5 and ICD-10 coding] Double click inside this text box to add/edit text. Delete placeholder text when you add your answers.
Treatment Plan   Medication: Increase fluoxetine 40mg po daily for PTSD #30 1 RF Continue with atomoxetine 80mg po daily for ADHD. #30 1 RF Instructed to call and report any adverse reactions. Future Plan: monitor for decrease re-experiencing, hyperarousal, and avoidance symptoms; monitor for improved concentration, less mistakes, less forgetful Education: Risks and benefits of medications are discussed including non-treatment. Potential side effects of medications discussed. Verbal informed consent obtained. Not to drive or operate dangerous machinery if feeling sedated. Not to stop medication abruptly without discussing with providers. Discussed risks of mixing medications with OTC drugs, herbal, alcohol/illegal drugs. Instructed to avoid this practice. Praised and Encouraged ongoing abstinence. Maintain support system, sponsors, and meetings. Discussed how drugs/ETOH affects mental health, physical health, sleep architecture. Patient was educated about therapy and services of the MHC including emergent care. Referral was sent via email to therapy team for PET treatment. Patient has emergency numbers: Emergency Services 911, the national Crisis Line 800-273-TALK, the MHC Crisis Clinic. Patient was instructed to go to nearest ER or call 911 if they become actively suicidal and/or homicidal. Time allowed for questions and answers provided. Provided supportive listening. Patient appeared to understand discussion and appears to have capacity for decision making via verbal conversation. RTC in 30 days Follow up with PCP for GI upset and headaches, reviewed PCP history and physical dated one week ago and include lab results Patient is amenable with this plan and agrees to follow treatment regimen as discussed.
 

Narrative Answers

  [In 1-2 pages, address the following:

· Explain what pertinent information, generally, is required in documentation to support DSM-5 and ICD-10 coding.

· Explain what pertinent documentation is missing from the case scenario, and what other information would be helpful to narrow your coding and billing options.

· Finally, explain how to improve documentation to support coding and billing for maximum reimbursement.]

Add your answers here. Delete instructions and placeholder text when you add your answers.

References

[Add APA-formatted citations for any sources you referenced]

Delete instructions and placeholder text when you add your citations.

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Pathways Mental Health

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Creating And Facilitating A Learning Environment

Creating And Facilitating A Learning Environment

Step 1 Read the scenario.

You are at the local health center, distributing information about the community efforts to promote an active walking plan. The center is crowded, and several clients are requesting information.
You are providing written instructions and a brochure to a client. This client has requested information about participating in a community program that is directed toward improving physical activity by promoting a family walking program. At the end of the walking program, the family that has achieved the most steps in the walking program will receive a year’s membership to a local fitness center. Several of the participants are asking questions.
You notice that the client has not read the brochure or instructions. When you ask if the client’s family would participate in the free fitness center membership if they win, the client responds with a question. “A free family membership at the fitness center is the prize?” You appraise the situation and realize that the client might not be able to read the brochure.

Step 2 Post a response to the discussion board by Wednesday at 11:59 pm Mountain Time
Answer the following questions in your initial response:

  • Describe two techniques used in your practice that you would use with the client to facilitate learning.
  • Describe the steps you would take in creating a supportive learning environment or sharing information to support this client.
  • Describe how you would informally assess the reading level of this client.

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Homework

Homework

Homework

The needs of the pediatric patient differ depending on age, as do the stages of development and the expected assessment findings for each stage. In a 500-750-words, examine the needs of a school-aged child between the ages of 5 and 12 years old and discuss the following:

  1. Compare the physical assessments among school-aged children. Describe how you would modify assessment techniques to match the age and developmental stage of the child.
  2. Choose a child between the ages of 5 and 12 years old. Identify the age of the child and describe the typical developmental stages of children that age.
  3. Applying developmental theory based on Erickson, Piaget, or Kohlberg, explain how you would developmentally assess the child. Include how you would offer explanations during the assessment, strategies you would use to gain cooperation, and potential findings from the assessment.

You are required to cite a minimum of three peer-reviewed sources to complete this Sources must be published within the last 5 years, appropriate for the, and relevant to nursing practice.

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Homework

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Nursing Role

Nursing Role

Nursing Role

Describe the nurse’s role and responsibility as health educator. What strategies, besides the use of learning styles, can a nurse educator consider when developing tailored individual care plans, or for educational programs in health promotion? When should behavioral objectives be utilized in a care plan or health promotion?

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Health Promotion Model

Health Promotion Model

Describe a health promotion model used to initiate behavioral changes. How does this model help in teaching behavioral changes? What are some of the barriers that affect a patient’s ability to learn? How does a patient’s readiness to learn, or readiness to change, affect learning outcomes?

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Week 5 Lab Discussion

Week 5 Lab Discussion

Please discuss one thing that you learned from lab this week.

  • 1-2 paragraphs in length
  • In APA format
     

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QUESTIONSABLE

QUESTIONSABLE

QUESTION A

Client is a 27 year old female who reports she has always been an anxious person from a young age but since the pandemic her anxiety has started to effect her social and work life- has had to call off a couple of days of work because of her symptoms. Client reports she has tried it all to help her anxiety- OTC supplements, meditation, talk therapy, exercising, eating right and is still unable to shake it. Client reports anxiety is about a 7/10 on a day to day basis and cannot identify any specific triggers for her anxiety and that she worries about everything and anything. Client reports increasingly troublesome anxiety for the last seven months and no identifiable triggers. Client reports sleep is okay but has some trouble falling asleep. Client reports no change to appetite. Client reports some lack of motivation to get out of bed in the morning because she knows how much the anxiety will ruin her day. Client denies any panic attacks. Client reports she has been married now for about two years and would like to start family planning but feels like she needs her anxiety in a better place. Client would like to trial a medication for her mental health but is concerned about weight gain and personality changes that she sees depicted on TV shows.

Assessment Scores

GAD- 7- Pt score 16

MDQ- negative

ISI- negative

PHQ-9- Pt score 6

Other Pertinent Information

NKDA

Current Daily meds- none

No SI, HI or safety concerns

Question 1– What medication would you recommend the client to trial and why? How you would conceptualize the case to a colleague? Please type your response below *

————–

Question 2– Two weeks after starting the medication you prescribed, the client above reaches out to report that they are feeling worse and not getting any better. The client reports they are not having any side effects from the medication. What would you recommend as next best steps?*

—————————

QUESTION B

Please read the following client scenario below and answer the following questions about this client’s case.

Client is a 22 year old male who reports no one takes his symptoms seriously and is done with feeling this way. Client reports he has been having thoughts of suicide but has not had a plan and doesn’t think he would ever try. Client identifies his family and girlfriend as support.

Assessment Scores

GAD- 7- Pt score 5

MDQ- negative

ISI- negative

PHQ-9- Pt score 22

Other Pertinent Information

NKDA

Current Daily meds- multivitamin gummy when he remembers to take it (most days 5/7)

Past Psych History- Denies

What appropriate next steps would you take? (Select all that apply)*

A.

Perform the C-SSRS

B.

Initiate and document a safety plan

C.

Call the client’s Emergency Contact to take them to the hospital

D.

Initiate treatment plan with appropriate medication and/or therapy

E.

Call 911

QUESTION C

Tell me about the most complex behavioral health client you have taken care of. Include your assessment and treatment plan including any prescribed medication and collaboration you required/utilized. Include rationale for treatment choices.

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QUESTIONSABLE

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Assignment 2: Study Plan

Assignment 2: Study Plan

Assignment 2: Study Plan

A study plan is essential for the purpose of staying on track and remaining focused during the completion of each progress goal and task. It will also help to avoid utter chaos and prevent stress related to confusion and procrastination (McKoy, 2018). The purpose of this paper is to explain the summary of the strengths and opportunities for improvement based on the test questions, create a study plan including three smart goals and associated tasks, and describe the resources to be used to complete the goals and tasks.

Summary of the Strengths and Opportunities for Improvement

My test grade was 70% out of 100%. Upon completion of the practice test questions, various strengths and opportunities for improvement were noted. Strengths comprised excellent skills in interviewing, assessment, intoxication and withdrawal; obtaining history and physicals; and the altered mental status. Opportunities for improvement include enhancing knowledge about how to use psychometrically validated tools such as the DSM-5, Beck Depression Inventory, the HEXACO, and the Adverse Childhood Experiences International Questionnaire. Also, I found myself to be very competent in the diagnosis and treatment sections, especially when distinguishing between different disorders. I also plan to improve my knowledge regarding ethical issues in the medical field.

SMART Goals and Tasks

Goal 1: To help me prepare for my national certification, I will study and follow the weekly readings in the course materials including the psychiatric interview.

Task one: Creating a timetable for studying specific material.

Task two: Specifying hours and the time needed for each material during the preparation of the national examination.

Task three: Consulting with my preceptor about the information I may need to know about as I prepare for my national certification.

Goal 2: To study the chapters of the “Psychiatric Mental Health Nurse Practitioner Certification Review Manual” by the end of the practicum period.

Task one: Following the weekly readings for each course.

Task two: Setting apart a specific day each week for reviewing the chapters assigned for the week.

Task three: Allocating a two hour period for studying.

Goal 3: To list the areas of my knowledge base that I consider weak and decide the topics I need to concentrate more on by week eleven.

Task one: Writing down my weaknesses.

Task two: Reviewing each of my weaknesses during the makeup hours allocated in my timetable.

Task three: Using weekly reading assignments to assess any additional witnesses.

To measure my progress, I will compare my overall main goals with the degree of accomplishment I experienced during specific milestones (for example, weekly milestones). I will also assess how well I completed my goals and go back to the already accomplished goals to determine any details that may have been missed initially (Kverno & Fenton, 2021). I will also use my assignment grades as a way of measuring my progress as well as utilizing the feedback I receive from my preceptor and instructors (Harper et al., 2017).

Resources to Accomplish the Goals and Tasks

I will utilize the Psychiatric Mental Health Nurse Practitioner Review Manual as a key resource during the progress of the course (Horowitz & Posmontier, 2020). Additionally, I will utilize my relationship with colleagues to form a study group using Internet applications like Microsoft Teams or Zoom. Also, I will utilize an online review course to obtain online educational tutoring as a resource for completing the goals and tasks (Peterson et al., 2019).

Conclusion

I plan to devote a lot of time and effort to perfecting my study plan and ensuring that it helps me achieve my goals and tasks. I will also stick to the plan and utilize every available resource to establish and achieve my goals. In the process, I will incorporate other process goals and objectives that will help me achieve my long-term goals. I will utilize several appropriate resources to prepare myself and make sure that I am confident and ready for my national certification exam.

References

Harper, D. C., McGuinness, T. M., & Johnson, J. (2017). Clinical residency training: Is it essential to the Doctor of Nursing Practice for nurse practitioner preparation?. Nursing outlook, 65(1), 50-57.

Horowitz, J. A., & Posmontier, B. (2020). A call to action: Reclaiming our PMH APN heritage. Archives of Psychiatric Nursing, 34(5), 351-354.

Kverno, K. S., & Fenton, A. (2021). Specialization Within a Specialty: Advanced Practice Psychiatric Nursing Pathways for the Greatest Good. Journal of psychosocial nursing and mental health services, 59(10), 13-18.

McCoy, K. T. (2018). Achieving full scope of practice readiness using evidence for psychotherapy teaching in web and hybrid approaches in psychiatric mental health advanced practice nursing education. Perspectives in psychiatric care, 54(1), 74-83.

Peterson, B. L., Pittenger, A. L., Kaas, M. J., & Lounsbery, J. L. (2019). Partnering for a sustainable interprofessional psychiatric mental health nurse practitioner education curriculum. Journal of Nursing Education, 58(12), 723-727.

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Fishbone Chart

Fishbone Chart

The purpose of this assignment is to use a Fishbone Diagram to complete a root cause analysis. Identify a problem in your practice environment and utilize the topic Resource “Fishbone Analysis Diagram Template” to work through the problem to the root cause. Refer to “Problem-Solving Your Fishbone Into a Wishbone,” located in the topic Resources to complete this assignment.

While APA style is not required for Part 1, 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.

Prepare Part 2 of the template according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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

Rubric

Fishbone Diagram

The Fishbone Analysis Diagram is present and includes substantial relevant details.

A description of the purpose of progress tracking in project management is present and thorough.

A description of the how and when it is best to implement project adjustments is present and thorough.

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

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