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Wk 3 Patho Knowledge Check

Take Test: Module 2 Knowledge Check

Test Information

DescriptionInstructionsMultiple AttemptsNot allowed. This test can only be taken once.Force CompletionThis test can be saved and resumed later.

 Question Completion Status:

QUESTION 1

1. CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”
   HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.
   Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dl
   His diagnosis is an acute inferior wall myocardial infarction.
   1 of 2 Questions:
   Why is HDL considered the “good” cholesterol?
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2 points  

QUESTION 2

1. CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”
   HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.
   Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dl
   His diagnosis is an acute inferior wall myocardial infarction.
   2 of 2 Questions:
   Explain the role inflammation has in the development of atherosclerosis.
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3 points  

QUESTION 3

1. A 45-year-old woman with a history of systemic lupus erythematosus (SLE) presents to the Emergency Room (ER) with complaints of sharp retrosternal chest pain that worsens with deep breathing or lying down. She reports a 3-day history of low-grade fever, listlessness and says she feels like she had the flu. Physical exam reveals tachycardia and a pleural friction rub. She was diagnosed with acute pericarditis.
   Question:
   What does the Advanced Practice Registered Nurse (APRN) recognize as the result of the pleural friction rub?
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1 points  

QUESTION 4

1. A 15-year-old adolescent male comes to the clinic with his parents with a chief complaint of fever, nausea, vomiting, poorly localized abdominal pain, arthralgias, and “swollen lymph nodes”. States he has felt “lousy” for a couple weeks. The fevers have been as high as 102 F. His parents thought he had the flu and took him to an Urgent Care Center. He was given Tamiflu® and sent home. He says the Tamiflu didn’t seem to work. States had a slight sore throat a couple weeks ago and attributed it to the flu. Physical exam revealed thin young man who appears to be uncomfortable but not acutely ill. Posterior pharynx reddened and tonsils 3+ without exudate. + anterior and posterior cervical lymphadenopathy. Tachycardic and a new onset 2/6 high-pitched, crescendo-decrescendo systolic ejection murmur auscultated at the left sternal border. Rapid strep +. The patient was diagnosed with acute rheumatic heart disease (RHD).
   Question:
   Explain how a positive strep test has caused the patient’s symptoms.
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1 points  

QUESTION 5

1. The APRN sees a 74-year-old obese female patient who is 2 days post-op after undergoing left total hip replacement. The patient has had severe post op nausea and vomiting and has been unable to go to physical therapy. Her mucus membranes are dry. The patient says she feels like the skin on her left leg is too tight. Exam reveals a swollen, tense, and red colored calf. The patient has a duplex ultrasound which reveals the presence of a deep venous thrombosis (DVT).
   Question:
   Describe the factors that could have contributed to the development of a DVT in this patient explain how each of the factors could cause DVT.
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1 points  

QUESTION 6

1. A 45-year-old woman is 10 days status post partial small bowel resection for Crohn Disease and has been recuperating at home. She suddenly develops severe shortness of breath, becomes weak, and her blood pressure drops to 80/40 mmHg (previous readings ~130/80s mmHg). The pulse oximetry is 89% on room air. The APRN suspects the patient experienced a massive pulmonary embolus.
   Question:
   Explain why a large pulmonary embolus interferes with oxygenation.
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1 points  

QUESTION 7

1. A 45-year-old woman is 10 days status post partial small bowel resection for Crohn Disease and has been recuperating at home. She suddenly develops severe shortness of breath, becomes weak, and her blood pressure drops to 80/40 mmHg (previous readings ~130/80s mmHg). The pulse oximetry is 89% on room air. While waiting for the Emergency Medical Service (EMS) to arrive, the APRN places EKG leads and the EKG demonstrates right ventricular strain.
   Question:
   Explain why a large pulmonary embolism causes right ventricular strain.
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1 points  

QUESTION 8

1. A 12-year-old girl is brought to the Emergency Room (ER) by her mother with complaints of shortness of breath, wheezing, tachypnea, tachycardia, and a non-productive cough. The mother states they had just come from a fall festival where the entire family enjoyed a hayride. The symptoms began shortly after they left the festival but got better a couple hours after they returned home. The symptoms began again about 6 hours later and seem to be worse. The mother states there is no history of allergies or frequent respiratory infections. The child is up to date on all vaccinations. The child was diagnosed with asthma. The nurse practitioner explained to the mother that her child was exhibiting symptoms of asthma, and probably had an early asthmatic response and a late asthmatic response.
   Question 1 of 2:
   Explain early asthmatic responses and the cells responsible for the responses.
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2 points  

QUESTION 9

1. A 12-year-old girl is brought to the Emergency Room (ER) by her mother with complaints of shortness of breath, wheezing, tachypnea, tachycardia, and a non-productive cough. The mother states they had just come from a fall festival where the entire family enjoyed a hayride. The symptoms began shortly after they left the festival but got better a couple hours after they returned home. The symptoms began again about 6 hours later and seem to be worse. The mother states there is no history of allergies or frequent respiratory infections. The child is up to date on all vaccinations. The child was diagnosed with asthma. The nurse practitioner explained to the mother that her child was exhibiting symptoms of asthma, and probably had an early asthmatic response and a late asthmatic response.
   Question 2 of 2:
   Explain late asthmatic responses and the cells responsible for the responses.
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2 points  

QUESTION 10

1. A 64-year-old man with a 40 pack/year history of cigarette smoking has been diagnosed with emphysema.  He asks the APRN if this means he has COPD.
   Question 1 of 2:
   Explain the pathophysiology of emphysema and how it relates to COPD.
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2 points  

QUESTION 11

1. A 64-year-old man with a 40 pack/year history of cigarette smoking has been diagnosed with emphysema.  He asks the APRN if this means he has COPD.
   Question 2 of 2:
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2 points  

QUESTION 12

1. Mr. Jones is a 78-year-old gentleman who presents to the clinic with a chief complaint of fever, chills and cough. He also reports some dyspnea. He has a history of right sided CVA, COPD, dyslipidemia, and HTN. Current medications include atorvastatin 40 mg po qhs, lisinopril, and fluticasone/salmeterol. He reports more use of his albuterol rescue inhaler.
   Vital signs Temp 101.8 F, pulse 108, respirations 21. PaO2 on room air 86% and on O2 4 L nasal canula 94%. CMP WNL, WBC 18.4. Physical exam reveals thin, anxious gentleman with mild hemiparesis on left side due to CVA. HEENT WNL except for diminished gag reflex and uneven elevation of the uvula, CV-HR 108 RRR without murmurs, rubs, or click, no bruits. Resp-coarse rhonchi throughout lung fields. CXR reveals consolidation in right lower lobe. He was diagnosed with community acquired pneumonia (CAP).
   Question:
   Patient was hypoxic as evidenced by the low PaO2. Explain the pathologic processes that caused this patient’s hypoxemia.
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1 points  

QUESTION 13

1. A 64-year-old woman with moderately severe COPD comes to the pulmonary clinic for her quarterly checkup. The APRN reviewing the chart notes that the patient has lost 5% of her body weight since her last visit. The APRN questions the patient and patient admits to not having much of an appetite and she also admits to missing some meals because it “takes too much work” to cook and consume dinner.
   Question:
   The APRN recognizes that COPD has a deleterious effect on patients. Explain why patients with COPD are at risk for malnutrition.
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1 points  
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NURS 6052 Evidence-Based

Evaluation Table
Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

* These levels are from the Johns Hopkins Nursing Evidence-Based Practice: Evidence Level and Quality Guide
· Level I
Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis
· Level II
Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis
· Level III
Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis
· Level IV
Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence
· Level V
Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence
**Note on Conceptual Framework
· The following information is from Walden academic guides which helps explain conceptual frameworks and the reasons they are used in research. Here is the link /orders/academicguides.waldenu.edu/library/conceptualframework
· Researchers create theoretical and conceptual frameworks that include a philosophical and methodological model to help design their work. A formal theory provides context for the outcome of the events conducted in the research. The data collection and analysis are also based on the theoretical and conceptual framework.
· As stated by Grant and Osanloo (2014), “Without a theoretical framework, the structure and vision for a study is unclear, much like a house that cannot be constructed without a blueprint. By contrast, a research plan that contains a theoretical framework allows the dissertation study to be strong and structured with an organized flow from one chapter to the next.”
· Theoretical and conceptual frameworks provide evidence of academic standards and procedure. They also offer an explanation of why the study is pertinent and how the researcher expects to fill the gap in the literature.
· Literature does not always clearly delineate between a theoretical or conceptual framework. With that being said, there are slight differences between the two.
References
The Johns Hopkins Hospital/Johns Hopkins University (n.d.). Johns Hopkins nursing dvidence-based practice: appendix C: evidence level and quality guide. Retrieved October 23, 2019 from /orders/www.hopkinsmedicine.org/evidence-based-practice/_docs/appendix_c_evidence_level_quality_guide.pdf
Grant, C., & Osanloo, A. (2014). Understanding, Selecting, and Integrating a Theoretical Framework in Dissertation Research: Creating the Blueprint for Your” House”. Administrative Issues Journal: Education, Practice, and Research, 4(2), 12-26.
Walden University Academic Guides (n.d.). Conceptual & theoretical frameworks overview. Retrieved October 23, 2019 from /orders/academicguides.waldenu.edu/library/conceptualframework
Critical Appraisal Tool Worksheet Template
 
 

Nurs 6521 Assignment: Off-Label Drug Use in Pediatrics

Nurs 6521 Assignment: Off-Label Drug Use in Pediatrics

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 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.

 Interactive media piece:

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).

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.

Nurs-6512 Assign Wk6

Assignment 1: Lab Assignment: Assessing the Abdomen
A male went to the emergency room for severe midepigastric abdominal pain. He was diagnosed with AAA; however, as a precaution, the doctor ordered a CTA scan.
Because of a high potential for misdiagnosis, determining the precise cause of abdominal pain can be time consuming and challenging. By analyzing case studies of abnormal abdominal findings, nurses can prepare themselves to better diagnose conditions in the abdomen.
In this Lab 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 assessments and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.
To Prepare
Review the Episodic note case study your instructor provides you for this week’s Assignment.

• About      the Episodic note case study provided:
  • Review       this week’s Learning Resources and consider the insights they provide       about the case study.
  • Consider       what history would be necessary to collect from the patient in the case       study.
  • Consider       what physical assessment 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.

Case study
ABDOMINAL ASSESSMENT
Subjective:
CC: “My stomach has been hurting for the past two days.”
HPI: LZ, 65 y/o AA male, presents to the emergency department with a two days history of intermittent epigastric abdominal pain that radiates into his back. He went to the local Urgent Care where was given PPI’s with no relief. At this time, the patient reports that the pain has been increasing in severity over the past few hours; he vomited after lunch, which led his to go to the ED at this time. He has not experienced fever, diarrhea, or other symptoms associated with his abdominal pain.
PMH: HTN
Medications: Metoprolol 50mg
Allergies: NKDA
FH: HTN, Gerd,  Hyperlipidemia
Social Hx: ETOH, smoking for 20 years but quit both 2 years ago, divorced for 5 years, 3 children, 2 males, 1 female
Objective:

• VS: Temp 98.2; BP 91/60; RR 16; P 76; HT 6’10”; WT 262lbs
• Heart: RRR, no murmurs
• Lungs: CTA, chest wall symmetrical
• Skin: Intact without lesions, no urticaria
• Abd: abdomen is tender in the epigastric area with      guarding but without mass or rebound.
• Diagnostics: US and CTA

Assessment:

1. Abdominal Aortic Aneurysm (AAA)
2. Perforated Ulcer
3. Pancreatitis

PLAN: 
The Assignment

1. Analyze      the subjective portion of the note. List additional information that      should be included in the documentation.
2. Analyze      the objective portion of the note. List additional information that should      be included in the documentation.
3. Is      the assessment supported by the subjective and objective information? Why      or why not?
4. What      diagnostic tests would be appropriate for this case, and how would the      results be used to make a diagnosis?
5. 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.Episodic/Focused SOAP Note Template
    
   Patient Information:
   Initials, Age, Sex, Race
   S.
   CC (chief complaint) a BRIEF statement identifying why the patient is here – in the patient’s own words – for instance “headache”, NOT “bad headache for 3 days”.
   HPI: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form not a list. If the CC was “headache”, the LOCATES for the HPI might look like the following example:
   Location: head
   Onset: 3 days ago
   Character: pounding, pressure around the eyes and temples
   Associated signs and symptoms: nausea, vomiting, photophobia, phonophobia
   Timing: after being on the computer all day at work
   Exacerbating/ relieving factors: light bothers eyes, Aleve makes it tolerable but not completely better
   Severity: 7/10 pain scale
   Current Medications: include dosage, frequency, length of time used and reason for use; also include OTC or homeopathic products.
   Allergies: include medication, food, and environmental allergies separately (a description of what the allergy is ie angioedema, anaphylaxis, etc. This will help determine a true reaction vs intolerance).
   PMHx: include immunization status (note date of last tetanus for all adults), past major illnesses and surgeries. Depending on the CC, more info is sometimes needed Soc Hx: include occupation and major hobbies, family status, tobacco & alcohol use (previous and current use), any other pertinent data. Always add some health promo question here – such as whether they use seat belts all the time or whether they have working smoke detectors in the house, living environment, text/cell phone use while driving, and support system.
   Fam Hx: illnesses with possible genetic predisposition, contagious or chronic illnesses. Reason for death of any deceased first degree relatives should be included. Include parents, grandparents, siblings, and children. Include grandchildren if pertinent.
   ROS: cover all body systems that may help you include or rule out a differential diagnosis You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe.
   Example of Complete ROS:
   GENERAL:  Denies weight loss, fever, chills, weakness or fatigue.
   HEENT:  Eyes: Denies visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat:  Denies hearing loss, sneezing, congestion, runny nose or sore throat.
   SKIN:  Denies rash or itching.
   CARDIOVASCULAR:  Denies chest pain, chest pressure or chest discomfort. No palpitations or edema.
   RESPIRATORY:  Denies shortness of breath, cough or sputum.
   GASTROINTESTINAL:  Denies anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.
   GENITOURINARY:  Burning on urination. Pregnancy. Last menstrual period, MM/DD/YYYY.
   NEUROLOGICAL:  Denies headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.
   MUSCULOSKELETAL:  Denies muscle, back pain, joint pain or stiffness.
   HEMATOLOGIC:  Denies anemia, bleeding or bruising.
   LYMPHATICS:  Denies enlarged nodes. No history of splenectomy.
   PSYCHIATRIC:  Denies history of depression or anxiety.
   ENDOCRINOLOGIC:  Denies reports of sweating, cold or heat intolerance. No polyuria or polydipsia.
   ALLERGIES:  Denies history of asthma, hives, eczema or rhinitis.
   O.
   Physical exam: From head-to-toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head to toe format i.e. General: Head: EENT: etc.
   Diagnostic results: Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines)
   A .
   Differential Diagnoses (list a minimum of 3 differential diagnoses).Your primary or presumptive diagnosis should be at the top of the list. For each diagnosis, provide supportive documentation with evidence based guidelines.
   P. 
   This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.
   References
   You are required to include at least three evidence based peer-reviewed journal articles or evidenced based guidelines which relates to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.
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Assess and treat pediatric clients presenting symptoms of a mental health disorder

For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting symptoms of a mental health disorder.
The Assignment:
Examine Case 2: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.
At each Decision Point, stop to complete the following:

• Decision #1: Differential Diagnosis
  • Which Decision did you select?
  • Why did you select this Decision? Support your  response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?
  •  
• Decision #2: Treatment Plan for Psychotherapy
•       Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
•       What were you hoping to achieve by making this Decision? Support your response with evidence and references to
•       the Learning Resources.
•       Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why
•       were they different?
•  
• Decision #3: Treatment Plan for Psychopharmacology
  • Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
•  
• Also include how ethical considerations might impact   your treatment plan and communication with clients and their families.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

Case #2 Anxiety disorder, OCD, or something else?

BACKGROUND
Tyrel is an 8-year-old black male who is brought in by his mother for a variety of psychiatric complaints. Shaquana, Tyrel’s mother, reports that Tyrel has been exhibiting a lot of worry and “nervousness” over the past 2 months. She states that she notices that he has been quite “keyed up” and spends a great deal of time worrying about “germs.” She states that he is constantly washing his hands because he feels as though he is going to get sick like he did a few weeks ago, which kept him both out of school and off the playground. He was also not able to see his father for two weekends because of being sick. Shaquana explains that although she and her ex-husband Desmond divorced about 2 years ago, their divorce was amicable and they both endeavor to see that Tyrel is well cared for.
Shaquana reports that Tyrel is irritable at times and has also had some sleep disturbances (which she reports as “trouble staying asleep”). She reports that he has been more and more difficult to get to school as he has become nervous around his classmates. He has missed about 8 days over the course of the last 3 weeks. He has also stopped playing with his best friend from across the street.
His mother reports that she feels “responsible” for his current symptoms. She explains that after he was sick with strep throat a few weeks ago, she encouraged him to be more careful about washing his hands after playing with other children, handling things that did not belong to him, and especially before eating. She continues by saying “maybe if I didn’t make such a big deal about it, he would not be obsessed with germs.”
Per Shaquana, her pregnancy with Tyrel was uncomplicated, and Tyrel has met all developmental milestones on time. He has had an uneventful medical history and is current on all immunizations.
OBJECTIVE
During your assessment of Tyrel, he seems cautious being around you. He warms a bit as you discuss school, his friends at school, and what he likes to do. He admits that he has been feeling “nervous” lately, but when you question him as to why, he simply shrugs his shoulders.
When you discuss his handwashing with him, he tells you that “handwashing is the best way to keep from getting sick.” When you question him how many times a day he washes his hands, he again shrugs his shoulders. You can see that his bilateral hands are dry. Throughout your assessment, Tyrel reveals that he has been thinking of how dirty his hands are; and no matter how hard he tries to stop thinking about his “dirty” hands, he is unable to do so. He reports that he gets “really nervous” and “scared” that he will get sick, and that the only way to make himself feel better is to wash his hands. He reports that it does work for a while and that he feels “better” after he washes his hands, but then a little while later, he will begin thinking “did I wash my hands well enough? What if I missed an area?” He reports that he can feel himself getting more and more “scared” until he washes his hands again.
MENTAL STATUS EXAM
Tyrel is alert and oriented to all spheres. Eye contact varies throughout the clinical interview. He reports his mood as “good,” admits to anxiety. Affect consistent to self-reported mood. He denies visual/auditory hallucinations. No overt delusional or paranoid thought processes were apparent. He denies suicidal ideation.
Lab studies obtained from Tyrel’s pediatric nurse practitioner were all within normal parameters. An antistreptolysin O antibody titer was obtained for reasons you are unclear of, and this titer was shown to be above normal parameters.
Decision Point One
BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PMHNP GIVE TO TYREL?
In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.
 
Generalized Anxiety Disorder (GAD)
Obsessive Compulsive Disorder
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (“PANDAS”)
ANSWER CHOSEN: Obsessive Compulsive Disorder
Decision Point Two
BASED ON THE ABOVE IN FORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.
 
Begin Zoloft 50 mg orally daily
Begin Fluvoxamine immediate release 25 mg orally at bedtime
Begin Fluvoxamine controlled release 100 mg orally in the morning
 
ANSWER CHOSEN

Begin Fluvoxamine immediate release 25mg orally at bedtime
 
RESULTS OF DECISION POINT TWO
·  Client returns to clinic in four weeks
· Upon return to the clinic, Tyrel’s mother reported that he has had some  
  decrease in his symptoms. She states that the frequency of the handwashing 
  has decreased, and Tyrel seems a bit more “relaxed” overall.
·  She also reports that Tyrel has not fully embraced returning to school, but that  
  his attendance has improved. She reported that over this past weekend, Tyrel    
  went outside to play with his friend from across the street, which he has not  
 done in a while.
 
Decision Point Three
BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.
 
Increase Fluvoxamine to 50 mg orally at bedtime
Augment with an atypical antipsychotic such as Abilify
Augment treatment with cognitive behavioral therapy
ANSWER CHOSEN: 

Increase Fluvoxamine to 50 mg orally at bedtime
Guidance to Student
In terms of an actual diagnosis, the child’s main symptoms are most consistent with obsessive-compulsive disorder. There may also be an element of social phobia developing, but at this point, the PMHNP has not assessed the nature of the school avoidance—that is, why is the child avoiding school. Notice that nothing in the scenario tells us that the PMHNP has assessed this.
Fluvoxamine immediate release is FDA-approved for the treatment of OCD in children aged 8 years and older. Fluvoxamine’s sigma-1 antagonist properties may cause sedation and as such, it should be dosed in the evening/bedtime.
At this point, it would be appropriate to consider increasing the bedtime dose, especially since the child is responding to the medication and there are no negative side effects.
Atypical antipsychotics are typically not used in the treatment of OCD. There is also nothing to tell us that an atypical antipsychotic would be necessary (e.g., no psychotic symptoms). Additionally, the child seems to be responding to the medication, so there is no rationale as to why an atypical antipsychotic would be added to the current regimen.
Cognitive behavioral therapy is the psychotherapy of choice for treating OCD. The PMHNP should augment medication therapy with CBT. If further assessment determines that Tyrel has social anxiety disorder, CBT is effective in treating this condition as well.
Learning Resources
Required Readings
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.  Chapter      31, “Child Psychiatry” (pp. 1253–1268)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author  “Anxiety Disorders”
American Academy of Child & Adolescent Psychiatry (AACAP). (2012a). Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 51(1), 98–113. Retrieved from http://www.jaacap.com/article/S0890-8567(11)00882-3/pdf 
McClelland, M., Crombez, M-M., Crombez, C., Wenz, C., Lisius, M., Mattia, A., & Marku, S. (2015). Implications for advanced practice nurses when pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is suspected: A qualitative study. Journal of Pediatric Health Care, 29(5), 442–452. doi:10.1016/j.pedhc.2015.03.005
Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press. 
To access information on the following medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

SCORE A+ WITH HELP FROM OUR PROFESSIONAL WRITERS – Assess and treat pediatric clients presenting symptoms of a mental health disorder

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 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.

• 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. Assess and treat pediatric clients presenting symptoms of a mental health disorder

• 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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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 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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Evidence-based treatment for schizophrenia

Evidence-based treatment for schizophrenia

Children and adolescents with schizophrenia have more difficulty functioning in academic or work settings, and significant impairment usually persists into adulthood. They may have speech or language disorders and in some cases borderline intellectual functioning. These individuals are more likely to complete suicide attempts or die from other accidental causes. Schizophrenia is characterized by positive and negative symptoms. Positive symptoms include hallucinations, delusions, and behavior disturbance. Negative symptoms include blunted affect and attention, apathy, and lack of motivation and social interest.
In this Assignment, you compare treatment plans for adults diagnosed with schizophrenia with treatment plans for children and adolescents diagnosed with schizophrenia. You also consider the legal and ethical issues involved in medicating children diagnosed with schizophrenia.
                    
                                                    To Prepare for this Assignment:
· Review the Learning Resources concerning early-onset schizophrenia.
The Assignment (2 pages):
· Compare at least two evidence-based treatment plans for adults diagnosed with schizophrenia with evidence-based treatment plans for children and adolescents diagnosed with schizophrenia.
· Explain the legal and ethical issues involved with forcing children diagnosed with schizophrenia to take medication for the disorder and how a PMHNP may address those issues.
Note: (1)To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
            (2) DO NOT FORGET TO INCLUDE INTRODUCTION,CONCLUSION AND   
                  REFERENCES
Required Readings
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

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

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

• “Schizophrenia Spectrum and      Other Psychotic Disorders”

McClellan, J., & Stock, S. (2013). Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. Journal of the American Academy of Child & Adolescent Psychiatry, 52(9), 976–990. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00112-3/pdf
Giles, L. L., & Martini, D. R. (2016). Challenges and promises of pediatric psychopharmacology. Academic Pediatrics, 16(6), 508–518. doi:10.1016/j.acap.2016.03.011
Hargrave, T. M., & Arthur, M. E. (2015). Teaching child psychiatric assessment skills: Using pediatric mental health screening tools. International Journal of Psychiatry in Medicine, 50(1), 60–72. Retrieved from http://search.proquest.com.ezp.waldenulibrary.org/docview/1702699596?accountid=14872

ADDITIONAL INSTRUCTIONS FOR THE CLASS

SCORE A+ WITH HELP FROM OUR PROFESSIONAL WRITERS – Evidence-based treatment for schizophrenia

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 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.

• 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. Evidence-based treatment for schizophrenia

• Guarantee

  

• Zero Plagiarism
• On-time delivery
• A-Grade Papers
• Free Revision
• 24/7 Support
• 100% Confidentiality
• Professional Writers

• Services Offered

• Custom paper writing
• Question and answers
• Essay paper writing
• Editing and proofreading
• Plagiarism removal services
• Multiple answer questions

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 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.

Looking for a Similar Assignment? Order a custom-written, affordable, plagiarism-free paper

Nursing Finances

Throughout this course, you’ve examined the importance of anticipating financial fluctuations that may impact your organization’s ability to provide services. While financial managers have no time machines or crystal balls, they do have expense forecasts. Expense forecasting is one of the preeminent tools that financial managers can use to prepare their organizations for future fiscal turbulence. In this Assignment, you will examine a scenario and generate a corresponding expense forecast in Excel.
Before pursuing an opportunity or making a major purchase, financial decision makers must first ascertain if the expenditures are justified. Determining whether a new process, system, or purchase will yield worthwhile returns is no easy task. However, managers have a variety of tools to help them decide whether the new expenditure is warranted. Analyzing a venture’s benefit/cost ratio, marginal profit and loss statement, and break-even points enable nurse managers to make educated decisions about how they choose to commit their funds.

Note: For those Assignments in this course that require you to perform calculations you must:Use the Excel spreadsheet template for the Week 3 assignment
Show all your calculations and formulas in the spreadsheet.
Answer any questions included with the problems (as text in the Excel spreadsheet).

 
Expense Forecasting
In this Application Assignment you calculate scenarios focusing on benefit/cost ratio analysis, marginal profit and loss statements, and break-even analysis. For these scenarios, you will utilize the provided figures to perform calculations and then make recommendations about the viability of the investment opportunities
Expense Forecasting Scenario
Your department has performed 20,000 procedures during the first six months (January–June) of 20X1. Spending during that period of time was $210,000 for fixed expense items and $1,200,000 for variable expense items. Of those amounts, $50,000 of fixed expense money was spent on preparing for a Joint Commission survey. Volume is anticipated to be 10% higher in the second half of the year. On November 1st, two new procedure technicians will begin work. The salary and fringe benefit costs for each are $96,000/year. Based on the information provided, prepare an expense forecast for 20X1.
Annualization for Fixed:  (Adjusted Total for Year to Date Expense/6) * 12 =Total Annualized Amounts
Annualization for Variable (Adjusted Total for Year to Date Expense/ 20,000) * 40,000 =Total Annualized Amounts.
Financial Analysis Cycle

Marginal Profit and Loss Statement Scenario

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

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

Break-Even Analysis Scenario

You can charge $1,075 for a new service. Demand is anticipated to be 8,000 units a year. Your business is able to handle up to 16,500 units annually, so capacity should not be a problem. The average collection rate is 80%. The new service has annual fixed costs of $4,700,000. Variable cost per unit of service is $420.
Question: Use break-even analysis to determine if this new service is financially viable. If the business is not financially viable, what steps could you take to make a case to proceed with implementation?  Explain your decision.

Benefit/Cost Ratio Analysis Scenario

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

• What is meant by  benefit/cost ratio, average payback period and ROI  and why are the all  important to understand when purchasing new equipment?
• Based on this information, would you pursue this opportunity?
• Explain your decision  in 250-500 words in the text box below.

References:
 

Baker, J. J., Baker, R. W., & Dworkin, N. R.  (2018). Health care finance: Basic  tools for nonfinancial managers (5th ed.). Burlington, MA: Jones and  Bartlett Learning.
Chapter 14, “Trend Analysis, Common Sizing, and Forecasted Data” (pp. 149-160)
The focus of this chapter is the use of trend analysis and forecasting to develop future budgets and make financial decisions about capital purchases, programs, and personnel.
Chapter 15, “Using Comparative Data” (pp. 161-173)
In this chapter, you are introduced to the criteria for identifying other health care organizations that are comparable to your own. Data from these organizations can then be used to evaluate your own organizational performance.
Chapter 19, “Estimates, Benchmarking, and Other Measurement Tools” (pp. 223-231)
In this chapter, you continue exploring the concept of financial benchmarking. The chapter focuses on the importance of benchmarking for identifying performance gaps.

Zelman, W., McCue, M., & Glick, N. (2009). Financial management of health care organizations: An introduction to fundamental tools, concepts, and applications (3rd ed.). Hoboken, NJ: Jossey-Bass.
Retrieved from the Walden Library databases.
Chapter 5, “Working Capital Management” (pp. 187–231)
This chapter examines the concept of working capital. The authors explore the specifics of current assets and the management of the working capital cycle.
Chapter 11, “Responsibility Accounting” (pp. 468–497)
Review: This chapter explores the trend toward the decentralization of health care organizations and the challenges this presents. This chapter also describes responsibility centers, or organizational units intended to achieve specific tasks.

Mulva, S., & Dai, J. (2009) Health care facility benchmarking. HERD, 3(1), 28–37.
Reprinted by permission of Sage Publications via the Copyright Clearance Center.
This article describes a national health care facility’s benchmarking program. It is designed to compare measures of capital project performance.

Agency for Healthcare Research and Quality. (2013). Measuring and benchmarking clinical performance. Retrieved from www.ahrq.gov

Ettorchi-Tardy, A., Levif, M., & Michel, P. (2012). Benchmarking: A Method for Continuous Quality Improvement in Health. Healthcare Policy, e101-e119. Retrieved fromhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3359088/

Expense Forecasting

Name	Assignment
Expense Forecasting
Based on the information provided, prepare an expense forecast for 20X1 using the template below:
Spending during January- June 20X1 (6 months)
·      Fixed expense items: $210,000
·      Variable expense items: $1,200,000
·      One time expense: $50,000 of fixed expense money was spent on preparing for a Joint Commission survey
Procedures preformed during January- June 20X1 (6 months)
·      Your department has performed 20,000 procedures during the first six months
On November 1,20X1, two new procedure technicians will begin work. The salary and fringe benefit costs for each is:	$96,000	yearly
Description	Fixed	Variable	TOTAL
Year to Date Expense
Adjustments
Add back “One Time” credits
Deduct “one Time” expenses
Adjusted total for year to date expense
Annualization
Divide by months (fixed)	6
Multiple by months (fixed)	12
Divide by volume	20,000
Multiply by volume	40,000
Annualized Amounts
Adjustments
Add back “One Time” expenses
Deduct “One Time” credits
Expense two new technicians
Expense Forecast as of 12/31/X1
Calculations:
Annualization for Fixed: (Adjusted Total for Year to Date Expense/6) * 12 =Total Annualized Amounts
Annualization for Variable (Adjusted Total for Year to Date Expense/ 20,000) * 40,000 =Total Annualized Amounts

Marginal Profit and Loss

Marginal Profit and Loss Statement Scenario
You are examining a proposal for a new business opportunity – a new procedure for which demand is expected to be 1,400 units the first year, growing by 600 units each year thereafter. The price charged per procedure is $1,000. The collection rate is anticipated to be 80%. Each procedure consumes $300 of supplies. Salary cost is estimated to cost $540,000 each year, fringe benefits are 25% of salaries, rent for the facility is $55,000/yr and operating cost are $120,000/yr.
Year One	Year Two	Year Three	Year Four	Year Five
Marginal Revenue
Units of Volume
Price Procedure
Collection Rate
Marginal Net Revenue
Marginal Costs
Variable Costs
Units of Volume
Variable Cost Supplies per Unit/procedure
Marginal Variable Cost
Fixed Costs
Salary Costs
Fringe Benefits
Rent
Operating Cost
Marginal Fixed Costs
Total Marginal Costs
Annual Marginal Profit
Cumulative Profit Margin
Question: Below is a marginal P&L for this business opportunity. Based on that analysis, should this opportunity be pursued. Explain your decision.
Answer:

Breakeven Analysis

Break-Even Analysis Scenario

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

Price to be Charged

Collection Rate

Average Collection per Service

Variable cost per unit of service

Fixed Operating Costs

Break-Even Point =

Fixed Cost/(Net Revenue per Unit-Variable Cost per Unit)

Capacity:

Demand:

Breakeven:

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

Answer:

Benefit Cost Ratio

Benefit/Cost Ratio Analysis Scenario
You are considering the acquisition of a new piece of equipment with a useful life of five years. This new technology will make your clinical operation more efficient and allow for a reduction of 10 FTEs. The equipment purchase price is $4,500,000 plus 10% installation fee. The purchase price includes service for the first year, an item that has an annual cost of $10,000. There is a potential for additional volume of 150,000 units in the first year, growing by 30,000 each year thereafter. The price charged per unit is $15.00 with a 50% collection rate. The staff being eliminated are paid $12.50 per hour. The fringe benefits rate is 20%. The hurdle rate is 7.5%.
Question: After reviewing Dr. Ward’s Video and the calculations below, please answer the following questions: 1. What is meant by benefit/cost ratio, average payback period and ROI and why are the all important to understand when purchasing new equipment? Based on this information, would you pursue this opportunity? Explain your decision in 250-500 words in the text box below.
Investment Present Value
Present Value Factors
Total Investment	Present Value
Construction	Equipment	Installation	Other
Year 0	$	4,500,000	$	450,000	$	4,950,000	1	$	4,950,000
Year 1
Year 2
Year 3
Year 4
Total	$	4,500,000	$	450,000	$	4,950,000	$	4,950,000
Benefit Present Value
Present Value Factors
Revenue Increases	Revenue Decreases	Expense Decreases	Expense Increases	Total Benefit	Present Value
Year 1	1,125,000	312,000	1,437,000	0.93	1,336,744
Year 2	1,350,000	312,000	10,000	1,652,000	0.865	1,429,529
Year 3	1,575,000	312,000	10,000	1,877,000	0.805	1,510,911
Year 4	1,800,000	312,000	10,000	2,102,000	0.749	1,573,979
Year 5	2,025,000	312,000	10,000	2,327,000	0.697	1,620,892
Total	7,875,000	1,560,000	40,000	9,395,000	7,472,055
Net Present Value	2,522,055
Benefit/Cost Ratio	1.51
Total Cash Inflow	9,395,000
Average annual cash inflow	1,879,000
Average payback period (in Years)	2.6
Return on investment =	Average Annual Return / Average Investment
=	( Total Benefit / Total Years ) / (Investment / 2)
=	( $9,395,000 / 5 ) / ( $4,950,000 / 2 )
=	$1,879,000 / $2,470,000
=	76%
Answer:

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Counseling Adolescents

The Case Study on Disruptive Behavior
Disruptive Behaviors
Four disruptive behavior demonstrations are shown (choose One). Critically analyze each of them. At the end of each clip, you will be prompted to answer several questions based on what you just observed (Never mind recording your answer to the media. Just use the answer template and respond to the question there).
There will be an opportunity to record your responses within the media. It will be saved directly to the computer you are using. It is important to view and respond to the questions in their entirety, as your recorded responses will only be saved to this computer. If you change computers, your recorded responses will not be saved (Never mind recording your answer to the media. Just use the answer template and respond to the question there).
Go to this link below to view the video.
/orders/mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6640/09/mm/disruptive_behaviors_01/index.html
Assignment
Post an explanation of your observations of the client in the case study you selected, including behaviors that align to the criteria in DSM-5.
 
Then, explain therapeutic approaches you might use with this client, including psychotropic medications if appropriate.
 
Finally, explain expected outcomes for the client based on these therapeutic approaches. Support your approach with evidence-based literature.

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Assignment: Change Implementation

Assignment: Change Implementation And Management Plan

It is one of the most cliché of clichés, but it nevertheless rings true: The only constant is change. As a nursing professional, you are no doubt aware that success in the healthcare field requires the ability to adapt to change, as the pace of change in healthcare may be without rival.
As a professional, you will be called upon to share expertise, inform, educate, and advocate. Your efforts in these areas can help lead others through change. In this Assignment, you will propose a change within your organization and present a comprehensive plan to implement the change you propose.
To Prepare:

• Review the Resources and identify one change that you believe is called for in your organization/workplace.
  • This may be a change necessary to effectively address one or more of the issues you addressed in the Workplace Environment Assessment you submitted in Module 4. It may also be a change in response to something not addressed in your previous efforts. It may be beneficial to discuss your ideas with your organizational leadership and/or colleagues to help identify and vet these ideas.
• Reflect on how you might implement this change and how you might communicate this change to organizational leadership.

The Assignment (5-6-minute PowerPoint presentation):
Change Implementation and Management Plan
Create a narrated PowerPoint presentation of 5 or 6 slides with video that presents a comprehensive plan to implement the change you propose.
Your presentation should be 5–6 minutes in length and should include a video with you as presenter.
Your Change Implementation and Management Plan should include the following:

• An executive summary of the issues that are currently affecting your organization/workplace (This can include the work you completed in your Workplace Environment Assessment previously submitted, if relevant.)
• A description of the change being proposed
• Justifications for the change, including why addressing it will have a positive impact on your organization/workplace
• Details about the type and scope of the proposed change
• Identification of the stakeholders impacted by the change
• Identification of a change management team (by title/role)
• A plan for communicating the change you propose
• A description of risk mitigation plans you would recommend to address the risks anticipated by the change you propose

By Day 2 of Week 11

Submit your Change Implementation and Management Plan with audio and video.
Rubric:
Create a 5- or 6-slide narrated PowerPoint with video that presents a comprehensive plan to implement changes you propose. Your Change Implementation and Management Plan should include the following:

·  An executive summary of the issues that are currently affecting your organization/workplace (this can include the work you completed in your Workplace Environment Assessment).
·   A description of the changes being proposed.
·   Justifications for the changes, including why addressing them will have a positive impact on your organization/workplace.
Details about the type and scope of the proposed changes.
·   Identification of the stakeholders impacted by the changes.
·   Identification of a change management team (by title/role).
·   A plan for communicating the changes you propose.
·   A description of risk mitigation plans you would recommend to address the risks anticipated by the changes you propose.
Include an audio/video presentation that is 5–6 minutes in length with you as a presenter.
Written Expression and Formatting – English writing standards:

Correct grammar, mechanics, and proper punctuation
This is from the previous work we did , we can address this issue , or what you think.
Work Environment Assessment- this is my discussion
Using the Clark Healthy Workplace Inventory (Clark, 2015) my workplace ranks 90, or very healthy.  Why it ranks as healthy or civil is that between units of the hospital there is great communication between units, to the extent that is a need on one unit as far as staffing, another unit will offer to help, this is the norm, and not the exception for our hospital. We also feel supported by management during times of crisis, I work in two distinct areas where things can escalate very quickly, both in inpatient psych, and Children pavilion for adolescent psych patients. We know we will always get backup from other building staff and security if things get escalated where there is danger to patients or staff.
Success in an organization comes from hardworking people who have a strong mission and vision with great strategies in place. This depends greatly on the leadership, management, and the team. To put things in perspective, the introduction of the workplace health status would give a broader picture. To be discussed below is a brief description of the results of the Work Environment Assessment at Chicago Lakeshore Hospital and based on the results, the explanation of how civil is this place with the reasons behind the claim. Also, this discussion includes a description of a situation where incivility in the workplace has happened and how was it addressed.
Workplace health is the status of the workplace concerning the workers, how civil is the place, and the overall environment safety for the employees. Lack of civility at the workplace contributes to poor employees’ job satisfaction, lack of courtesy and respect among peers, and it leads to poor patient outcomes (Tips to Improve Civility in the Workplace, 2017). Incivility at workplaces has the potential to emotional and physical distress to the workers and that can cause poor quality care and patient outcomes (Armstrong, 2017). To assess the civility of the workplaces, researchers have discovered tools to help assess the workplaces and the Work Environment Assessment is one of the tools.
Using the Work Environment Assessment tool to assess Chicago Lakeshore Hospital revealed 90 which is a moderately healthy place. This means, in this organization, people live by the shared mission and vision, there is trust and respect among the workers, and communication at all levels is clear (Clark Healthy Workplace Inventory – americannursetoday.com. [n.d.]). The result assures the presence of teamwork and high levels of employees’ satisfaction. The workload is distributed equal and the organization offers competitive salaries. Based on my hospital workplace assessment results, the majority of the employees would recommend the place as a good place to work and overall there are high levels of employee satisfaction, therefore better outcomes (Clark Healthy Workplace Inventory – americannursetoday.com. [n.d.]).
Incivility incident at the workplace
Courtesy and respect are not only meant for people of a certain rank within the organizations. These basic values and others are for everyone. Clark (2017), emphasizes all nurses have the obligation to foster healthy workplaces with an atmosphere of dignity, professionalism, and respect. Unfortunately, studies reveal incivility at workplaces, bullying, and lack of mutual respect (Armstrong, 2017). Incivility at the workplace has been linked to poor performance which impacts patient safety and the quality of patient outcomes (Armstrong, 2017). Marshall and Broome (2017) state that “workplace violence, incivility, and bullying are barriers to developing safe environments for providers and can occur in any setting” (p.261). The American Nurses Association (ANA; n.d.) defines incivility as “one or more rude, discourteous, or disrespectful actions that may or may not have a negative intent behind them” (para.2).  This brings back the memory of my former workplace. Doctors were very much valued and respected, but the nurses did not receive the same respect from the doctors. At times, nurses were hesitant to call the doctors for notification of patient condition change simply because of the fear of the expected response. There was no mutual respect. I am not sure how did this problem resolve after leaving the place but a few years down, the hospital was sold out to another company.
Conclusion
Civility at the workplace is not only important for the workers’ feelings it also influences overall performance, productivity, and patient outcomes. The consequences of incivility at workplaces “can result in life-threatening mistakes, preventable complications, and harm or even death of a patient” (Clark, 2017). It is with that intensity that the workplace health assessment should be one of our priorities. Despite the individual differences, we must find a way to improve civility at our workplaces. The first step towards improvement is to assess the current status and the Work Environment Assessment is a great tool.
References
Armstrong, N. E. (2017). A Quality Improvement Project Measuring the Effect of an Evidence-
Based Civility Training Program on Nursing Workplace Incivility in a Rural Hospital Using Quantitative Methods. Online Journal of Rural Nursing & Health Care, 17(1), 100–137. /orders/doi-org.ezp.waldenulibrary.org/10.14574/ojrnhc.v17i1.438
Clark, C. M. (2017). An Evidence-Based Approach to Integrate Civility, Professionalism, and
Ethical Practice Into Nursing Curricula. NURSE EDUCATOR, 42(3), 120–126. /orders/doi-org.ezp.waldenulibrary.org/10.1097/NNE.0000000000000331
Clark Healthy Workplace Inventory – americannursetoday.com. (n.d.). Retrieved from
/orders/americannursetoday.com/wp-content/uploads/2015/11/Clark-Healthy-Workplace-Inventory.pdf.
Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd ed.). New Tork, NY: Springer.
Tips to Improve Civility in the Workplace. (2017). AACN Bold Voices, (1), 18. Retrieved from
/orders/search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=edsovi&AN=edsovi.01436852.201701000.00025&site=eds-live&scope=sit
References:
Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd ed.). New York, NY: Springer.

• Chapter 8, “Practice Model Design, Implementation, and Evaluation” (pp. 195–246)

/orders/medcom.uiowa.edu/annsblog/wp-content/uploads/2012/10/JONA-FINAL-Cullen-2012.pdf
/orders/wdhb.org.nz/contented/clientfiles/whanganui-district-health-board/files/rttc_leading-change-by-j-kotter-harvard-business-review.pdf
http://www.ijhpm.com/article_3183_5015382bcf9183a74ef7e79b0a941f65.pdf

ADDITIONAL INSTRUCTIONS FOR THE CLASS

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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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Economic Characteristics of the Healthcare Industry

In this Assessment, you will use information from the case scenario below, along with the supporting documents provided, to demonstrate your ability to apply economic concepts to make recommendations for organizational decisions.
Case Scenario: Launching a Cancer Drug: Comanapracil
You are a pharmaceutical executive. You believe that your firm, Ropache, may have developed a promising new drug, Comanapracil, which seems to arrest the progress of breast cancer for 2 years with no significant side effects. Clinical trials suggest that the drug is 100% effective for 2 years. After 2 years, tumor growth resumes at the same rate. Therefore, Comanapracil can only be used for a 2-year course, after which it loses its effectiveness.
Professional Skills: Written Communication, Technology, and Critical Thinking and Problem Solving are assessed in this Competency
Your response to this Assessment should:

• Use the Assessment documents and video as required.
• Reflect the criteria provided in the Rubric.
• Adhere to the required assignment length.
• Use the APA course template.
• Download the Writing Checklist to review prior to submitting your Assessment.

This Assessment requires submission of two (2) files. Save your files as follows:

• Save Part I as FM005_PartI_firstinitial_lastname (for example, FM005_PartI_J_Smith).
• Save Part II as FM005_PartII_firstinitial_lastname (for example, FM005_PartII_J_Smith).

When you are ready to upload your completed Assessment, use the Assessment tab on the top navigation menu.
Instructions
Before submitting your Assessment, carefully review the rubric. This is the same rubric the assessor will use to evaluate your submission and it provides detailed criteria describing how to achieve or master the Competency. Many students find that understanding the requirements of the Assessment and the rubric criteria help them direct their focus and use their time most productively.
Rubric
Access the following to complete this Assessment:

• U.S. Breast Cancer Statistics
• Annual Costs of Cancer Care—Cancer Prevalence and Cost of Care Projections:
• Chemo Costs in U.S. Driven Higher by Shift to Hospital Outpatient Facilities
• GDP Per Capita
• Health Expenditure Per Capita
• Life Expectancy at Birth, Total (Years)
• Breast Cancer Drug – Comparison Chart

This assessment has two-parts.  Click each of the items below to complete this assessment.

Part I: Determine Pricing and Marketing Strategy for a New Drug

You have been tasked with developing a pricing and marketing strategy for Comanapracil. As you undertake this task, refer to the following resources mentioned above:

• U.S. Breast Cancer Statistics
• Annual Costs of Cancer Care—Cancer Prevalence and Cost of Care Projections
• Chemo Costs in U.S. Driven Higher by Shift to Hospital Outpatient Facilities
• Breast Cancer Drug—Comparison Chart

Create a 10- to 15-slide presentation, for the board of directors, to convince them that Comanapracil is a good investment. The presentation should address the following economic issues related to the marketing of Comanapracil:

• Develop and present estimates for the demand for Comanapracil and the price of the drug you think the market will bear. Be sure to include the number of customers for this drug.
• Describe where and to whom you will focus your marketing efforts. For each, detail why they are important.
• Explain how you will ensure that insurance companies pay for your drug.
• Explain the elasticity of demand for a drug like Comanapracil. What factors could potentially change the elasticity of demand?
• Assume you are able to obtain a patent, and are ready to go to market immediately. Explain the length of time for which your drug will receive patent protection, so that you are protected from competition prior to generics entering the market. Also, explain why patent protection exists in healthcare.

Part II: Compare International Healthcare Systems to Develop an International Market Entry Strategy

It is your job to develop a market analysis for four different healthcare markets with unique insurance systems. These four analyses will be contained within one 10- to 11-slide presentation to the board of directors. Your analysis will serve as a basis for deciding which country to market Comanapracil:

• Germany
• United States
• Ghana
• Brazil

Create your presentation as follows:

• The first slide will be an analysis of the relationship between spending on healthcare per capita and life expectancy in each country. Begin by referring to the World Bank charts “GDP Per Capita,” “Health Expenditures Per Capita,” and “Life Expectancy at Birth, Total (Years).” Using these, create a chart comparing the spending on healthcare per capita with the life expectancy in each country. Underneath the chart, on the same slide, address the question: Is there a relationship between life expectancy and healthcare spending?
• Next, based on what you have learned about the healthcare systems of Germany, the United States, Ghana, and Brazil, create four slides (one for each country) that summarize how each healthcare system is structured.
• Next, create another four slides (again one for each country). Each of these slides should summarize your findings from conducting a SWOT analysis for each country (that is, identify the economic strengths, weaknesses, opportunities and threats) associated with marketing Comanapracil in each country.
• Create one to two slides recommending which two countries are most attractive for marketing Comanapracil and why.
• Your board has shown a particular interest in the German market. In order to market your drug in Germany successfully, you must be approved by the German Institute for Quality and Efficiency in Health Care (IQWIG). Create two to three slides, addressed to the IQWIG, which argue for the importance of why your drug should be covered. Address the following issues:
  • How much of a gain in health outcomes will this drug provide?
  • Do other drugs provide similar effectiveness in treating this disease?
  • How many people will benefit from this drug? Explain why some people will benefit from the drug more than others.

Competency: FM005: Economic Characteristics of the Healthcare Industry
Subject Matter Expert: Wendy.berry@mail.waldenu.edu
 
Student ID#: CBL006031
Student Email: karleneharvey39@gmail.com
 
Dear Karlene Harvey,
As you know, Walden University considers academic integrity to be essential for each student’s intellectual development and that each student agrees to respect and acknowledge the research and ideas of others and to abide by the rules relating to academic integrity.  In evaluating your FM005 First Assessment submission the Turnitin Similarity has identified a potential issue that relates to academic integrity.  More specifically, the work you submitted to your assessment is more reflective of work from another student (Paper ID: 1119266047).
 
Specifically, your Turnitin (TII) Similarity has identified the following concerns that violate the Walden University Student Handbook, Section 3. Student Expectations and Responsibilities, pages 34 through 40.
1. Your words are too similar to a previous author and you fail to give credit to the author.
a. Student Handbook: Plagiarism (pg. 36). Plagiarism is defined as use of intellectual material produced by another person without acknowledging its source.
2. It appears that you are copying or attempting to copy from others for this assessment
a. Student Handbook: Cheating (pg. 36). Cheating is defined as fraud, deceit, or dishonesty in an academic assignment. It includes using or attempting to use materials, or assisting others in using materials, that are prohibited or inappropriate in the context of the academic assignment in question
 
 

 
From your TII Similarity report there was a 55% match (student papers from 25-Apr-2019)
Class: FM005: Economic Characteristics of the Healthcare Industry
Assignment: FM005 Assessment Submission (Attempt 1)
Paper ID: 1119266047
 
 
 
As an example, see your passages colored red in the screen shot below, which are very similar to another student’s paper, Paper ID: 1119266047.
 

It is very important that you provide a detailed response to the information provided in this letter and a comprehensive explanation of the matters I have set forth. I refer you to the policies on academic integrity contained in the Student Conduct and Responsibilities section of the Walden University catalog found online at: catalog.waldenu.edu (Select Handbook from the drop down, then Section 3: Student Expectations and Responsibilities, then Student Conduct and Responsibilities, then Code of Conduct)
 
Please provide your response to me by email within five (5) business days of the date of this letter, therefore no later than November 18, 2020.  Your response should include any information that explains the procedure you used to complete FM005: Economic Characteristics of the Healthcare Industry, Assessment one (1) as well as your response to the information above. Please understand that this is not an accusation; rather, it is a request for information that provides an explanation. Respond to me directly, to the email address provided below.
 
Based on the evidence I have presented in this letter, and the response you provide, I will work with our academic leadership to determine how the matter will best be resolved.
Please feel free to contact me if you have any questions.
Sincerely,
Wendy M. Berry, PhD, Faculty
Wendy.berry@mail.waldenu.edu
 
Cc: Sarah.pavelka2@mail.waldenu.edu, MHA Program Director (Tempo)

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