One important application of epidemiology is to identify factors that could increase the likelihood of a certain health problem occurring within a specific population. Epidemiologists use measures of effect to examine the association or linkage in the relationship between risk factors and emergence of disease or ill health. For instance, they may use measures of effect to better understand the relationships between poverty and lead poisoning in children, smoking and heart disease, or low birth weight and future motor skills.
What is the significance of measures of effect for nursing practice? In this Discussion, you will consider this pivotal question. To prepare:
With the Learning Resources in mind, consider how measures of effect strengthen and support nursing practice.
What would be the risk of not using measures of effect in nursing practice?
Conduct additional research in the Walden Library and other credible resources and locate two examples in the scholarly literature that support your insights.
By tomorrow 04/11/2018 3pm, write a minimum of 550 words in APA format with at least 3 scholarly references from the list of required readings below. Include the level one headings as numbered below” Post a cohesive scholarly response that addresses the following:
Analyze how measures of effect strengthen and support nursing practice. PROVIDE AT LEAST TWO SPECIFICS EXAMPLES from the literature to substantiate your insights.
Assess dangers of not using measures of effect in nursing practice.
Discussion: The Impact Of Ethnicity On Antidepressant
Discussion: The Impact Of Ethnicity On Antidepressant
Major depressive disorder is one of the most prevalent disorders you will see in clinical practice. Treatment for this disorder, however, can vary greatly depending on client factors, such as ethnicity and culture. As a psychiatric mental health professional, you must understand the influence of these factors to select appropriate psychopharmacologic interventions. For this Discussion, consider how you might assess and treat the individuals in the case studies based on the provided client factors, including ethnicity and culture.
To prepare for this Discussion:
Case 2: Volume 1, Case #7: The case of physician do not heal thyself
· Review this week’s Learning Resources and reflect on the insights they provide.
· Go to the Stahl Online website and examine the case study you were assigned.
· Take the pretest for the case study.
· Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.
· Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).
· Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.
· Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.
· Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.
· Review the posttest for the case study.
Assignment- Case study #7 uploaded at the end.
Post a response to the following:
· Provide the case number in the subject line of the Discussion thread.- Case #7:
· List three questions you might ask the patient if he or she were in your office. Provide a rationale for why you might ask these questions.
· Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
· Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.
· List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.
· List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
· For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?
· If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided.
· Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations
Required Readings
Note: All Stahl resources can be accessed through this link provided.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
Chapter 6, “Mood Disorders”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Howland, R. H. (2008). Sequenced Treatment Alternatives to Relieve Depression (STAR*D). Part 1: Study design. Journal of Psychosocial Nursing and Mental Health Services, 46(9), 21-24. doi:02793695-20081001-0510.3928/02793695-20080901-06
Howland, R. H. (2008). Sequenced Treatment Alternatives to Relieve Depression (STAR*D). Part 2: Study outcomes. Journal of Psychosocial Nursing and Mental Health Services, 46(10), 21-24. doi:02793695-20081001-0510.3928/02793695-20080901-06
Yasuda, S.U., Zhang, L. & Huang, S.-M. (2008). The role of ethnicity in variability in response to drugs: Focus on clinical pharmacology studies. Clinical Pharmacology & Therapeutics, 84(3), 417–423. Retrieved from /orders/web.archive.org/web/20170809004704//orders/www.fda.gov/downloads/Drugs/ScienceResearch/…/UCM085502.pdf
PATIENT FILE
The Case: The case of physician do not heal thyself
The Question: Does the patient have a complex mood disorder, a personality disorder or both?
The Dilemma: How do you treat a complex and long-term unstable disorder of mood in a diffi cult patient?
Pretest Self Assessment Question (answer at the end of the case)
Frequent mood swings are more a sign or symptom of a mood disorder than they are of a personality disorder
A. True B. False
Patient Intake • 60-year-old man • Chief complaint is “being unstable” • Patient estimates that he has spent about two thirds of the time over
the past year being in a mixed dysphoric state and about one third as depressed, but waxing and waning every few days, or even every few hours
Psychiatric History: Childhood and Adolescence • As a young child, had symptoms of generalized anxiety and
separation anxiety • Also, as a child, remembers “emotional trauma” from mother, herself
with recurrent episodes of either unipolar or bipolar depression who was often physically unavailable because of hospitalizations, or emotionally distant when depressed at home
• Has had a lifetime of multiple turbulent interpersonal relationships since childhood, with family members, with friends and especially with women
• As an older child and adolescent, continued to have not only subsyndromal generalized anxiety but developed at least subsyndromal levels of OCD with ruminations, checking and rigidity
• He was told these were good traits and would make him a good student, which he was, with good grades through high school and college, gaining admission to medical school
Psychiatric History: Adulthood • Diagnosed as major depression for the fi rst time at age 23, early in
medical school – Was his worst depression so far, as other depressions previously characterized as unhappiness and transient depressed moods of a few days duration and with more anxiety than depression, improving without treatment
– Actively suicidal and overdosed on his medications at this time but recovered
– In retrospect, patient believes that he has long experienced rejection sensititivity with up to 2 depressive episodes per year since age 16 up to the present
• No clear history of any full syndromal manic or hypomanic episodes • Since age 23, however, has had many episodes lasting a week or
more of irritability, infl ated self esteem, increased goal-directed work activity, decreased need for sleep, overtalkativeness, racing thoughts, psychomotor agitation and risky behavior; could also experience euphoria or expansiveness to a signifi cant degree but only for 2 or 3 days at most and usually shorter
• He interpreted these as good traits, indicative of creative persons, and were the reason he was productive as well as creative
• In getting his history, it is not clear whether he has had an irritable dysphoric temperament since childhood, a superimposed episodic subsyndromal dysphoric mixed hypomania, or both
• First marriage ages 32–33 – Depressive episode and overdosed again when fi rst marriage
broke up • Second marriage between 35 and 36
– Another depressive episode after breakup of this marriage • Third marriage ages 46 to 58
– Another depressive episode after breakup of this marriage
Medication History • Starting with his fi rst diagnosed episode of depression in medical
school, treated off and on with TCAs and benzodiazepines, starting and stopping them over many years in relationship to his symptoms
• First received lithium at age 43, 17 years ago • Unclear whether this was an augmentation strategy for resistant
depression or for bipolar spectrum symptoms • Was not that helpful according to the patient • States he has had many, many medication trials since then • Valproate (Depakote) not tolerated • Clonazapam (Klonopin) helped sleep • Oxcarbazapine (Trileptal) caused dysphoria and agitation • Verapamil caused/worsened depression • Risperidone (Risperdal) caused depression • Fluoxetine (Prozac) caused rapid fl eeting relief of depression, but also insomnia and headache
• Other SSRIs caused activation and were not tolerated and discontinued after a few doses
• Presents now only taking methylphenidate (Ritalin), which he prescribes for himself as he does not think his physicians know as much about his case, or what he needs, as he does and they will not prescribe it for him
Social and Personal History • Married and divorced 3 times, currently single • No children • Non smoker • No drug abuse, rarely drinks • Physician and successful businessman
Medical History • Crohn’s disease
Family History • Father: sleep disorder • Mother: either bipolar or unipolar depression, unsure, but successfully
treated with ECT • Maternal uncle: depression • Maternal aunt: depression • Maternal grandmother: hospitalized for “manic depressive disorder”
Current Medications • Azothiaprine and Remicaid for Crohn’s • Methylphenidate
Based on just what you have been told so far about this patient’s history what do you think is his diagnosis?
• Recurrent major depression with an anxious/dysphoric temperament • Bipolar II depression • Bipolar II mixed episode • Bipolar NOS • Bipolar NOS superimposed upon a personality disorder (narcissistic,
borderline, other) • Primarily a cluster B personality disorder (antisocial/histrionic/
narcissistic/borderline)
Attending Physician’s Mental Notes: Initial Psychiatric Evaluation • Here is a case that could be a complex combination of a mood
disorder plus a personality disorder in someone who has never experienced mania and probably has never reached the threshold of experiencing unequivocal hypomania as defi ned by DSM IV or ICD10
• It is very diffi cult to separate the mood disorder from the personality disorder in a one hour initial evaluation session, plus looking at the medical records
• A complete diagnosis will have to await spending more time with the patient, and if possible, having access to the input of other observers as well
• However, seems likely that there is more to this case than a mood disorder, and probably cluster B personality traits if not personality disorder is comorbid
How would you treat him?
• Continue his methylphenidate • Discontinue his methylphenidate • Start an antidepressant • Restart lithium • Start an anticonvulsant mood stabilizer • Start an atypical antipsychotic • Make sure he agrees to weekly insight oriented psychotherapy • Consider psychoanalysis
Attending Physician’s Mental Notes: Initial Psychiatric Evaluation, Continued • Since the patient lives in another city, psychotherapy will have to
be an option via another mental health professional, although some supervision of that plus advice on medications can be possible as a consultant
• The patient is open to pursuing psychotherapy as long as he respects the therapist
• Before recommending psychopharmacologic treatment, it would be good to review what we know from the available history about his response to medications already taken
• As shown from the history of this case, it can be impossible to determine with great accuracy the effects of the medications by taking a history. One should be skeptical of the information as it can be unreliably reported in records and by a patient because it is complex and the medication effects can be subtle
– How many medications were taken long enough to have had a chance to work?
– Did some medications provoke mood instability while others stabilized mood?
– If the person has a mood disorder with an underlying personality disorder, will medications treat only the mood disorder and expose the symptoms of the personality disorder, or
– These questions are better answered if you live the ups and down along with the patient and experience the signs and symptoms of such a patient in real time
– However, the real question is what can you do to help such a patient and what are the realistic goals of treatment
– Finally, is treatment defi ned as medications, insight oriented psychotherapy, or both?
• About the only thing solid here is that antidepressants seem to be provocative at times in terms of causing activation and thus should be given cautiously and only concomitantly with mood stabilizing medication
• Has taken numerous mood stabilizing medications that he reported cause depression, especially those that are used to treat mania
• He has a demanding job and is not willing to put up with much sedation and will not accept weight gain
• It is possible that he is a bipolar spectrum patient with more depression than mania and with more pure depressive states alternating with mixed states of dysphoria/irritability superimposed upon depression, but not full syndrome mixed bipolar disorder
• Thus he has four needs” – Treat from “below” (i.e., antidepressant) – Stabilize from “below: (i.e. prevent cycling into depression) – Treat from “above” (in his case, not to treat euphoric mania, but to treat irritability) – Stabilize from “above” (i.e. prevent cycling into mixed states of
dysphoric/irritable depression) • Highly unlikely that this will be possible with a single agent • For now, decided to avoid an antidepressant and to stop the
methylphenidate which may help depression but at the expense of destabilizing him and causing cycling into irritable mixed states
• For now, a low side effect mood stabilizing agent with antidepressant and maintenance potential (i.e., treating from below and stabilizing from below) such as lamotrigine seems to be a good bet
• After this is given, might consider adding lithium which he has tolerated in the past although unclear what therapeutic actions it had for him; however, might treat and stabilize him from above in synergy with lamotrigine for a total therapeutic picture
Case Outcome: First Interim Followup, Week 12 • Patient fl ies back for a followup appointment 3 months later • Has stopped methylphenidate and his psychiatrist in his home city
started lamotrigine by slow upward titration, but a bit faster and to a higher dose than recommended and now taking 400 mg/day
• Mood stabilized but at a level of low grade consistent depression with decreased libido and sexual dysfunction
• Told to reduce lamotrigine to 200 mg and wait another month or two because it can take a while yet for lamotrigine’s antidepressant effect to kick in and its mood stabilizing effects may have already started
Case Outcome: Second Interim Followup, Week 16 • Phone consultation • Learned that the patient decided that lamotrigine was making him
depressed and ruining his sex life, so discontinued it and completely relapsed in terms of depression
• Patient agrees to restart lithium after blood and urine tests from his physician
Case Outcome: Third, Fourth, and Fifth Interim Followup Visits, Weeks 20, 24 and 28 • Phone consultations • Patient has normal labs and starts lithium at week 20 only has a
blood level of 0.4, so told to increase dose • At week 24 calls and states that higher doses give him unacceptable
diarrhea and exacerbates his Crohn’s disease symptoms, so he is back down to the low dose of lithium
• Also, restarted methylphenidate as needed for dysphoric mood and low energy
• Told to increase his lithium again, more slowly and not to 1800 mg/ day which caused diarrhea but only to 1500 mg a day or 1500 mg alternating with 1800 mg/day on alternate days and to stop his methylphenidate
• Also told to restart lamotrigine titrating up to only half his previous dose, namely 200 mg/day with the strategy that both drugs together would allow him to take each in lower tolerable doses for him, yet working together to add their therapeutic effects
Case Outcome: Sixth and Seventh Interim Followup Visits, Weeks 32 and 36 • Brief phone consults with the patient and his psychiatrist on the
phone together • Getting regular psychotherapy “whatever” • Monitored by his local psychiatrist monthly face to face appointments • Lithium level 0.7, occasional tremor and diarrhea but mostly tolerable • Mood is stable and overall “feels much better”
Case Outcome: Eighth Interim Followup, Week 40 • Emergency phone call • Can’t get a hold of his psychiatrist where he lives • Patient calls from a football stadium where his alma mater is playing in a big football game • “I’m in trouble” • Patient states he has been much troubled recently about always feeling somewhat dysphoric, not really worse recently, but just tired of never being “well”
• Denies psychosocial stressors but feels desperate and suicidal • Now at the football game, his thoughts are entirely about suicide,
making his will, shooting others at the game, and killing himself • Fortunately, he states he neither has a gun with him nor does he own
one • Has weird reaction to the football game, because when his team scores, he is not euphoric but bursts into tears • “help me”
What would you do now?
• Tell him to call his local psychiatrist • Tell him to go to the emergency room • Tell him to call the suicide hot line • Tell him to settle down and that you will either call in a prescription for an antipsychotic or coordinate it with his local psychiatrist • Tell the patient to fi nd another consultant
Case Outcome: Eighth Interim Followup, Week 40, Continued • Told the patient to settle down and you would call his psychiatrist to
meet him at his local emergency room which he agrees to do after the game ends
• Also patient states he feels much better now that he has spoken on the phone, and also now that his team is now winning
• Local psychiatrist sees him in the emergency room and starts him on aripiprazole 2.5 mg increasing if tolerated and not effective to 5.0 mg 1 to 3 days later, increasing to 7.5 mg if tolerated and not effective 1 to 3 days later
Case Outcome: Ninth Interim Followup, Week 41 • One week later, phone consult with his psychiatrist on the line • Patient states he contacted his local psychiatrist the same day as
his phone call from the football stadium, and saw him a week later (which was yesterday)
• Got the prescription for aripiprazole and the next day following the phone call from the football stadium, left on a business trip from California to New York
• In New York, the aripiprazole was not effective at 2.5 mg, so the next day he became desperate and took 20 mg (not an overdose attempt, just to hurry up the therapeutic response)
• Also increased his lamotrigine on his own to 400 mg/day • Lowered his lithium dose • Flew back to California • Had gait disturbance, tremor, word-fi nding problems, memory loss,
yet still verbally provocative, desperate with recurring suicidal and homicidal ideation
• “I want to hang myself”
What would you do now?
• Start another antipsychotic • Reinstate the original doses of lamotrigine and lithium • Tell the patient and his local psychiatrist to fi nd another consultant
Case Outcome: Ninth Interim Followup, Week 41, Continued • Actually, this time, felt as though the patient was manipulating and
scolded him with his psychiatrist on the line • Told him that his psychiatrist is the treating physician, not the consultant, and the consultant’s advice is to see his psychiatrist and to have future contacts with the consultant either by phone with his psychiatrist on the line, or face to face with his psychiatrist on the line
• Told to decrease lamotrigine, increase lithium back to previous levels and to discontinuie aripiprazole
• Also advised starting ziprasidone 40 mg at night with food
Case Outcome: Tenth Interim Followup, Week 42 • Phone call with local treating psychiatrist and the patient one week
later • Patient was compliant with instructions • Now states the ziprasidone “turned a switch” • By this he means that suicidal ideation abated immediately,
depression no longer dysphoric but only low grade at worst • Some fatigue/inertia • Some tongue chewing suggesting a mild ziprasidone induced EPS • Dramatically better and very pleased • Suggest to them that the consultant will now resign from the case • Did he live happily every after?
Case Outcome: Eleventh Interim Followup, Week 54 • About 3 months later, that is, 1 year after the initial psychiatric
evaluation, got phone call from a new psychiatrist in the patient’s home city where the patient had transferred his care
• States that the patient decided to add fl uoxetine 10 mg, stopped lamotrigine, tried 160 mg of ziprasidone, now back to 40 mg
• The story goes on. . . .
Case Debrief • This intelligent and manipulative patient with a genuine mood
disorder and a personality disorder is decidedly unstable, but able to function as a physician even though not able to maintain long-term interpersonal relationships
• Is not very compliant, often making therapeutic decisions on his own about how to treat his own case, especially when things are not going well
• It is diffi cult to determine whether his periods of mood stability are related to drug treatment or to the lack of psycho-social stressors, but there is the sense that medications are somewhat helpful for the worst of his mood swings even though the medications are not helpful for his responses to psycho-social stressors
Take-Home Points • Difficult patients are difficult • To paraphrase Tolstoy in Anna Karenina
– “Happy families are all alike; every unhappy family is unhappy in its own way”
– One could say in cases like this one, “Stable patients are all alike; every unstable patient is unstable in his own way”
• Temperament and personality are factors in bipolar disorder and might even be part of bipolar disorder and are certainly part of the barriers to treatment effectiveness and to treatment compliance/adherence
• A realistic goal in a case like this may be less of a roller coaster, but not full stabilization or true remission, yet well enough to stay employed, have relationships and not be desperate, suicidal or homicidal
• Patients tend to hate depressed states more than mixed states whereas those around patients tend to hate the patient’s mixed irritable states more than their depressed states
Performance in Practice: Confessions of a Psychopharmacologist • What could have been done better here?
– Should the consultant have stayed engaged after the intial consultation?
– The involvement of two psychiatrists allowed the patient the opportunity for splitting and chaos
– Should psychotherapy have played a more prominent role here? • Possible action item for improvement in practice
– Make a more concerted effort to defi ne the role of a consultant versus a primary psychiatrist, who is the quarterback of the team, allowing the consultant to play a secondary role, and perhaps in cases like this, try and ensure no direct contact with the consultant without the primary psychiatrist also being present
– Set realistic goals for a patient like this and realize long term stability may not be attainable
Tips and Pearls • Lamotrigine, lithium and an atypical antipsychotic can be a useful triple
combination for unstable cases of mood and personality disorder and combinations and doses can be found that are relatively tolerable
• Stimulants have no role in a case like this • Antidepressants can be destabilizing in a case like this • Physicians can be especially diffi cult to treat when they are patients
as they tend to interfere with their own treatments
Two-Minute Tute: A brief lesson and psychopharmacology tutorial (tute) with relevant background material for this case – Distinguishing personality disorders from mood disorders
Posttest Self Assessment Question: Answer Frequent mood swings are more a sign or symptom of a mood disorder than they are of a personality disorder A. True B. False
Answer: False Mood swings are prominent signs of both mood disorders and personality disorders; not all mood swings are mood disorders
References 1. Stahl SM, Mood Disorders, in Stahl’s Essential
Psychopharmacology, 3rd edition, Cambridge University Press, New York, 2008, pp 453–510
2. Stahl SM, Antidepressants, in Stahl’s Essential Psychopharmacology, 3rd edition, Cambridge University Press, New York, 2008, pp 511–666
3. Stahl SM, Mood Stabilizers, in Stahl’s Essential Psychopharmacology, 3rd edition, Cambridge University Press, New York, 2008, pp 667–720
4. Stahl SM, Lamotrigine in Stahl’s Essential Psychopharmacology The Prescriber’s Guide, 3rd edition, Cambridge University Press, New York, 2009, pp 259–66
5. Stahl SM, Lithium, in Stahl’s Essential Psychopharmacology The Prescriber’s Guide, 3rd edition, Cambridge University Press, New York, 2009, pp 277–82
6. Stahl SM, Ziprasidone, in Stahl’s Essential Psychopharmacology The Prescriber’s Guide, 3rd edition, Cambridge University Press, New York, 2009, pp 589–94
7. Stahl SM, Aripiprazole, in Stahl’s Essential Psychopharmacology The Prescriber’s Guide, 3rd edition, Cambridge University Press, New York, 2009, pp 45–50
8. Schwartz TL and Stahl,SM, Ziprasidone in the treatment of bipolar disorder, in Akiskal H and Tohen M, Bipolar Psychopharmacotherapy: Caring for the Patient, 2nd edition, Wiley Press
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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. Discussion: The Impact Of Ethnicity On Antidepressant
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NURS 6050 Walden University The Roles of RNs and APRNs in Policy Making Essay
NURS 6050 Walden University The Roles of RNs and APRNs in Policy Making Essay
Word cloud generators have become popular tools for meetings and team-building events. Groups or teams are asked to use these applications to input words they feel best describe their team or their role. A “word cloud” is generated by the application that makes prominent the most-used terms, offering an image of the common thinking among participants of that role.
What types of words would you use to build a nursing word cloud? Empathetic, organized, hard-working, or advocate would all certainly apply. Would you add policy-maker to your list? Do you think it would be a very prominent component of the word cloud?
Nursing has become one of the largest professions in the world, and as such, nurses have the potential to influence policy and politics on a global scale. When nurses influence the politics that improve the delivery of healthcare, they are ultimately advocating for their patients. Hence, policy-making has become an increasingly popular term among nurses as they recognize a moral and professional obligation to be engaged in healthcare legislation. To Prepare:
Revisit the Congress.gov website provided in the Resources and consider the role of RNs and APRNs in policy-making.
Reflect on potential opportunities that may exist for RNs and APRNs to participate in the policy-making process.
Post an explanation of at least two opportunities that exist for RNs and APRNs to actively participate in policy-making. Explain some of the challenges that these opportunities may present and describe how you might overcome these challenges. Finally, recommend two strategies you might make to better advocate for or communicate the existence of these opportunities to participate in policy-making. Be specific and provide examples.
NURS 6050 Walden Assessing a Healthcare Program Policy Evaluation Paper
NURS 6050 Walden Assessing a Healthcare Program Policy Evaluation Paper
NURS 6050 Walden Assessing a Healthcare Program Policy Evaluation Paper
NURS 6050 Walden Assessing a Healthcare Program Policy Evaluation Paper
Description
Program/policy evaluation is a valuable tool that can help strengthen the quality of programs/policies and improve outcomes for the populations they serve. Program/policy evaluation answers basic questions about program/policy effectiveness. It involves collecting and analyzing information about program/policy activities, characteristics, and outcomes. This information can be used to ultimately improve program services or policy initiatives.
Nurses can play a very important role assessing program/policy evaluation for the same reasons that they can be so important to program/policy design. Nurses bring expertise and patient advocacy that can add significant insight and impact. In this Assignment, you will practice applying this expertise and insight by selecting an existing healthcare program or policy evaluation and reflecting on the criteria used to measure the effectiveness of the program/policy. To Prepare:
Review the Healthcare Program/Policy Evaluation Analysis Template provided in the Resources.
Select an existing healthcare program or policy evaluation or choose one of interest to you.
Review community, state, or federal policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described.
The Assignment: (2–3 pages)
Based on the program or policy evaluation you selected, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following:
Describe the healthcare program or policy outcomes.
How was the success of the program or policy measured?
How many people were reached by the program or policy selected?
How much of an impact was realized with the program or policy selected?
At what point in program implementation was the program or policy evaluation conducted?
What data was used to conduct the program or policy evaluation?
What specific information on unintended consequences was identified?
What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.
Did the program or policy meet the original intent and objectives? Why or why not?
Would you recommend implementing this program or policy in your place of work? Why or why not?
Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after 1 year of implementation.
NURS 6050 Walden University Global Healthcare Comparison Matrix and Narrative Statement
NURS 6050 Walden University Global Healthcare Comparison Matrix and Narrative Statement
Description
If you talk about a possible poor health outcome, do you believe that outcome will occur? Do you believe eye contact and personal contact should be avoided?
You would have a difficult time practicing as a nurse if you believed these to be true. But they are very real beliefs in some cultures.
Differences in cultural beliefs, subcultures, religion, ethnic customs, dietary customs, language, and a host of other factors contribute to the complex environment that surrounds global healthcare issues. Failure to understand and account for these differences can create a gulf between practitioners and the public they serve.
In this Assignment, you will examine a global health issue and consider the approach to this issue by the United States and by one other country. To Prepare:
Review the World Health Organization’s (WHO) global health agenda and select one global health issue to focus on for this Assignment.
Select at least one additional country to compare to the U.S. for this Assignment.
Reflect on how the global health issue you selected is approached in the U.S. and in the additional country you selected.
The Assignment: (1- to 2-page Global Health Comparison Matrix; 1-page Plan for Social Change) Part 1: Global Health Comparison Matrix
Focusing on the country you selected and the U.S., complete the Global Health Comparison Matrix. Be sure to address the following:
Consider the U.S. national/federal health policies that have been adapted for the global health issue you selected from the WHO global health agenda. Compare these policies to the additional country you selected for study.
Explain the strengths and weaknesses of each policy.
Explain how the social determinants of health may impact the global health issue you selected. Be specific and provide examples.
Using the WHO’s Organization’s global health agenda as well as the results of your own research, analyze how each country’s government addresses cost, quality, and access to the global health issue selected.
Explain how the health policy you selected might impact the health of the global population. Be specific and provide examples.
Explain how the health policy you selected might impact the role of the nurse in each country.
Explain how global health issues impact local healthcare organizations and policies in both countries. Be specific and provide examples.
Part 2: A Plan for Social Change
Reflect on the global health policy comparison and analysis you conducted in Part 1 of the Assignment and the impact that global health issues may have on the world, the U.S., your community, as well as your practice as a nurse leader.
In a 1-page response, create a plan for social change that incorporates a global perspective or lens into your local practice and role as a nurse leader.
Explain how you would advocate for the incorporation of a global perspective or lens into your local practice and role as a nurse leader.
Explain how the incorporation of a global perspective or lens might impact your local practice and role as a nurse leader.
Explain how the incorporation of a global perspective or lens into your local practice as a nurse leader represents and contributes to social change. Be specific and provide examples
The dissemination of EBP results serves multiple important roles. Sharing results makes the case for your decisions. It also adds to the body of knowledge, which creates opportunities for future practitioners. By presenting results, you also become an advocate for EBP, creating a culture within your organization or beyond that informs, educates, and promotes the effective use of EBP. To Prepare:
Review the final PowerPoint presentation you submitted in Module 5, and make any necessary changes based on the feedback you have received and on lessons you have learned throughout the course.
Consider the best method of disseminating the results of your presentation to an audience.
To Complete:
Create a 5-minute, 5- to 6-slide narrated PowerPoint presentation of your Evidence-Based Project.
Be sure to incorporate any feedback or changes from your presentation submission in Module 5.
Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy.
Lydia Otoo
Walden University
July 28,2019
Recommending an Evidence-Based
Practice Change
Organization Description and Readiness for Change
Description of Healthcare Organization
The healthcare organization at which the change is proposed is a nursing home taking care of the elderly
The culture of the Nursing home is driven by the need to deliver quality nursing care to patients
The culture of change movement is aimed at transitioning the nursing home from an institution to homes for residents aimed at improving quality of care and overall quality of life for residents.
The organization is ready for change, has all infrastructure and needed resources needed to implement change, whereas staff are also supportive of change process.
2
The healthcare organization at which the change is proposed is a nursing home taking care of the elderly
The culture of the Nursing home is driven by the need to deliver quality nursing care to patients
The culture of change movement is aimed at transitioning the nursing home from an institution to homes for residents aimed at improving quality of care and overall quality of life for residents (Ellis,2019) .
The organization is ready for change, has all infrastructure and needed resources needed to implement change, whereas staff are also supportive of change process.
Current Problem & Opportunity for Change
Nursing home operates in a restrictive setting, where standardized approach to care is applied
Opportunity for change is application of personalized care to meet individual needs of patients.
Circumstances surrounding need for change: Only standardized approach to care is implemented, thus individual needs of patients are not being met
Scope of the Issue: Health providers and elderly patients are affected
Risks associated with Change: Possibility of resistance by stakeholders, limitation of resources needed in implementation and change in scope
3
Problem: Nursing home operates in a restrictive setting, where standardized approach to care is applied
Opportunity for change is application of personalized care to meet individual needs of patients.
Circumstances surrounding need for change: Only standardized approach to care is implemented, thus individual needs of patients are not being met
Scope of the Issue: Health providers and elderly patients are affected
Risks associated with Change: Possibility of resistance by stakeholders, limitation of resources needed in implementation and change in scope (Mackey & Bassendowski, 2017).
Evidence Based Idea
Evidence based for changed that has been proposed is providing patient-centered care for elderly patients at the nursing home
EBP approach to patient centered care has been extensively researched
Patient-centered care is based on value based care to address specific needs of patients
Alignment of patient-centered care and value based care is needed to improve overall wellbeing of patients
Patient centered care to be aligned to patient outcomes, perspectives and experiences to adequately address patient needs.
Plan for knowledge transfer of the change
Proposed change is implementation of patient centered care and value based care to patients
Plan for knowledge transfer entails seminar training for all medical professionals at the nursing home.
Knowledge creation entails continuous transfer, combination and conversion of different content about patient centered and value based care. The new approach is implemented as policies at the nursing home.
Dissemination process entails teaching personnel at the nursing home about change. Methods include memo, newsletter, workshops and conferences.
Organizational adoption and implementation: Entails implementation of developed policies to achieve changeover
5
Proposed change is implementation of patient centered care and value based care to patients
Plan for knowledge transfer entails seminar training for all medical professionals at the nursing home(Friesen-Storms et al., 2015).
Knowledge creation entails continuous transfer, combination and conversion of different content about patient centered and value based care. The new approach is implemented as policies at the nursing home.
Dissemination process entails teaching personnel at the nursing home about change. Methods include memo, newsletter, workshops and conferences.
Organizational adoption and implementation: Entails implementation of developed policies to achieve changeover
Description of Measurable Outcomes
With the implementation of patient centered care and value based care, the
following measurable outcomes are anticipated to be achieved:
Residents access to quality care: Residents overall improvement in health is evaluated to determine effectiveness of implemented approach.
Homelike atmosphere: Practices and structures are designed to be less like an institution and more homelike .
Relationship between patients and professionals: Close relationships maintained between health professionals at nursing home and patients.
Staff empowerment and collaboration.
Staff are more empowered to undertake roles and there is more collaborative decision making to deliver enhanced care that is patient-centered
Overall Quality Improvement in Processes: Continuous quality improvement initiatives implemented through culture change and ongoing process to achieve better care (Friesen-Storms et al., 2015).
With the implementation of patient centered care and value based care, the
following measurable outcomes are anticipated to be achieved:
Residents access to quality care: Residents overall improvement in health is evaluated to determine effectiveness of implemented approach.
Homelike atmosphere: Practices and structures are designed to be less like an institution and more homelike .
Relationship between patients and professionals: Close relationships maintained between health professionals at nursing home and patients.
Staff empowerment and collaboration:
Staff are more empowered to undertake roles and there is more collaborative decision making to deliver enhanced care that is patient-centered
Overall Quality Improvement in Processes: Continuous quality improvement initiatives implemented through culture change and ongoing process to achieve better care.
6
Lessons Learned
Critical appraisal of peer reviewed articles
Critical appraisal fundamental in assessing usefulness and validity of research findings
Critical appraisal evaluates appropriateness of study design for research question and key methodological features of design
Appraisal determines suitability of statistical methods used and interpretation, potential conflict of interest relevance of research to practice.
Lessons from completing literature evaluation table
Interpretation of research findings
Synthesis of sources and application to practice
Analysis of conceptual framework
Evaluation of research variables
Examination of data analysis methods used
Appraisal of research findings relevant to practice (Melnyk & Fineout-Overholt, 2018).
Lessons Learned
Lessons from completing the levels of evidence table
How to assess studies based on methodological quality of design
How to assess studies based on evidence
Assessing studies based on applicability ti patient care
Assessing strength of provided recommendations in studies
Lessons from completing the outcomes synthesis table
I learned how to organize research studies
How to integrate different resources together
How to synthesize research on a given topic
References
Ellis, P. (2019). Evidence-based practice in nursing. Learning Matters.
Friesen-Storms, J. H., Bours, G. J., van der Weijden, T., & Beurskens, A. J.
(2015). Shared decision making in chronic care in the context of evidence
based practice in nursing. International journal of nursing studies, 52(1), 393-
402.
Mackey, A., & Bassendowski, S. (2017). The history of evidence-based practice
in nursing education and practice. Journal of Professional Nursing, 33(1), 51-55.
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing &
healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
To prepare:
· Review this week’s Learning Resources and reflect on the insights they provide.
· Read the case study I am Feeling Like I’m Going Crazy
· For guidance on assessing the client, refer to pages 137-142 of the Wheeler text in this week’s Learning Resources.
· Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Post to Discussion Question link and then select Create Thread to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking Submit!
By Day 1-Postan Explanation of the most likely DSM-5 diagnosis for the client in the case study. 2- Be sure to link those behaviors to the criteria in the DSM-5. Then, 3-Explain Group Therapeutic Approaches you might use with this patient. 4-Explain expected Outcomes for the client based on these therapeutic approaches. 5-Finally consider Legal and Ethical implications of counseling children and adolescent clients with psychiatric disorders. 6-Support your approach with evidence-based literature.
IDENTIFICATION: The patient is a 15-year-old male of Native American descent who resides at home
with his mother and 6-year-old brother.
He is seen for the psychiatric evaluation on an inpatient crisis unit. Collateral information was obtained
from the patient’s mother.
CHIEF COMPLAINT: “I am feeling like I’m going crazy”
HISTORY OF CHIEF COMPLAINT: Patient reports that he intentionally cut his leg at school yesterday
before gym class. He realized that he would not be able to participate in class because he could not
control the bleeding of the cuts. He went to the nurse and she referred him to the ER for admission. The
ER provider admitted him to the acute psychiatric unit as he was at risk of harming himself due to
suicidal ideation. He reports that he harmed himself by cutting as he was feeling abandoned by his
boyfriend. He states that he is not emotionally supportive. He reports that self-injurious behavior began
10 months ago, and he uses a disposable razor to cut his upper arm or forearm. He reports problems
with sleep onset. He reports low self-esteem and low energy level. He endorsed a history of two prior
suicide attempts by taking a palm-full of acetaminophen; the most recent attempt was 2 months ago.
He did not report his attempt denies serious adverse effects. His last suicidal ideation due to pressure of
getting good grades and low self-esteem. He used to participate in the school band but stopped
attending rehearsals about 2 months ago because he was no longer interested.
Patient’s mother expressed frustration and difficulty understanding why the patient treats her
disrespectfully when she gives the patient everything the patient wants, such as clothing and money to
go out with friends. The patient’s mother acknowledged that she works a lot and is infrequently at
home, but stated that when she tries to spend time with the patient and express interest in his life, the
patient shuts her out or states that he does not have time to spend with her because she needs to finish
his homework. Patient’s mother additionally expresses confusion about why the patient behaves so
differently than she did at that age, reporting that he was expected to be respectful and comply with her
mother’s requests.
PAST PSYCHIATRIC HISTORY: No prior psychotherapy or trials of psychiatric medication.
MEDICAL HISTORY: Multiple wounds noted on patient’s right upper arm, which appear to be healing. No
known allergies. No acute or chronic medication conditions. Review of systems is negative. Patient
appears to be average height and weight. He denies any recent changes in weight.
HISTORY OF DRUG OR ALCOHOL ABUSE: No alcohol use. States that he tried marijuana once 3 months
ago. Denies use of any other illicit substances.
FAMILY HISTORY: Patient’s parents were both born in the US. The patient was born in the United States.
Patient reports that her parents got divorced when she was 5 years old. His father currently lives in Los
Angeles and he has minimal contact with him. Family history of mental illness denied.
Personal History
Perinatal: No known perinatal complications.
Childhood/Adolescence: The patient attends the local private high school where he used to get good
grades in her classes, mostly As and Bs; however, he states her grades have declined recently and she is
in danger of failing several classes. He reports recent loss of close friends due to interpersonal conflict.
He identifies as pansexual and is currently dating a male peer. They have been dating for the past 2
months. He states that she would like to have sex with him, but he is not ready yet.
TRAUMA/ABUSE HISTORY: Patient denies trauma or abuse history.
Mental Status Examination
Appearance: Good grooming and hygiene. Cooperative.
Behavior and psychomotor activity: no increased or decreased psychomotor agitation. Sits quietly in
chair.
Consciousness: Alert.
Orientation: To person, place, time.
Memory: Not formally assessed but appears to be intact based on patient’s ability to relate details from
the past.
Concentration and attention: Not formally assessed, but no indication of abnormalities.
Visuospatial ability: Not formally assessed.
Abstract thought: Intact.
Intellectual functioning: Appears to be above average.
Speech and language: Quiet volume, regular rate and rhythm.
Perceptions: No evidence of perceptual disturbance. Patient denies auditory and visual hallucinations.
Thought processes: Coherent and goal directed.
Thought content: Distressed about peer relationships.
Suicidality or homicidality:
Denies current suicidal or homicidal ideation; however, reports suicidal thoughts yesterday on the way
to the hospital.
Mood: “Depressed”
Affect: Constricted.
Boards of Nursing (BONs) exist in all 50 states, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands. Similar entities may also exist for different regions. The mission of BONs is the protection of the public through the regulation of nursing practice. BONs put into practice state/region regulations for nurses that, among other things, lay out the requirements for licensure and define the scope of nursing practice in that state/region.
It can be a valuable exercise to compare regulations among various state/regional boards of nursing. Doing so can help share insights that could be useful should there be future changes in a state/region. In addition, nurses may find the need to be licensed in multiple states or regions. To Prepare:
Review the Resources and reflect on the mission of state/regional boards of nursing as the protection of the public through the regulation of nursing practice.
Consider how key regulations may impact nursing practice.
Review key regulations for nursing practice of your state’s/region’s board of nursing and those of at least one other state/region and select at least two APRN regulations to focus on for this Discussion..
By Day 3 of Week 5
Post a comparison of at least two APRN board of nursing regulations in your state/region with those of at least one other state/region. Describe how they may differ. Be specific and provide examples. Then, explain how the regulations you selected may apply to Advanced Practice Registered Nurses (APRNs) who have legal authority to practice within the full scope of their education and experience. Provide at least one example of how APRNs may adhere to the two regulations you selected. Grid View
· List View
Excellent
Good
Fair
Poor
Main Posting
45 (45%) – 50 (50%)
Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.
Supported by at least three current, credible sources.
Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
40 (40%) – 44 (44%)
Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.
At least 75% of post has exceptional depth and breadth.
Supported by at least three credible sources.
Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
35 (35%) – 39 (39%)
Responds to some of the discussion question(s).
One or two criteria are not addressed or are superficially addressed.
Is somewhat lacking reflection and critical analysis and synthesis.
Somewhat represents knowledge gained from the course readings for the module.
Post is cited with two credible sources.
Written somewhat concisely; may contain more than two spelling or grammatical errors.
Contains some APA formatting errors.
0 (0%) – 34 (34%)
Does not respond to the discussion question(s) adequately.
Lacks depth or superficially addresses criteria.
Lacks reflection and critical analysis and synthesis.
Does not represent knowledge gained from the course readings for the module.
Contains only one or no credible sources.
Not written clearly or concisely.
Contains more than two spelling or grammatical errors.
Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness
10 (10%) – 10 (10%)
Posts main post by day 3.
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
Does not post by day 3.
First Response
17 (17%) – 18 (18%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Response is effectively written in standard, edited English.
15 (15%) – 16 (16%)
Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.
13 (13%) – 14 (14%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 12 (12%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.
Second Response
16 (16%) – 17 (17%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Response is effectively written in standard, edited English.
14 (14%) – 15 (15%)
Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.
12 (12%) – 13 (13%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 11 (11%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.
Participation
5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days.
Lab Assignment: Differential Diagnosis For Skin Conditions
Properly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms, and incrementally narrow them down until one diagnosis is determined as the most likely cause.
In this Lab Assignment, you will examine several visual representations of various skin conditions, describe your observations, and use the techniques of differential diagnosis to
determine the most likely condition.
To Prepare
· Review the Skin Conditions document provided in this week’s Learning Resources, and select one condition to closely examine for this Lab Assignment. ( See attached documents with pictures) “Skin Conditions”
· Consider the abnormal physical characteristics you observe in the graphic you selected. How would you describe the characteristics using clinical terminologies?
· Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.
· Consider which of the conditions is most likely to be the correct diagnosis, and why.
· Search the Walden library for one evidence-based practice, peer-reviewed article based on the skin condition you chose for this Lab Assignment.
· Review the Comprehensive SOAP Exemplar found in this week’s Learning Resources to guide you as you prepare your SOAP note. ( See attachment)
· Download the SOAP Template found in this week’s Learning Resources, and use this template to complete this Lab Assignment. ( See attachment and use it for this assignment)
Assignment – Instructions
· Choose one skin condition graphic from the document provided (identify by number in your Chief Complaint) “Skin Conditions”
· Document your assignment in the SOAP (Subjective, Objective, Assessment, and Plan) (Use the attached template)
· Use clinical terminologies to explain the physical characteristics featured in the graphic.
· Formulate a differential diagnosis of three to five possible conditions for the skin graphic that you chose.
· Determine which is most likely to be the correct diagnosis and explain your reasoning using at least three different references, one reference from current evidence-based literature from your search and two different references from this week’s Learning Resources.
NOTES FROM INSTRUCTOR – **IMPORTANT**
· “Use the SOAP template to document the skin condition you choose. You are to be creative and complete the missing information. For this assignment you will not complete a plan. You will stop after completing the assessment section.
Resources from school:
· Bonifant, H., & Holloway, S. (2019). A review of the effects of ageing on skin integrity and wound healing. British Journal of Community Nursing, 24, S28–S33. /orders/doi-org.ezp.waldenulibrary.org/10.12968/bjcn.2019.24.Sup3.S28
· Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Chapter 9, “Skin, Hair, and Nails
· Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.
Assignment 1: Lab Assignment: Differential Diagnosis
for Skin Conditions
Properly identifying the cause and type of a patient’s skin condition involves a process of
elimination known as differential diagnosis. Using this process, a health
professional can take a
given set of physical abnormalities, vital signs, health assessment findings, and patient
descriptions of symptoms, and incrementally narrow them down until one diagnosis is
determined as the most likely cause.
In this Lab Assignmen
t, you will examine several visual representations of various skin
conditions, describe your observations, and use the techniques of differential diagnosis to
determine the most likely condition.
To Prepare
·
Review the Skin Conditions document
provided in this week’s Learning Resources, and
select one condition to closely examine for this Lab Assignment.
( See attached
documents with pictures)
“
Skin
Conditions
”
·
Consider the abnormal physical characteristics you observe in the graphic you selected.
How would you d
escribe the characteristics using clinical terminologies?
·
Explore different conditions that could be the cause of the skin abnormalities in the
graphics you selected.
·
Consider which of the conditions is most likely to be the correct diagnosis, and why.
·
Sea
rch the Walden library for one evidence
–
based practice, peer
–
reviewed article based
on the skin condition you chose for this Lab Assignment.
·
Review the Comprehensive SOAP Exemplar found in this week’s Learning Resources
to guide you as you prepare your SOA
P note.
(
See attachment)
·
Download the SOAP Template found in this week’s Learning Resources, and use this
template to complete this Lab Assignment.
( See attachment and use it for this
assignment)
Assignment
–
Instructions
·
Choose one skin condition graphic
from the
document provided
(identify by number in
your Chief Complaint)
“
Skin Conditions
”
·
D
ocument your assignment in the SOAP (Subjective, Objective, Assessment, and Plan)
(Use the attached template)
·
Use clinical terminologies to explain the physical characteristics featured in the graphic.
·
Formulate a differential diagnosis of
three to five
po
ssible conditions for the skin
graphic that you chose.
·
Determine which is most likely to be the correct diagnosis and explain your reasoning
using at least three different references, one reference from current evidence
–
based
literature from your search a
nd two different references from this week’s Learning
Resources.
Assignment 1: Lab Assignment: Differential Diagnosis
for Skin Conditions
Properly identifying the cause and type of a patient’s skin condition involves a process of
elimination known as differential diagnosis. Using this process, a health professional can take a
given set of physical abnormalities, vital signs, health assessment findings, and patient
descriptions of symptoms, and incrementally narrow them down until one diagnosis is
determined as the most likely cause.
In this Lab Assignment, you will examine several visual representations of various skin
conditions, describe your observations, and use the techniques of differential diagnosis to
determine the most likely condition.
To Prepare
Review the Skin Conditions document provided in this week’s Learning Resources, and
select one condition to closely examine for this Lab Assignment. ( See attached
documents with pictures) “Skin Conditions”
Consider the abnormal physical characteristics you observe in the graphic you selected.
How would you describe the characteristics using clinical terminologies?
Explore different conditions that could be the cause of the skin abnormalities in the
graphics you selected.
Consider which of the conditions is most likely to be the correct diagnosis, and why.
Search the Walden library for one evidence-based practice, peer-reviewed article based
on the skin condition you chose for this Lab Assignment.
Review the Comprehensive SOAP Exemplar found in this week’s Learning Resources
to guide you as you prepare your SOAP note. ( See attachment)
Download the SOAP Template found in this week’s Learning Resources, and use this
template to complete this Lab Assignment. ( See attachment and use it for this
assignment)
Assignment – Instructions
Choose one skin condition graphic from the document provided (identify by number in
your Chief Complaint) “Skin Conditions”
Document your assignment in the SOAP (Subjective, Objective, Assessment, and Plan)
(Use the attached template)
Use clinical terminologies to explain the physical characteristics featured in the graphic.
Formulate a differential diagnosis of three to five possible conditions for the skin
graphic that you chose.
Determine which is most likely to be the correct diagnosis and explain your reasoning
using at least three different references, one reference from current evidence-based
literature from your search and two different references from this week’s Learning
Resources.
