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Assignment: week 10 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

Assignment:Week 10 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

Impulsivity, compulsivity, and addiction are challenging disorders for patients across the life span. Impulsivity is the inclination to act upon sudden urges or desires without considering potential consequences; patients often describe impulsivity as living in the present moment without regard to the future (MentalHelp.net, n.d.). Thus, these disorders often manifest as negative behaviors, resulting in adverse outcomes for patients. For example, compulsivity represents a behavior that an individual feels driven to perform to relieve anxiety (MentalHelp.net, n.d.). The presence of these behaviors often results in addiction, which represents the process of the transition from impulsive to compulsive behavior.

In your role as the psychiatric nurse practitioner (PNP), you have the opportunity to help patients address underlying causes of the disorders and overcome these behaviors. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with impulsivity, compulsivity, and addiction.

To prepare for this Assignment:

Review this week’s Learning Resources, including the Medication Resources indicated for this week.

Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients requiring therapy for impulsivity, compulsivity, and addiction.

The Assignment: 5 pages

Examine Case Study: A Puerto Rican Woman With Comorbid Addiction. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Comorbid Addiction (ETOH and Gambling)

BACKGROUND

Mrs. Maria Perez is a 53 year old Puerto Rican female who presents today due to a rather “embarrassing problem.”

SUBJECTIVE

Mrs. Perez admits that she has had “problems” with alcohol since her father died in her late teens. She reports that she has struggled with alcohol since her 20’s and has been involved with Alcoholics Anonymous “on and off” for the past 25 years. She states that for the past 2 years, she has been having more and more difficulty maintaining her sobriety since the opening of the new “Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during its grand opening at which point she was “hooked.” She states that she gets “such a high” when she is gambling. While gambling, she “enjoys a drink or two” to help calm her during high-stakes games. She states that this often gives way to more drinking and more reckless gambling. She also reports that her cigarette smoking has increased over the past 2 years and she is concerned about the negative effects of the cigarette smoking on her health.

She states that she attempts to abstain from drinking but she gets such a “high” from the act of gambling that she needs a few drinks to “even out.” She also notices that when she drinks, she doesn’t smoke “as much,” but she enjoys smoking when she is playing at the slot machines. She also reports that she has gained weight from drinking so much. She currently weights 122 lbs., which represents a 7 lb. weight gain from her usual 115 lb. weight.

Mrs. Perez is quite concerned today because she borrowed over $50,000 from her retirement account to pay off her gambling debts, and her husband does not know.

MENTAL STATUS EXAM

The client is a 53 year old Puerto Rican female who is alert and oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. Her speech is clear, coherent, and goal directed. Her eye contact is somewhat avoidant during the clinical interview. When you make eye contact with her, she looks away or looks down. She demonstrates no noteworthy mannerisms, gestures, or tics. Her self-reported mood is “sad.” Affect is appropriate to content of conversation and self-reported mood. She denies visual or auditory hallucinations, and no delusional or paranoid thought processes are readily appreciated. Insight and judgment are grossly intact; however, impulse control is impaired. She is currently denying suicidal or homicidal ideation.

Diagnosis: Gambling disorder, alcohol use disorder

Decision #1 (1 page)

Which decision did you select?

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision Point One

Select what you should do:

Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks

RESULTS OF DECISION POINT ONE

Client returns to clinic in four weeks

Mrs. Perez says she feels “wonderful” as she has not “touched a drop” of alcohol since receiving the injection

Client reports that she has not been going to the casino, as frequently, but when she does go she “drops a bundle” (meaning, spends a lot of money gambling)

Client She is also still smoking, which has her concerned. She is also reporting some problems with anxiety, which also has her concerned

Decision #2 (1 page)

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision P Decision Point Two Two

Dec Decision Point Two

Add on Valium (diazepam) 5 mg orally TID/PRN/anxiety

RESULTS OF DECISION POINT TWO

Client returns to clinic in four weeks

Mrs. Perez reports that when she first received the Valium, it helped her tremendously. She states “I was like a new person. This is a miracle drug!” However, she reports that she has trouble “waiting” between drug administration times and sometimes takes her Valium early

She is asking today for an increase the Valium dose or frequency

Decision #3 (1 page)

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision Point Three

Continue current dose of Vivitrol, increase Valium to 10 mg orally TID/PRN/anxiety. Refer to counseling for her ongoing gambling issue

Guidance to Student

Anxiety is a common side effect of Vivitrol. Mrs. Perez reports that she is doing well with this medication, and like other side effects, the anxiety associated with this medication may be transient. The psychiatric mental health nurse practitioner should never initiate benzodiazepines in a client who already has issues with alcohol, or other substance dependencies. Additionally, benzodiazepines are not to be used long-term. Problems associated with long-term benzodiazepine use include the need to increase the dose in order to achieve the same therapeutic effect. This is what we are seeing in Mrs. Perez’s case.

The most appropriate course of action in this case would be to continue the current dose of Vivitrol, while decreasing the Valium with the goal of discontinuation of the drug within the next two weeks. At that point, you would need to evaluate whether or not the side effect of anxiety associated with Vivitrol persists.

Increasing the dose of Valium would not be appropriate, neither would maintaining her on the current dose of Valium. Additionally, the client should be referred for counseling to help with her gambling addiction, as there are no FDA approved medications gambling disorder.

Medication should never be added treat side effect of another medication, unless that side effect is known to be transient (for instance, benzodiazepines are sometimes prescribed to overcome the initial problem of “activation” associated with initiation of SSRI, or SNRI therapy). However, in a client with multiple addictive disorders, benzodiazepines should never be used (unless they are only being used for a limited duration of therapy such as acute alcohol detoxification to prevent seizures).

Additionally, it should be noted that Mrs. Perez continues to engage in problematic gambling, at considerable personal financial cost. Mrs. Perez needs to be referred to a counselor who specializes in the treatment of gambling disorder, and should also be encouraged to establish herself with a local chapter of gamblers anonymous.

You need to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions, and to enhance her overall health.

Conclusion (1 page)

Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at /orders/academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

RESULTS OF DECISION POINT TWO

· Client returns to clinic in four weeks

· Mrs. Perez reports that when she first received the Valium, it helped her tremendously. She states “I was like a new person. This is a miracle drug!” However, she reports that she has trouble “waiting” between drug administration times and sometimes takes her Valium early

· She is asking today for an increase the Valium dose or frequency

RESULTS OF DECISION POINT TWO

· Client returns to clinic in four weeks

· She is asking today for an increase the Valium dose or frequency

53-year-old Puerto Rican Female

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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. Assignment: week 10 Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

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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NURS 6630 Week 10 Assignment

NURS 6630 Week 10 Assignment: Assessing and Treating Clients With Dementia

NURS 6630 Week 10 Assignment

The Alzheimer’s Association defines dementia as “a general term for a decline in mental ability severe enough to interfere with daily life” (Alzheimer’s Association, 2016). This term encompasses dozens of cognitive disorders of impaired memory formation, recall, and communication. The care and treatment of clients with dementia is dependent on multiple factors, including the stage of dementia, comorbidities, family support, and even the care setting. In your role, as the psychiatric mental health nurse practitioner, you must be prepared to not only treat clients with these various cognitive disorders, but also the multiple behavioral issues that often accompany them. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with dementia.

Reference: Alzheimer’s Association. (2016). What is dementia? Retrieved from http://www.alz.org/what-is-dementia.asp

Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

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

To access the following chapter, 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 13, “Dementia and Its Treatment”

Stahl, S. M. (2014b). The prescriber’s guide (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.

Review the following medications:

For insomnia
donepezil
galantamine
memantine
rivastigmine

Bui, Q. (2012). Antidepressants for agitation and psychosis in patients with dementia. American Family Physician, 85(1), 20–22. Retrieved from http://www.aafp.org/journals/afp.html

Note: Retrieved from from the Walden Library databases.

Meltzer, H. Y., Mills, R., Revell, S., Williams, H., Johnson, A., Bahr, D., & Friedman, J. H. (2010). Pimavanserin, a serotonin receptor inverse agonist for the treatment of Parkinson’s disease psychosis. Neuropsychopharmacology, 35, 881–891. Retrieved from http://www.nature.com/npp/journal/v35/n4/pdf/npp2009176a.pdf

Required Media

Laureate Education. (2016h). Case study: An elderly Iranian man with Alzheimer’s disease [Interactive media file]. Baltimore, MD: Author.

Note: This case study will serve as the foundation for this week’s Assignment.

To prepare for this Assignment:

Review this week’s Learning Resources. Consider how to assess and treat clients requiring therapy for dementia.

Walden NURS 6630 Week 10 Sample Paper (Assessing and Treating Clients with Dementia)

Assessing and Treating Clients with Dementia

Student’s Name:

Institutional Affiliation:

Assessing and Treating Clients with Dementia

The treatment of brain degeneration illnesses such as Alzheimer’s will require the PMHNP to consider the benefits and side effects of such treatments. The PMHNP will recognize that though the brain degeneration caused by conditions such as Alzheimer’s is not reversible, it can be controlled when the right medication and dosage are administered to patients. This paper explores the pharmacokinetics and pharmacodynamics of the medications administered to control Alzheimer’s in a 76-year-old Iranian male.

Decision #1

For the first decision, I decided to administer Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID after two weeks. I made the decision to administer Exelon (rivastigmine) 1.5 mg to the patient and increase the dosage to 3 mg after two weeks as the drug is known to be effective in limiting the symptoms of degenerative brain disease as a cholinesterase inhibitor (Khoury, Rajamanickam, & Grossberg, 2018). I also made the decision, to begin with, a 1.5 mg dosage and increase to 3mg after two weeks as this would help to avoid severe side effects on the patients a such as the loss of appetite, nausea, and upset stomach (Khoury et al., 2018). The medication would benefit the patients and cause less harm.

The other two decisions, which would be to administer Aricept (donepezil) 5 mg orally or Razadyne (galantamine) 4 mg orally BID, would be less advantageous and would not be considered. The central reason for not administering Aricept (donepezil) 5 mg to the 76-year-old Iranian male would be because of the severe side effects associated with the drug. According to Agboton, Mahdavian, Singh, et al. (2014), Aricept has been shown to cause a slow and irregular heartbeat in some patients, which can result in fainting. On the other hand, the decision to administer Razadyne would be less advantageous as it can cause severe side effects such as fast, slow, and irregular breathing, which would be detrimental to the elderly patient’s health. Razadyne would also have a higher probability of contributing to severe side effects such as slow or irregular heartbeats in a patient and would not be considered (Nakagawa, Ohnishi, Kobayashi, et al., 2017).

By making the decision to administer Exelon (rivastigmine) 1.5 mg orally and increase to 3 mg orally BID in 2 weeks, I was hoping to help limit the symptoms of Alzheimer’s on the patient, including loss of interest in important activities, and increasing the patients Mini-Mental State Exam (MMSE) score. According to Kandiah, Pai, Senanarong, et al. (2017), Exelon will be effective in treating most symptoms of Alzheimer’s and will boost the brain’s activity of patients.

What I was hoping to achieve after administering Exelon 1.5 mg orally and increasing the dose to 3 mg orally after two weeks and the results of the decision were different because no improvements were noted in the patient’s MMSE score. The patient was also quite disinterested in important activities in their life, such as religious activities. From the results, it was evident that the medication had not yet been effective on the patient. According to Khoury et al. (2018), cholinesterase inhibitors will not be effective from the onset, with effects likely to be observed in the second month of administration.

Decision #2

For the second decision, I choose to increase the dosage of Exelon to 4.5 mg orally. I selected this decision because the patient had not displayed any severe side effects with the administration of 3mg of Exelon in the past month. Increasing the dosage of Exelon to 4.5 mg was also needed to bring about the preferred results of limiting the symptom of Alzheimer’s on the patient. According to Kandiah et al. (2017), increasing the dosage of Exelon is recommended among patients who do not experience severe side effects so as to limit the symptoms of Alzheimer’s.

By making the decision to increase the dosage of Exelon to 4.5 mg, I was hoping to improve the patient’s brain functionality and interest in activities which they liked. What I expected to achieve in increasing the dosage of Exelon to 4.5 mg was similar to what I achieved in that after a month, the patients showed increased functionality by attending religious activities and showing interest. This showed the dosage was effective in limiting the symptoms of Alzheimer’s on the patient.

Decision #3

For the third decision, I choose to increase Exelon dosage to 6mg orally. According to Khoury et al. (2018), increasing the dosage of Exelon is recommended in cases where the patient does not show any severe side effects. The increased dosage will be more effective in limiting Alzheimer’s symptoms.

By making the decision to increase the Exelon dosage of the 76-year-old Iranian patient to 6mg, I was hoping to sustain the patient’s interests in activities which they liked and improve the brain functionality. Cholinesterase inhibitors help to stabilize the symptoms of Alzheimer’s and help patients to regain interest in activities they consider important while functioning better (Kandiah et al., 2017). What I was hoping to accomplish by increasing the dosage was similar to what I achieved in that the patient showed an increased interest in religious activities and general improvement in brain function. This showed that the increased dosage was effective in limiting Alzheimer’s symptoms in the patients.

Ethical Considerations

In treating the 76-year-old Iranian male, the ethical principles of confidentiality and beneficence would be followed. Only the medication that provides the benefits to the patients would be considered, with all the information related to the treatment being held in confidence by all involved parties.

References

Agboton, C Mahdavian, S., Singh, A., Ghazvini, P., Hill, A., & Sweet, R. (2014). Impact of

nighttime donepezil administration on sleep in the older adult population: A retrospective study. Mental Health Clinician 1; 4 (5): 257–259. doi: /orders/doi.org/10.9740/mhc.n222761.

Khoury, R., Rajamanickam, J., & Grossberg, G. T. (2018). An update on the safety of current

therapies for Alzheimer’s disease: focus on rivastigmine. Therapeutic advances in drug safety, 9(3), 171–178. /orders/doi.org/10.1177/2042098617750555.

Kandiah N, Pai MC, Senanarong V, Looi I, Ampil E, Park KW, Karanam AK, & Christopher S.

(, 2017). Rivastigmine: the advantages of dual inhibition of acetylcholinesterase and butyrylcholinesterase and its role in subcortical vascular dementia and Parkinson’s disease dementia. Clin Interv Aging. 12:697-707 /orders/doi.org/10.2147/CIA.S129145.

Nakagawa, R., Ohnishi, T., Kobayashi, H., Yamaoka, T., Yajima, T., Tanimura, A., Kato, T., &

Yoshizawa, K. (2017). Long-term effect of galantamine on cognitive function in patients with Alzheimer’s disease versus a simulated disease trajectory: an observational study in the clinical setting. Neuropsychiatric disease and treatment, 13, 1115–1124. /orders/doi.org/10.2147/NDT.S133145.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

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NURS 6630 Week 10 Assignment: Assessing and Treating Clients With Dementia

Reference: Alzheimer’s Association. (2016). What is dementia? Retrieved from http://www.alz.org/what-is-dementia.asp

Required Readings

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

Chapter 13, “Dementia and Its Treatment”

Stahl, S. M. (2014b). The prescriber’s guide (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.

Review the following medications:

For insomnia
donepezil
galantamine
memantine
rivastigmine

Bui, Q. (2012). Antidepressants for agitation and psychosis in patients with dementia. American Family Physician, 85(1), 20–22. Retrieved from http://www.aafp.org/journals/afp.html

Note: Retrieved from from the Walden Library databases.

Required Media

Laureate Education. (2016h). Case study: An elderly Iranian man with Alzheimer’s disease [Interactive media file]. Baltimore, MD: Author.

Note: This case study will serve as the foundation for this week’s Assignment.

To prepare for this Assignment:

Review this week’s Learning Resources. Consider how to assess and treat clients requiring therapy for dementia.

Walden NURS 6630 Week 10 Sample Paper (Assessing and Treating Clients with Dementia)

Assessing and Treating Clients with Dementia

Student’s Name:

Institutional Affiliation:

Assessing and Treating Clients with Dementia

Decision #1

Decision #2

Decision #3

Ethical Considerations

References

Agboton, C Mahdavian, S., Singh, A., Ghazvini, P., Hill, A., & Sweet, R. (2014). Impact of

nighttime donepezil administration on sleep in the older adult population: A retrospective study. Mental Health Clinician 1; 4 (5): 257–259. doi: /orders/doi.org/10.9740/mhc.n222761.

Khoury, R., Rajamanickam, J., & Grossberg, G. T. (2018). An update on the safety of current

therapies for Alzheimer’s disease: focus on rivastigmine. Therapeutic advances in drug safety, 9(3), 171–178. /orders/doi.org/10.1177/2042098617750555.

Kandiah N, Pai MC, Senanarong V, Looi I, Ampil E, Park KW, Karanam AK, & Christopher S.

Nakagawa, R., Ohnishi, T., Kobayashi, H., Yamaoka, T., Yajima, T., Tanimura, A., Kato, T., &

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Who We Are

We are a professional custom writing website. If you have searched for a question and bumped into our website just know you are in the right place to get help with your coursework.

Do you handle any type of coursework?

Is it hard to Place an Order?

1. Click on “Order Now” on the main Menu and a new page will appear with an order form to be filled.
2. Fill in your paper’s requirements in the “PAPER INFORMATION” section and the system will calculate your order price/cost.
3. Fill in your paper’s academic level, deadline, and the required number of pages from the drop-down menus.
4. Click “FINAL STEP” to enter your registration details and get an account with us for record-keeping and then, click on “PROCEED TO CHECKOUT” at the bottom of the page.
5. From there, the payment sections will show, follow the guided payment process and your order will be available for our writing team to work on it.

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Discussion Questions (DQ)

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LopesWrite Policy

Late Policy

Communication

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Week 10 Assignment: Assessing and Treating Clients With Dementia

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Therapy for Patients With Anxiety Disorders and PTSD Treatment

I’m no longer at the mercy of my PTSD, and I would not be here today had I not had the proper diagnosis and treatment. It’s never too late to seek help.

—P.K. Philips, PTSD patient

For individuals presenting with posttraumatic stress disorder (PTSD) and other anxiety disorders, everyday life can be a constant challenge. Clients requiring anxiolytic therapy may present with anxiousness, depression, substance abuse issues, and even physical symptoms related to cardiovascular, respiratory, and gastrointestinal ailments. As a psychiatric nurse practitioner, you must be prepared to address the many needs of individuals seeking treatment for PTSD and other anxiety disorders.

This week, as you study anxiolytic therapies and PTSD treatments, you examine the assessment and treatment of patients with PTSD and other anxiety disorders. You also explore ethical and legal implications of these therapies.

Reference: Philips, P. K. (n.d.). My story of survival: Battling PTSD. Anxiety and Depression Association of America. /orders/adaa.org/living-with-anxiety/personal-stories/my-story-survival-battling-ptsd

Objectives

· Assess patient factors and history to develop personalized plans of anxiolytic therapy for patients

· Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring anxiolytic therapy

· Synthesize knowledge of providing care to patients presenting with anxiolytic therapy

· Analyze ethical and legal implications related to prescribing anxiolytic therapy to patients across the lifespan

· Assess psychopharmacologic approaches to treatment for patients across the lifespan

Assignment: Assessing and Treating Patients With Anxiety Disorders

Common symptoms of anxiety disorders include chest pains, shortness of breath, and other physical symptoms that may be mistaken for a heart attack or other physical ailment. These manifestations often prompt patients to seek care from their primary care providers or emergency departments. Once it is determined that there is no organic basis for these symptoms, patients are typically referred to a psychiatric mental health practitioner for anxiolytic therapy. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with anxiety disorders.

To prepare for this Assignment:

· Review this week’s Learning Resources, including the Medication Resources indicated for this week.

· Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients requiring anxiolytic therapy.

The Assignment: 5 pages

Examine Case Study: A Middle-Aged Caucasian Man With Anxiety. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

Introduction to the case (1 page)

· Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

· Which decision did you select?

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

· Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

Note: Support your rationale with a minimum 5 academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

Learning Resources

Required Readings (click to expand/reduce)

Bui, E., Pollack, M. H., Kinrys, G., Delong, H., Vasconcelos e Sá, D., & Simon, N. M. (2016). The pharmacotherapy of anxiety disorders. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 61–71). Elsevier.

American Psychiatric Association. (2010a). Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. /orders/psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/acutestressdisorderptsd.pdf

American Psychiatric Association. (2010c). Practice guideline for the treatment of patients with panic disorder (2nd ed.). /orders/psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/panicdisorder.pdf

Bendek, D. M., Friedman, M. J., Zatzick, D., & Ursano, R. J. (n.d.). Guideline watch (March 2009): Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. /orders/psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/acutestressdisorderptsd-watch.pdf

Cohen, J. A. (2010). Practice parameter for the assessment and treatment of children and adolescents with posttraumatic stress disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 49(4), 414–430. /orders/jaacap.org/action/showPdf?pii=S0890-8567%2810%2900082-1

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

Hamilton, M. (1959). Hamilton Anxiety Rating Scale (HAM-A). PsycTESTS. /orders/doi.org/10.1037/t02824-0

Ostacher, M. J., & Cifu, A. S. (2019). Management of posttraumatic stress disorder. JAMA, 321(2), 200–201. /orders/doi.org/10.1001/jama.2018.19290

Strawn, J. R., Wehry, A. M., DelBello, M. P., Rynn, M. A., & Strakowski. S. (2012). Establishing the neurobiologic basis of treatment in children and adolescents with generalized anxiety disorder. Depression and Anxiety, 29(4), 328–339. /orders/doi.org/10.1002/da.21913

Medication Resources (click to expand/reduce)

IBM Corporation. (2020). IBM Micromedex.

/orders/www.micromedexsolutions.com/micromedex2/librarian/deeplinkaccess?source=deepLink&institution=SZMC%5ESZMC%5ET43537

Note: To access the following medications, use the IBM Micromedex resource. Type the name of each medication in the keyword search bar. Be sure to read all sections on the left navigation bar related to each medication’s result page as this information will be helpful for your review in preparation for your Assignments.

Review the following medications:

· benzodiazepines

· citalopram

· desvenlafaxine

· duloxetine

· escitalopram

· fluoxetine

· paroxetine

· sertraline

· venlafaxine

· vilazodone

· vortioxetine

· propranolol

· prazosin

Generalized Anxiety Disorder Middle-Aged White Male With Anxiety

BACKGROUND INFORMATION

The client is a 46-year-old white male who works as a welder at a local steel fabrication factory. He presents today after being referred by his PCP after a trip to the emergency room in which he felt he was having a heart attack. He stated that he felt chest tightness, shortness of breath, and feeling of impending doom. He does have some mild hypertension (which is treated with low sodium diet) and is about 15 lbs. overweight. He had his tonsils removed when he was 8 years old, but his medical history since that time has been unremarkable. Myocardial infarction was ruled out in the ER and his EKG was normal. Remainder of physical exam was WNL.

He admits that he still has problems with tightness in the chest and episodes of shortness of breath- he now terms these “anxiety attacks.” He will also report occasional feelings of impending doom, and the need to “run” or “escape” from wherever he is at.

In your office, he confesses to occasional use of ETOH to combat worries about work. He admits to consuming about 3-4 beers/night. Although he is single, he is attempting to care for aging parents in his home. He reports that the management at his place of employment is harsh, and he fears for his job. You administer the HAM-A, which yields a score of 26.

Client has never been on any type of psychotropic medication.

MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. He is appropriately dressed. Speech is clear, coherent, and goal-directed. Client’s self-reported mood is “bleh” and he does endorse feeling “nervous”. Affect is somewhat blunted, but does brighten several times throughout the clinical interview. Affect broad. Client denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, as is insight. He denies suicidal or homicidal ideation.

You administer the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26.

Diagnosis: Generalized anxiety disorder

RESOURCES

§ Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0

Decision Point One

Select what you should do:

Begin Zoloft 50 mg po daily

Begin Imipramine 25 mg po BID

Begin Buspirone 10 mg po BID

Generalized Anxiety Disorder Middle-Aged White Male With Anxiety

Decision Point One

Begin Zoloft 50 mg orally daily

RESULTS OF DECISION POINT ONE

Begin Zoloft 50 mg orally daily

· Client returns to clinic in four weeks

· Client informs you that he has no tightness in chest, or shortness of breath

· Client states that he noticed decreased worries about work over the past 4 or 5 days

· HAM-A score has decreased to 18 (partial response)

Decision Point Two

Increase dose to 75 mg orally daily

RESULTS OF DECISION POINT TWO

Increase dose to 75 mg orally daily

· Client returns to clinic in four weeks

· Client reports an even further reduction in his symptoms

· HAM-A score has now decreased to 10. At this point- continue current dose (61% reduction in symptoms)

Decision Point Three

Maintain current dose

Guidance to Student At this point, it may be appropriate to continue client at the current dose. It is clear that the client is having a good response (as evidenced by greater than a 50% reduction in symptoms) and the client is currently not experiencing any side effects, the current dose can be maintained for 12 weeks to evaluate full effect of drug. Increasing drug at this point may yield a further decrease in symptoms, but may also increase the risk of side effects. This is a decision that you should discuss with the client. Nothing in the client’s case tells us that we should consider adding an augmentation agent at this point as the client is demonstrating response to the drug. Avoid polypharmacy unless symptoms cannot be managed by a single drug.

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Discussion: Treatment for a Patient With a Common Condition

NURS 6630: Psychopharmalogical Approaches to Treat Psychopathology

Insomnia is one of the most common medical conditions you will encounter as a PNP. Insomnia is a common symptom of many mental illnesses, including anxiety, depression, schizophrenia, and ADHD (Abbott, 2016). Various studies have demonstrated the bidirectional relationship between insomnia and mental illness. In fact, about 50% of adults with insomnia have a mental health problem, while up to 90% of adults with depression experience sleep problems (Abbott, 2016). Due to the interconnected psychopathology, it is important that you, as the PNP, understand the importance of the effects some psychopharmacologic treatments may have on a patient’s mental health illness and their sleep patterns. Therefore, it is important that you understand and reflect on the evidence-based research in developing treatment plans to recommend proper sleep practices to your patients as well as recommend appropriate psychopharmacologic treatments for optimal health and well-being.

Reference: Abbott, J. (2016). What’s the link between insomnia and mental illness? Health. /orders/www.sciencealert.com/what-exactly-is-the-link-between-insomnia-and-mental-illness#:~:text=Sleep%20problems%20such%20as%20insomnia%20are%20a%20common,bipolar%20disorder%2C%20and%20attention%20deficit%20hyperactivity%20disorder%20%28ADHD%29

For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.

Case: An elderly widow who just lost her spouse.

Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:

Metformin 500mg BID

Januvia 100mg daily

Losartan 100mg daily

HCTZ 25mg daily

Sertraline 100mg daily

Current weight: 88 kg

Current height: 64 inches

Temp: 98.6 degrees F

BP: 132/86

By Day 3 of Week 7

Post a response to each of the following:

List three questions you might ask the patient if 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, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.

List a differential diagnosis 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 ethical prescribing or decision-making. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making?

Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.

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NURS 6630: Psychopharmalogical Approaches to Treat Psychopathology

Week 7 peer responses

Dathne Frazier-Sturdivant

RE: Weekly Topic Respond/ Post here- Do not Start Own Thread

COLLAPSE

Week 7

Initial Post

The first question I would ask this patient is whether she has sought grief counseling? The second would be do you consume excess caffeine? And the third would be are you compliant with taking your Zoloft? I would seek feedback from her family and friends to find out if her habits or behavior has changed in anyway?

The differential diagnosis that I would suggest would be grief. Bereavement often effects individuals both physically and mentally. Severe, persistent and disabling grief known as complicated grief (CG) as well as prolonged grief disorder (PGD) have been added to the International Classification of Diseases 11th Edition (Lancel et al., 2020). Hallmark presentation of PGD are persistent and severe yearning for the deceased and/or preoccupation with the deceased, combined with symptoms of intense emotional pain. Bereavement and grief are associated with sleep disturbances. Conversely, the lack of sleep often exacerbates or prolongs the grief process.

I would have a CMP drawn to assess overall hemodynamic status. I would perhaps order a sleep study to measure the true amount of sleep that the patient is getting and assess any physical causes that may be disturbing her sleep. I would be cautious about using sleep aids due to the patient’s age and risk for falls.

The two medications that I would add would be:

Trazadone 50mg po HS, may repeat in 1hr if remains awake. Trazadone is a commonly used atypical antidepressant with strong sedative actions. Known to decrease sleep latency and prolong sleep duration; it does not cause tolerance or physical dependence (Rosenthal & Burchum,2021). I would monitor for postural hypotension and caution the patient that she may experience some daytime grogginess.

To avoid the use of another psychotropic, I would choose to begin the patient on a complementary therapy using a medicine which combines melatonin, vitamin B6 and extracts from medicinal plants California poppy extract, passionflower extract, and lemon balm extract. Novanuit Triple Action is associatied with high compliance, a benign side effect profile, and low potential for dependence and addiction (Lemoine, 2019). This product has been proven in a pilot study to significantly increase elements of sleep such as total sleep duration, decrease sleep onset latentcy and daytime impairment related to disturbed sleep pattern. During the drug trial, subjects used a daily electronic sleep diary to measure sleep quality, total sleep duration and functional daytime disability. After 2 weeks of consistent use of Novanuit, sleep was rated to increase 2 points higher on a 0-10 scale. After 4 weeks, compliance was measured at 97.5%, with reports of significant improvement of sleep and mood.

I would follow-up with the patient at 2 weeks to assess improvement of sleep quality and duration. I would continue to encourage grief counseling. I would also encourage light exercise and participating in enjoyable activities. I would also assess patient’s depressive symptoms and consider increasing her Zoloft to 150mg if depression has not improved with better sleep.

I would schedule an appointment 4 weeks to check patient’s progress.

References

Lancel, M., Stroebe, M., & Eisma, M. C. (2020). Sleep disturbances in bereavement: A systematic review. Sleep Medicine Reviews, 53. /orders/doi-org.ezp.waldenulibrary.org/10.1016/j.smrv.2020.101331

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Lemoine, P., Bablon, J.C., & Da Silva, C. (2019). A combination of melatonin, vitamin B6 and medicinal plants in the treatment of mild-to moderate insomnia: A prospective pilot study. Complementary Therapies in Medicine, 45, 104-108

——————————————————————————————————————

Second response

Rosette Joseph

RE: Week 7- Initial discussion post

COLLAPSE

Treatment for a Patient with a Common Condition

Insomnia disorder in older adults is multifactorial and is associated with difficulty falling asleep or staying asleep and can also be implicated in many medical and psychiatric disorders. Insomnia is a disruption in the amount and quality of sleep that impairs functioning (Morgan & Townsend, 2021). As people age, sleep patterns and the amount of sleep can also change. A baby can sleep between 10 to 14 hours per day, whereas an older person is recommended to rest for at least 7-8 hours daily (Brewster et al., 2018). Insomnia is frequently associated with aging, related to decreased restorative stage 3 of nonrapid eye movement sleep and advance phase shift leading to early morning riser (Cherukuri et al. 2018). In the case scenario of this 75-year-old patient that already has several comorbidities of HTN, DM, & major depressive disorder (MDD), who had experienced the death of her spouse of 41 years ten months ago is a significant life event that is a risk factor of her mood and her current state of insomnia. While evaluating the current patient list of medication, she is on Sertraline 100 mg daily for her MDD. One of the side effects of that drug is difficulty falling asleep or staying asleep (U.S. Food & Drug Administration n.d).

There are many pharmacological, non-pharmacological that can be used to provide appropriate intervention for insomnia and tools used to assess insomnia, but the clinician should be cautious when evaluating an older adult due to the possibility of polypharmacy. Three questions I might ask this patient. Using an insomnia questionnaire includes:

How often do you have trouble sleeping, and when did insomnia begin?

How long does it take to fall asleep?

How often do you awaken during the night, and how long does it take to fall back to sleep? And I would even go further to ask the patient what had she tried to help improve her insomnia?

Using open-ended questions can help differentiate the type of insomnia, either acute, which is often caused by an emotional or physical discomfort such as a life stressor (DerSarkissian, 2019), in this patient situation, the passing of husband of 41 years, chronic insomnia, or pharmacological can all be a factor. Therefore, as a clinician asking her about her sleep history should be evaluated to help guide treatment. Identifying other people in the patient life that can give feedback is vital; using a patient and family-centered approach is best. If they live in the same house, the patient children can be helpful, but if they do not live in the same place, it might be hard to ask some questions regarding sleeping habits, such as if they snore or have restless leg syndrome.

Unlike other sleep disorders, insomnia disorder relies on self-report (Levenson et al., 2015). The sleep disorder test is often used to diagnose insomnia and a physical exam where the clinician assesses the patient’s sleep history to determine the cause of the problem (DerSarkissian, 2019). Other diagnostic tests that may be appropriate in this patient’s case would be to have her keep a sleep diary, and it can help the clinician tracking the sleep patterns; another test is an Epworth Sleeping Scale that can be used to assess her daytime sleepiness as stated by DerSarkissian, 2019. Although this patient physical exam is within the defined limit and she denies any suicidal ideation, I think a physical and mental health exam is warranted to re-evaluate her mental status. I would recommend that the patient continues with her current Sertraline 100 mg daily, but take it early in the morning and use other technique mechanisms that can help her fall asleep and return in 4 weeks.

Differential Diagnosis

A differential diagnosis is grief related to the life stressors of her husband passing, is one the diagnosis that can be applied appropriately. Two pharmacological agents I would recommend are Ambien 5 mg for women by mouth at bedtime and in older individuals like this 75-year-old patient. Restoril 7.5 mg orally once a day at bedtime is the initial therapy recommended until the individual response is determined (Sinha, 2021).

In conclusion, proper evaluation and assessment of patient insomnia can help the clinician effectively develop mechanisms and strategies for managing insomnia. As a future nurse practitioner, the main goal is to help the patient manage and cope with life stressors to help improve her insomnia.

References

Brewster, G.S., Riegel, B., & Gehrman, P.R. (2018) Insomnia in the Older Adult. Sleep medicine clinics, 13, (1) /orders/doi.org/10.1016/j.jsmc.2017.09.002

Cherukuri, C.M., Kaplish, N., Malepah, D.C., Khawaja, I.S, Bhatia, S.K., & Bhatia, S.C., (2018) Insomnia in Older Adult. /orders/doi.org.10.3928/00485713/201805514-01

DerSarkissian, C., (2019). Diagnosing Insomnia /orders/www.webmd.com/sleep-disorders/diagnosing-insomnia

Levenson, J.C., Key, D.B., & Buysse, D.J (2015). The Pathophysiology of insomnia. Chest 147 -A (4). /orders/www.ncbi.nlm.nih.gov/pmc/articles/PMC 4388122/

Morgan, K.I., & Townsend, M.C. (2021). Bipolar and Related Disorders: Pocket Guide to Psychiatric Nursing. Eleventh ed. Chap 7 p169

U.S. Food & Drug Administration (n.d). drugs@ FDA: FDA-Approved drugs. /orders/www.accessdata.fda.gov/Script/cder/def/index.cfm.

Sinha, S., (2021). Restoril. /orders/www.drugs.com/restoril.htm

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Week 7 6630: Assessing and Treating Patients With Psychosis and Schizophrenia

Psychosis and schizophrenia greatly impact the brain’s normal processes, which interfere with the ability to think clearly. When symptoms of these disorders are uncontrolled, patients may struggle to function in daily life. However, patients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with psychosis and schizophrenia.

To prepare for this Assignment:

Review this week’s Learning Resources, including the Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with schizophrenia-related psychoses.

The Assignment: 5 pages

Examine Case Study: Pakistani Woman With Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

Introduction to the case (1 page)

Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

Which decision did you select?
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at /orders/academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

Freudenreich, O., Goff, D. C., & Henderson, D. C. (2016). Antipsychotic drugs. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 72–85). Elsevier.

American Psychiatric Association. (2019). Practice guideline for the treatment of patients with schizophrenia. /orders/www.psychiatry.org/File%20Library/Psychiatrists/Practice/Clinical%20Practice%20Guidelines/APA-Draft-Schizophrenia-Treatment-Guideline.pdf

Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine. /orders/www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf

Funk, M. C., Beach, S. R., Bostwick, J. R., Celano, C. M., Hasnain, M., Pandurangi, A., Khandai, A., Taylor, A., Levenson, J. L., Riba, M., & Kovacs, R. J. (2018). Resource document on QTc prolongation and psychotropic medications. American Psychiatric Association. /orders/www.psychiatry.org/File%20Library/Psychiatrists/Directories/Library-and-Archive/resource_documents/Resource-Document-2018-QTc-Prolongation-and-Psychotropic-Med.pdf

Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261–276. /orders/doi.org/10.1093/schbul/13.2.261

Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179–1192. /orders/www.ncbi.nlm.nih.gov/pmc/articles/PMC4388122/

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 and Adolescent Psychiatry, 52(9), 976–990. /orders/www.jaacap.org/article/S0890-8567(09)62600-9/pdf

Naber, D., & Lambert, M. (2009). The CATIE and CUtLASS studies in schizophrenia: Results and implications for clinicians. CNS Drugs, 23(8), 649–659. /orders/doi.org/10.2165/00023210-200923080-00002

Delusional Disorders: Pakistani Female With Delusional Thought Processes

BACKGROUND

The client is a 34-year-old Pakistani female who moved to the United States in her late teens/early 20s. She is currently in an “arranged” marriage (her husband was selected for her when she was 9 years old). She presents following a 21-day hospitalization for what was diagnosed as “brief psychotic disorder.” She was given this diagnosis as her symptoms have persisted for less than 1 month.

Prior to admission, she was reporting visions of Allah, and over the course of a week, she believed that she was the prophet Mohammad. She believed that she would deliver the world from sin. Her husband became concerned about her behavior to the point that he was afraid of leaving their 4 children with her. One evening, she was “out of control,” which resulted in his calling the police and her subsequent admission to an inpatient psych unit.

During today’s assessment, she appears quite calm and insists that the entire incident was “blown out of proportion.” She denies that she believed herself to be the prophet Mohammad and states that her husband was just out to get her because he never loved her and wanted an “American wife” instead of her. She says she knows this because the television is telling her so.

She currently weighs 140 lbs., and she is 5’ 5.

SUBJECTIVE

Client reports that her mood is “good.” She denies auditory/visual hallucinations but believes that the television talks to her. She believes that Allah sends her messages through the TV. At times throughout the clinical interview, she becomes hostile towards you but then calms down.

A review of her hospital records shows that she received a medical workup from physician, who reported her to be in overall good health. Lab studies were all within normal limits.

Client admits that she stopped taking her Risperdal about a week after she got out of the hospital because she thinks her husband is going to poison her so that he can marry an American woman.

MENTAL STATUS EXAM

The client is alert and oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Her speech is slow and, at times, interrupted by periods of silence. Self-reported mood is euthymic. Affect is constricted. Although the client denies visual or auditory hallucinations, she appears to be “listening” to something. Delusional and paranoid thought processes as described above. Insight and judgment are impaired. She is currently denying suicidal or homicidal ideation.

You administer the PANSS which reveals the following scores:

-40 for the positive symptoms scale

-20 for the negative symptom scale

-60 for general psychopathology scale

Diagnosis: Schizophrenia, paranoid type

RESOURCES

PANSS Scale. Available at: http://egret.psychol.cam.ac.uk/medicine/scales/PANSS

§ Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261–276. doi:10.1093/schbul/13.2.261

/orders/www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf

§ Clozapine REMS Program. (n.d.). Clozapine REMS: A guide for healthcare providers. Retrieved September 7, 2016, from /orders/www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf

http://www.ima.org.il/FilesUpload/IMAJ/0/40/20149.pdf

§ Paz, Z., Nalls, M., and Ziv, E. (2011). The genetics of benign neutropenia. Israel Medical Association Journal, 13(10), 625–629. Retrieved from http://www.ima.org.il/FilesUpload/IMAJ/0/40/20149.pdf

Decision Point One

Start Zyprexa (olanzapine) 10 mg orally at BEDTIME

RESULTS OF DECISION POINT ONE

Client returns to clinic in four weeks
Her PANSS decreases to a partial response (decrease in positive symptoms by 25%)
She comes in today with a reported weight gain of 5 pounds. When questioned further on this point, she states that she can never seem to get full from her meals, so she is snacking constantly throughout the day

Decision Point Two

Decrease Zyprexa to 7.5 mg orally at BEDTIME

RESULTS OF DECISION POINT TWO

Client returns to clinic in four weeks
Result of next decision (what happened): Client worsens (her positive symtpoms scale increased by 25% and her negative symptom scale score decreased by 10% indicating improved negative symptoms), but her weight becomes stabilized and excessive hunger abates
Husband explains that she is becoming less manageable at home, and he has to take time off from work because he is fearful of leaving her alone

Decision Point Three

Increase Zyprexa 10 MG orally at BEDTIME

Guidance to Student
Weight gain is a significant problem with Zyprexa. Next to Clozaril (clozapine), Zyprexa causes the most weight gain of all the atypical antipsychotics. This is a side effect that a significant number of clients will experience. There also appears to be an increased association of newly diagnosed diabetes mellitus in clients treated with Zyprexa. Although this can be disease related in this population, Zyprexa is above what would be considered coincidental.
Risperdal is a good option, although it is dosed twice daily and compliance in this population can be problematic. There is evidence that shows giving Risperdal all at once can be efficacious and therefore could be an option down the road should compliance become an issue. Weight gain is also possible with Risperdal, but it is not as great as that seen with Zyprexa. If compliance does become an issue with this client, Risperdal has a long-acting injectable formulation, Risperdal Consta, that could be used. Remember, Risperdal Consta has to be given every 2 weeks at the provider’s office, and therapeutic blood levels take time to achieve (on average 3–6 weeks or 2–3 injections). Oral overlapping therapy is required to bridge this period of time. Another option in someone who responds to Risperdal would be Invega Sustenna (paliperidone palmitate), which is the first metabolite of Risperdal and has greater activity at the D2 receptor than Risperdal. An advantage of Invega Sustenna over Risperdal Consta is that therapeutic blood levels are attained within the first 4–7 days, and overlapping oral therapy is usually not necessary. A disadvantage is that during the initiating phase of medication, the first two doses need to be given within 4–7 days of one another. This is followed by monthly injections. There is another product on the market called Invega Trinza, which is given once every 3 months. This product is for clients who have been stabilized on Invega Sustenna for at least 4 months where the last two doses were the same strength (two months of 156 mg injections).
Increasing Zyprexa to 15 mg at bedtime will only worsen the weight gain side effect. While additional benefits from increasing the dose may be possible from an efficacy standpoint, side effects always need to be taken into consideration. “First, do no harm.” Qsymia is a weight loss medication that is a combination of phentermine and topiramate. It is only indicated to treat obesity. This client’s BMI (28.9 kg/M2) does not fit the definition of obesity (BMI >30 Kg/M2- Following from CDC website: Class 1: BMI of 30 to < 35, Class 2: BMI of 35 to < 40, Class 3: BMI of 40 or higher. Class 3 obesity is sometimes categorized as “extreme” or “severe” obesity). There are two things wrong with this therapy option. First, there are only a few occasions where add-on therapy to treat a side effect is acceptable, and weight gain is not one of those scenarios. Secondly, phentermine has a lot of cardiovascular toxicities (such as elevated BP, HR, and increased workload on the heart).

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DNP 816: Analysis & Application of Health Data for DNP

Access to mental health resources following natural disasters

Northern Kentucky University

DNP 816: Analysis & Application of Health Data for DNP

Among people experiencing loss due to natural disaster (P), how does having access to a resource pamphlet (I) as compared to not having access to a resource pamphlet (C), affect a person’s mental health following questionnaire (O) over a year (T)?

PICOT question

Why is this important?

Almost 6,800 natural disasters occur worldwide each year (Homeland Security, 2021).

Following natural disasters, one-third to one-half of the citizens in the area are affect by mental health disparities (Cartier, 2021).

There are few immediate resources available following a natural disaster.

Major Findings Of the articles, there were two cross-sectional studies, one quasi-experimental study, a planned cohort study, and a systematic review.

Article	Important Findings	Authors
1	This study was conducted to determine if the number of traumatic events experienced by the residents of Fort McMurray correlated with the amount of mental health despair in the community. The results showed multiple traumas such as wildfires, trauma, and the COVID-19 pandemic contributed to a much higher likelihood of experiencing anxiety, depression, or PTSD.	Agyapong et al., 2022
2	In 2018, Texas residents were invited to complete and online survey of the effects of Hurricane Harvey and the traumatic flooding. In 2020, there was a nationwide survey sent out to residents to determine the level of disparity experienced by residents in the pandemic. The results show that the pandemic layered on to the experience of flooding from Hurricane Harvey greatly increased the mental health disease among the citizens.	Callender et al., 2022
3	This was a cross-sectional analysis completed from citizens that were affected by flooding from December 2013-March 2014. All citizens in the area were invited to participate in the surveys, and the participants were categorized in to flooded, disrupted by flooding, or unaffected. The results showed highest anxiety among participants that were flooded, but there was also a significant level of anxiety experienced by the disrupted lives among the participants.	Waite et al., 2017
4	The English National Study on Flooding and Health collected information from houses in the community that were flooded, disrupted, or unaffected by flooding. The results showed that women were more likely to suffer from depression, anxiety, and PTSD especially from losing items of sentimental value. For men, there was more concern over relationship problems and possible depression.	Tempest et al., 2017
5	The authors created a conceptual behavioral framework for individuals that suffered from depression, anxiety, or PTSD following a traumatic event. There were in-person, web-based, and telephone interviews conducted to determine if the framework was effective in determining immediate need for mental health resources. The results showed the framework was very effective in assessing the individual to assist in immediate need.	Goldmann et al., 2021

Gaps in Literature

Low sample size; No generalizability to the population

There was no updated surveys/questionnaires sent to the individuals to determine the long-term effects of the individuals

Some individuals were unable to be reached due to the lack of resources following the disasters

The question could be asked-were mental health disorders present prior to the natural disaster?

Research Needs & Next Steps

Follow up with retesting surveys to determine if there have been long-term mental health effects

Larger sample sizes to create a generalizable result from the population

Create an intervention for immediate access for individuals to have for mental health resources to prevent injury/long-term effects

Research needs to be conducted to see if resources affect the mental health quality of affected individuals

References

Agyapong, B., Shalaby, R., Eboreime, E., Obuobi-Donkor, G., Owusu, E., Adu, M., Mao, W., Oluwasina, F., & Agyapong, V. (2022). Cumulative trauma from multiple natural disasters increases mental health burden on residents of Fort McMurray. European Journal Psychotraumatology, 13. /orders/doi.org/10.1080/20008198.2022.2059999

Callender, R., Canales, J., Avendano, C., Craft, E., Ensor, K., & Miranda, M. (2022). Economic and mental health impacts of multiple adverse events: Hurricane Harvey, other flooding events, and the COVID-19 pandemic. Environmental Research, 214. /orders/doi.org/10.1016/j.envres.2022.11.4020

Cartier, K. (2021). Suicide rates may rise after natural disasters. Retrieved from /orders/eos.org/articles/suicide-rates-may-rise-after-natural-disasters

Goldmann, E., Abramson, D., Pitch-Loeb, R., Samarabandu, A., Goodson, V., Azofeifa, A., Hagemeyer, A., Al-Amin, N., & Lyerla, R. (2021). Rapid behavioral health assessment post-disaster: Developing and validating a brief, structured module. Journal of Community Health, 46. 982-991. /orders/doi.org/10.1007/s10900-021-00966-5

Homeland Security (2021). Natural disasters. Retrieved from /orders/www.dhs.gov/natural-disasters

Tempest, E., English National Study on Flooding and Health Study Group, Carter, C., Beck, C., & Rubin, J. (2017). Secondary stressors are associated with probable psychological morbidity after flooding: A cross-sectional analysis. The European Journal of Public Health, 27(6). 1042-7. /orders/doi.org/10.1093/eurpub/ckx182

Waite, T., Chaintarli, K., Beck, C., Bone, A., Amlot, R., Kovats, S., Reacher, M., Armstrong, B., Leonardi, G., Rubin, J., & Oliver, I. (2017). The English national cohort study of flooding and health: Cross-sectional analysis of mental health outcomes at year one. BMC Public Health, 17(219). /orders/doi.org/10.1186/s12889-016-4000-2

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Suppose a survey was done in three states on the Covid-19 pandemic situation

1. Suppose a survey was done in three states on the Covid-19 pandemic situation. Of the total population of the three states, 25% live in state X, 45% live in state Y, and 30% live in state Z. In state X, 20% of the citizens have been infected with Covid-19, in state B, 10% of the citizens have been infected with Covid-19, and in state C, 15% of the citizens have been infected with Covid-19.

Let X represents the event that the citizen is from state X, Y represents the event that the citizen is from state Y and Z represents the event that the citizen is from state Z. Let C represents the event that the citizen has been infected with Covid-19.

a) Find the probability that a randomly selected citizen has not been infected with Covid-19 and lives in state X.

b) Find the probability that a randomly selected citizen has been infected with Covid-19.

c) Given that a randomly selected citizen has been infected with Covid-19, find the probability that the selected citizen is from state Y.

Solution:

a) To find the probability that a randomly selected citizen has not been infected with Covid-19 and lives in state X, we need to find P(not C and X).

P(not C and X) = P(not C | X) * P(X)

We are given that 20% of citizens in state X have been infected with Covid-19. Therefore, the probability of not being infected in state X is 1 – 0.2 = 0.8.

P(not C and X) = 0.8 * 0.25 = 0.2

So, the probability that a randomly selected citizen has not been infected with Covid-19 and lives in state X is 0.2 or 20%.

b) To find the probability that a randomly selected citizen has been infected with Covid-19, we need to calculate P(C).

P(C) = P(C and X) + P(C and Y) + P(C and Z)

Given that 20% of citizens in state X, 10% in state Y, and 15% in state Z have been infected, we can calculate:

P(C) = 0.2 * 0.25 + 0.1 * 0.45 + 0.15 * 0.3
= 0.05 + 0.045 + 0.045
= 0.14

Therefore, the probability that a randomly selected citizen has been infected with Covid-19 is 0.14 or 14%.

c) To find the probability that a randomly selected citizen, who has been infected with Covid-19, is from state Y, we need to calculate P(Y | C).

P(Y | C) = P(Y and C) / P(C)

Given that 10% of citizens in state Y have been infected with Covid-19, and P(C) is 0.14 (from the previous calculation), we can calculate:

P(Y | C) = (0.1 * 0.45) / 0.14
= 0.045 / 0.14
≈ 0.3214

Therefore, the probability that a randomly selected citizen, who has been infected with Covid-19, is from state Y is approximately 0.3214 or 32.14%.

1. An aesthetic club has 100 members. Out of them 40 do dancing, 45 do music and 24 do drama. 15 do both dancing and music, 11 do both dancing and drama and 13 do both music and drama and 5 do dancing, music and drama. Remaining members do arts. Let D represents the randomly selected member does dancing, M represents the randomly selected member does music, R represents the randomly selected member does drama. A represents the randomly selected member does arts.

Represent the given information in a Venn diagram. Use that Venn diagram to answer the following questions.

a) Find the probability that a randomly selected member either does dancing or music.

b) Find whether the events “The randomly selected member does drama” and “The randomly selected member does music” are independent or not.

Solution:

To represent the given information in a Venn diagram, we can use the following notation:

D: Members who do dancing M: Members who do music R: Members who do drama A: Members who do arts

Based on the information provided, we can fill in the Venn diagram as follows:

———————
| A |
| |
| |
| |
———————
D | | M
| |
| |
| |
———————
| R |
| |
| |
| |
———————

Given this Venn diagram, we can answer the following questions:

a) To find the probability that a randomly selected member either does dancing or music, we need to calculate P(D or M).

P(D or M) = P(D) + P(M) – P(D and M)

From the information provided, we know that 40 members do dancing, 45 members do music, and 15 members do both dancing and music.

P(D) = 40/100 = 0.4 P(M) = 45/100 = 0.45 P(D and M) = 15/100 = 0.15

P(D or M) = 0.4 + 0.45 – 0.15 = 0.7

Therefore, the probability that a randomly selected member either does dancing or music is 0.7 or 70%.

b) To determine whether the events “The randomly selected member does drama” and “The randomly selected member does music” are independent or not, we need to compare P(R) and P(M|R) with P(M).

If P(R) * P(M|R) = P(M), then the events are independent. Otherwise, they are dependent.

From the Venn diagram, we see that 24 members do drama, and 13 members do both music and drama.

P(R) = 24/100 = 0.24 P(M|R) = 13/24 (number of members doing both music and drama divided by the number of members doing drama)

To calculate P(M), we need to find the total number of members doing music. We can do this by subtracting the members doing both music and drama (13) and the members doing only music (45 – 13 = 32).

P(M) = (13 + 32)/100 = 0.45

Now let’s check if P(R) * P(M|R) = P(M):

P(R) * P(M|R) = 0.24 * (13/24) = 0.13 P(M) = 0.45

Since P(R) * P(M|R) is not equal to P(M), the events “The randomly selected member does drama” and “The randomly selected member does music” are dependent.

Therefore, the events are not independent.

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Unit 14 : Maths for Computing

Pearson Higher Nationals in Computing

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INTERNAL VERIFICATION – ASSIGNMENT BRIEF
Programme Title:	BTEC Higher National Diploma in Computing
Assessor Name:
Internal Verifier Name:
Unit or Component Number and Title:	Unit 14 : Maths for Computing
Assignment title:	Importance of Maths in the Field of Computing
Assessment criteria targeted by this assignment brief:	All (P1 – D4)
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Has this assignment been submitted to the Assignment Checking Service? (If Yes, please keep a copy of the ACS feedback with this form)	Yes		No

INTERNAL VERIFIER CHECKLIST				Y/N
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*Are clear deadlines for assessment given?
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Is it likely to generate evidence that is valid and sufficient?
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Action required: (If none then please state n/a)	Target Date for Completion	Date Action Completed




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Assignment Brief Authorised for Use:
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Assessor signature	Date
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Higher Nationals

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Programme title	BTEC Higher National Diploma in Computing
Assessor			Internal Verifier
Unit(s)	Unit 14 : Maths for Computing
Assignment title	Importance of Maths in the Field of Computing
Student’s name
List which assessment criteria the Assessor has awarded.	Pass		Merit	Distinction

INTERNAL VERIFIER CHECKLIST
Do the assessment criteria awarded match those shown in the assignment brief?		Y/N
Is the Pass/Merit/Distinction grade awarded justified by the assessor’s comments on the student work?		Y/N
Has the work been assessed accurately?		Y/N
Is the feedback to the student: Give details: • Constructive? • Linked to relevant assessment criteria? • Identifying opportunities for improved performance? • Agreeing actions?		Y/N Y/N Y/N Y/N
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Higher Nationals – Summative Assignment Feedback Form

Student Name/ID

Unit Title

Unit 14 : Maths for Computing

Assignment Number

Assessor

Submission Date

Date Received 1st submission

Re-submission Date

Date Received 2nd submission

Assessor Feedback:

LO1 Use applied number theory in practical computing scenarios.
Pass, Merit & Distinction Descripts	P1	P2	M1	D1
LO2 Analyse events using probability theory and probability distributions.
Pass, Merit & Distinction Descripts	P3	P4	M2	D2
LO3 Determine solutions of graphical examples using geometry and vector methods.
Pass, Merit & Distinction Descripts	P5	P6	M3	D3
LO4 Evaluate problems concerning differential and integral calculus.
Pass, Merit & Distinction Descripts	P7	P8	M4	D4

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Student Name /ID Number
Unit Number and Title	Unit 14 : Maths for Computing
Academic Year	2022/23
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Assignment Title	Importance of Maths in the Field of Computing
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Unit Learning Outcomes:

LO1 Use applied number theory in practical computing scenarios.

LO2 Analyse events using probability theory and probability distributions.

LO3 Determine solutions of graphical examples using geometry and vector methods.

LO4 Evaluate problems concerning differential and integral calculus.

A farmer wants to make square shaped vegetable beds. The required squared area of vegetable beds will be prepared from a land which is 28 feet in length and 24 feet in width.

a) Find the minimum number of squared vegetable beds that can be prepared from the land without wasting any area.

b) Briefly explain the technique you used to solve (a).

2. In a company, 5 employees are doing overtime work. First day of the month, all the 5 employees did overtime work. Afterwards, those 5 employees do the overtime work once in 3,4,6, 8 and 12 days respectively.

a) On which day of the month, will all the 5 employees do the overtime work together?

b) Briefly explain the technique you used to solve (a).

Part 2

3. In a warehouse, boxes are stored such that 30 boxes on the bottom row and 21 on the top row. There are 10 rows in all, with each row having one more box than the one above it.

a) How many boxes have been stored?

b) Briefly explain the technique you used to solve (a).

4. A businessman has done an investment of Rs.200,000.00 on a new business expecting a 5% interest compounded yearly.

a) Find the total amount of money that the businessman would earn in 6 years.

b) Briefly explain the technique you used to solve (a).

Part 3

1. Define the multiplicative inverse in modular arithmetic and identify the multiplicative inverse of 7 mod 8 while explaining the algorithm used.

2. Prime numbers are important to many fields. In the computing field also prime numbers are applied. Provide examples and in detail explain how prime numbers are important in the field of computing.

Activity 02

Part 1

1. Define ‘Conditional Probability’ with a suitable example.

2. An aesthetic club has 100 members. Out of them 40 do dancing, 45 do music and 24 do drama. 15 do both dancing and music, 11 do both dancing and drama and 13 do both music and drama and 5 do dancing, music and drama. Remaining members do arts. Let D represents the randomly selected member does dancing, M represents the randomly selected member does music, R represents the randomly selected member does drama. A represents the randomly selected member does arts.

Represent the given information in a Venn diagram. Use that Venn diagram to answer the following questions.

a) Find the probability that a randomly selected member either does dancing or music.

b) Find whether the events “The randomly selected member does drama” and “The randomly selected member does music” are independent or not.

3. Suppose a survey was done in three states on the Covid-19 pandemic situation. Of the total population of the three states, 25% live in state X, 45% live in state Y, and 30% live in state Z. In state X, 20% of the citizens have been infected with Covid-19, in state B, 10% of the citizens have been infected with Covid-19, and in state C, 15% of the citizens have been infected with Covid-19.

a) Find the probability that a randomly selected citizen has not been infected with Covid-19 and lives in state X.

b) Find the probability that a randomly selected citizen has been infected with Covid-19.

c) Given that a randomly selected citizen has been infected with Covid-19, find the probability that the selected citizen is from state Y.

4. In a game if the player wins, a random gift will be given. There are 3 types [Watch, Voucher, Pen Drive] of gifts for the winners. There are 7 Vouchers, 6 Watches and 5 Pen Drives. The number tags of the gifts are stored in a box. If two players win the game and the number tags of the gifts are selected randomly without replacement.

a) Find the probability that the both winners get a Voucher.

b) Find the probability that one gift is a Watch and the other gift is a Pen Drive.

c) Find the probability that the two winners get different gifts.

Part 2

5. Differentiate between ‘Discrete Random Variable’ and ‘Continuous Random Variable”.

6. There are two boxes. In each box there are 4 cards with a different number printed on it. The four cards have been numbered as 1,2,3,4 in each box. Two cards are drawn random from each box. The random variable X represents the difference between the number on the card from box 1 minus the number on the card from box 2.

a) Find the mean of this probability distribution. (i.e. Find E[X] )

b) Find the variance and standard deviation of this probability distribution.

(i.e. Find V[X] and SD[X])

The random variables M and W are defined as follows:

M = X+5 and W = (1/2)X+5

c) Find E[M] and E[W].

d) Find V[M] and V[W].

e) Mary and William play a game using the cards in the above boxes. Randomly two cards are drawn, and Mary records his score using the random variable M and William uses the random variable W. They repeat this for a large number of times and compare their scores. Comment on any likely differences or similarities of their scores.

7. A discrete random variable Y has the following probability distribution.

Y=y	1	2	3	4	5
P(Y=y)	1/8	1/4	1/3	k	1/8

where k is a constant.

a) Find the value of k.

b) Find P(Y≤4).

c) Find P(Y>3).

Part 3

8. The “Winkles” quiz team has a winning rate of 72%. The team is planning to participate in 8 quizzes in the next month.

a) Let Y be the number of quizzes win by the team. What are the possible values of Y?

b) What is the probability that the team will win exactly 4 quizzes?

c) What is the probability that the team will lose 2 or less quizzes?

d) What is the mean number of quizzes that the team will win?

e) What are the variance and the standard deviation of the number of quizzes that the team will win?

9. In a boys’ school, there are 40 students in grade 9. The weight of the students was measured. The mean weight of the students was 55 kg and the standard deviation was 2.5 kg. Peter’s weight was 64kg. Would his weight be considered an outlier, if the weight of the students were normally distributed? Explain your answer.

10. The working life of a certain electrical equipment is normally distributed with a mean of 180 days and a standard deviation of 4 days.

For each of the following questions, construct a normal distribution curve and provide the answer.

a) About what percent of the products last between 176 and 184 days?

b) About what percent of the products last between 180 and 184 days?

For each of the following questions, use the standard normal table and provide the answer.

c) About what percent of the products last 172 or less days?

d) About what percent of the products last 184 or more days?

11. In the computing field, there are many applications of Probability theories. Hashing and Load Balancing are also included to those. Provide an example for an application of Probability in Hashing and an example for an application of Probability in Load Balancing. Then, evaluate in detail how Probability is used for each application while assessing the importance of using Probability to those applications.

Activity 03

Part 1

1. Find the equation (formula) of a circle with radius r and center C(h,k) and if the Center of a circle is at (7,-2) and a point on the circle is (-3,5) find the formula of the circle.

2. Find the equation (formula) of a sphere with radius r and center C(h, k, l) and show that

x² + y² + z² – 14x + 6y – 2z – 3 = 0 is an equation of a sphere. Also, find its center and radius.

3. Following figure shows a Parallelogram.

If a=(2i–j+3k) , b=(3i+5j–k), find the area of the Parallelogram.

Part 2

4. If 5x – 2y = 10, 4y = 3x + 36 are two functions. Evaluate the x, y values using graphical method.

5. Evaluate the surfaces in ³ that are represented by the following equations.

i. y = 2

ii. z = 6

6. Following figure shows a Tetrahedron.

Construct an equation to find the volume of the given Tetrahedron using vector methods and if the vectors of the Tetrahedron are a=(2i+j-3k), b=(-i+2j+4k) and c=(5i-7j+k), evaluate the volume of the Tetrahedron.

Activity 04

Part 1

1. Determine the slope of the following functions.

i. f(x) = 4x³ + 5x⁴ – 9x + 2

ii. f(x) = sin(3x) – 5x³ – 7

2. Let the velocity function of a moving object is V(t) = 7t³ + 5t² – 4t. What is the function for the acceleration of the object at time t.

Part 2

3. Find the area between the two curves f(x) = 3x² – 4 and g(x) = 2x+5 on the interval

(-1) ≤ x ≤ 1.

4. It is estimated that t years from now the bee population of a certain farm will be increasing at the rate of 9t ² + 10t – 7 hundred bees per year. It has been found that the number of flowers in the nearby botanical garden increases at the rate of approximately 400 flowers per 10 bees. By how much will the number of flowers in the nearby botanical garden increase during the next 2 years?

Part 3

5. Sketch the graph of f(x) = x³ – x⁴ + 6x² + 3 by applying differentiation methods for analyzing where the graph is increasing/decreasing, local maximum/minimum points [Using the second derivative test], concave up/down intervals with inflection points.

6. Identify the maximum and minimum points of the function f(x)= −4x ² + 6x + 3 by further differentiation. [i.e Justify your answer using both first derivative test and second derivative test.

Grading Rubric

Grading Criteria	Achievement (Yes/No)	Feedback
LO1 : Use applied number theory in practical computing scenarios.
P1 : Calculate the greatest common divisor and least common multiple of a given pair of numbers.
P2 : Use relevant theory to sum arithmetic and geometric progressions.
M1 : Identify multiplicative inverses in modular arithmetic.
D1 : Produce a detailed written explanation of the importance of prime numbers within the field of computing.
LO2 : Analyse events using probability theory and probability distributions.
P3 : Deduce the conditional probability of different events occurring within independent trials.
P4 : Identify the expectation of an event occurring from a discrete, random variable.
M2 : Calculate probabilities within both binomially distributed and normally distributed random variables.
D2 : Evaluate probability theory to an example involving hashing and load balancing.
LO3 : Determine solutions of graphical examples using geometry and vector methods.
P5 : Identify simple shapes using co-ordinate geometry.
P6 : Determine shape parameters using appropriate vector methods.
M3 : Evaluate the coordinate system used in programming a simple output device.
D3 : Construct the scaling of simple shapes that are described by vector coordinates.
LO4 : Evaluate problems concerning differential and integral calculus.
P7 : Determine the rate of change within an algebraic function.
P8 : Use integral calculus to solve practical problems involving area.
M4 : Analyse maxima and minima of increasing and decreasing functions using higher order derivatives.
D4 : Justify, by further differentiation, that a value is a minimum.

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