Comprehensive Psychiatric Evaluation 3

/0 Comments/in /by

Question

Step 1: You will use the Graduate Comprehensive Psychiatric Evaluation Template Download Graduate Comprehensive Psychiatric Evaluation Templateto:

Compose a written comprehensive psychiatric evaluation of a patient you have seen in the clinic.

Upload your completed comprehensive psychiatric evaluation as a Word doc. Scanned PDFs will not be accepted.

For the Comprehensive Psychiatric Evaluation Presentation Assignment: You will need to get it signed by your preceptor for the presentation (actual signature, not electronically typed).

Step 2: Each student will create a focused SOAP note video presentation in the next assignment. See Comprehensive Psychiatric Evaluation Presentation 3 for more details.

SOAP is an acronym that stands for Subjective, Objective, Assessment, and Plan.  

S = 

Subjective data: Patient’s Chief Complaint (CC); History of the Present Illness (HPI)/ Demographics; History of the Present Illness (HPI) that includes the presenting problem and the 8 dimensions of the problem (OLDCARTS or PQRST); Review of Systems (ROS) 

O = 

Objective data: Medications; Allergies; Past medical history; Family psychiatric history; Past surgical history; Psychiatric history, Social history; Labs and screening tools; Vital signs; Physical exam, (Focused), and Mental Status Exam 

A = 

Assessment: Primary Diagnosis and two differential diagnoses including ICD-10 and DSM5 codes 

P = 

  1. Plan: Pharmacologic and Non-pharmacologic treatment plan; diagnostic testing/screening tools, patient/family teaching, referral, and follow up 
  2. Other: Incorporate current clinical guidelines NIH Clinical GuidelinesLinks to an external site. or APA Clinical GuidelinesLinks to an external site., research articles, and the role of the PMHNP in your evaluation.   

Psychiatric Assessment of Infants and ToddlersLinks to an external site. 

Reminder: It is important that you complete this assessment using your critical thinking skills.  You are expected to synthesize your clinical assessment, formulate a psychiatric diagnosis, and develop a treatment plan independently. It is not acceptable to document “my preceptor made this diagnosis.”  An example of the appropriate descriptors of the clinical evaluation is listed below.  It is not acceptable to document “within normal limits.”   

Graduate Mental Status Exam Guide Download Graduate Mental Status Exam Guide 

Successfully Capture HPI Elements in Psychiatry E/M NotesLinks to an external site.
AAPC Admin. (2013, August 1). Successfully capture HPI elements in psychiatry E/M notes. Advancing the Business of Healthcare. https://www.aapc.com/blog/25848-successfully-captu…

Submission Instructions: 

Upload your completed Comprehensive Psychiatric Evaluation as a word document. It will be assessed through Turnitin.

Discussion 11 reply

/0 Comments/in /by

QUESTION

Other student discussion:

The content presented in the videos likely emphasizes the complex interplay between adolescent development, addiction, and the neurological impact of substance use, highlighting the significance of early education and intervention in substance use disorders (SUDs). Insights from these videos may include:

The Role of Adolescent Brain Development in Addiction: Adolescence is a critical period for brain development, making young individuals particularly susceptible to addiction. The videos probably showcase how the prefrontal cortex, responsible for decision-making and impulse control, is not fully developed in adolescents. This underdevelopment can lead to increased risk-taking behaviors, including drug use, and heightened vulnerability to addiction (Volkow, N.D., Koob, G.F., & McLellan, A.T., 2016).

Mechanisms of Relapse: Understanding the science behind relapse, including the triggers and neurological pathways involved, offers crucial insights into the chronic nature of addiction. These mechanisms underscore the importance of comprehensive treatment approaches that address both the physiological and psychological aspects of SUDs (Sinha, R., 2011).

  1. Impact of Drugs on Brain Functioning: The effects of substances, such as stimulants, on brain function are profound. Stimulants increase the levels of dopamine in the brain, which enhances feelings of pleasure and reward but also leads to significant changes in the brain’s reward system, potentially leading to addiction (Volkow, N.D., et al., 2007).
  2. Biases regarding individuals with SUD can range from viewing addiction as a moral failing rather than a medical condition, to underestimating the potential for recovery. These biases may affect the delivery of compassionate and effective care. Education and self-awareness are key to overcoming these biases, enhancing empathy, and improving treatment outcomes.
  3. Substance/addiction education is paramount for psychiatric mental health nurse practitioners (PMHNPs) and others in the healthcare field. It equips professionals with the knowledge and skills necessary to identify, treat, and support individuals with SUDs, contributing to more effective care and better patient outcomes.

Increasing knowledge on SUDs can involve engaging with continuing education programs, attending workshops and conferences focused on addiction medicine, and staying updated with current research in the field.

For an additional resource, the National Institute on Drug Abuse (NIDA) offers a wide range of educational videos and materials on the effects of drugs on the brain and body. Specifically, their video content on stimulants, such as cocaine or methamphetamine, highlights how these substances increase dopamine levels in the brain circuits related to reward and movement, leading to intense feelings of euphoria but at the risk of developing addictive behaviors and other severe health consequences (NIDA, 2020).

social work su

/0 Comments/in /by

Question

Mitch & Elanor Scenario

Mitch and Eleanor Connors have come to the Family Service Association for marital counseling.  Eleanor is concerned that their marriage is cracking under the strain of the prospect of Mitch losing his job.  Mitch tells the marital counselor that he does not want to go to counseling.  He has only agreed because Eleanor harassed him so much.  As far as Eleanor is concerned, she does not need counseling.  She is in counseling because Mitch is a problem.  Eleanor is hoping that you, the social worker, can talk some sense into Mitch. 

Mitch currently works at a local plastics factory called Superior Plastics.  For the past 6 months, there has been talk of the main branch of Superior Plastics moving to Southeast Asia, where labor is cheaper.  If this happens Mitch will lose his job within the next 6-8 months.  Mitch’s wife, Eleanor, also works part-time in personnel at Superior Plastics.  Mitch and Eleanor have 3 children, ages 12, 10 and 8.  The family has a comfortable middle-class lifestyle. 

Mitch is extremely distressed over the prospect of losing his job.  There is a 75% chance that this will happen.  He does his best not to think about the situation.  He is watching more T.V. after work, and having a few extra beers at night.  After all, what can he do?  He cannot control Superior Plastics or the economy.

Eleanor wants Mitch to start looking for a new job.  She thinks perhaps they should move to another area with more industry.  She is angry that Mitch is just watching T.V. and not doing something about the coming financial disaster.  She has begun looking around for a new job, but the jobs available pay less than her current part-time job at Superior Plastics.  

Eleanor has been spending hours on the telephone with her two sisters, who live in another state, talking about her fears of Mitch losing his job, and the family going under, financially.  Eleanor believes that the family could be homeless if nothing happens soon.  Mitch wishes Eleanor would stop nagging him and let him have some peace and quiet.  He feels he is under enough pressure right now. 

For the discussion:

Please list all of the strengths you find in this scenario

What are contributing factors to the problem? In other words, list what you believe is contributing to the problem/making it worse. 

Reply to one of your peers regarding what you appreciated about their response.

Pharmacology Question

/0 Comments/in /by

Question

Week 4 Assignment 2: Hypertension, Diabetes, and CKD3 Case Study

Value: 100 points

Due: Day 7

Case Study Scenario

Rachel Jones, a 63-year-old woman (weight 184 lb.), is a new patient referred to your primary care clinic. Her medical history includes type 2 diabetes mellitus (diagnosed in 2016), hypertension (diagnosed in 2012), and CKD3 with albuminuria (diagnosed in 2018). Ms. Jones is also a former smoker (quit in 2010).

Ms. Jones’ current medications include:

Lisinopril/HCTZ 20/12.5 mg twice daily

Aspirin 81 mg daily

Metformin 1000 mg twice daily

Dulaglutide 0.75 mg weekly

Glipizide XL 5 mg daily.

  • A baseline lipid panel returns with the following results:
  • TC 183 mg/dL
  • TG 123 mg/dL
  • HDL-C 41 mg/dL
  • LDL-C 115 mg/dL

Renal function test results include eGFR of 53 mL/min/1.73m2 and urine albumin-to-creatinine ratio of 74 mcg/mg. Ms. Jones’ BP today is 155/74 mm Hg and pulse 76 bpm. Her calculated 10-year ASCVD risk is 13.2%.

Assignment Instructions

  • Part A: Which one of the following diabetes-specific risk enhancers do you think is the most relevant when initiating high-intensity statin therapy in Ms. Jones? Explain not only your decision, but also why the other choices are not as relevant. Please use the textbook, as well as any relevant guidelines or primary literature, to formulate your selection and explain your answer.
  • Type 2 diabetes mellitus diagnosis within last 5 years
  • Presence of albuminuria
  • Baseline LDL-C above 100 mg/dL

Former smoker

Part B: You decide to initiate high-intensity statin therapy for Ms. Jones. Address each of the following:

Which drug do you choose?

Which one of the following is the best primary LDL blood work target for Ms. Jones according to the 2018 ACC/AHA guidelines?

Explain your decision about which medication to start, which target you will select, along with why the other choices are not optimal for Ms. Jones.

LDL Blood Work Target Choices:

  • LDL-C reduction of 30% from baseline
  • LDL-C reduction of at least 50% from baseline
  • LDL-C of <70 mg/dL
  • LDL-C of <100 mg/dL

Part C: Ms. Jones’ blood pressure is again high today when you see her in clinic. You check her home blood pressure monitoring log and see that her blood pressure fluctuates between 142-161/74-91, indicating poor control. You ask Ms. Jones if she has been compliant with her medications. She states she has been, but may have missed 3-4 doses per month. You note Ms. Jones is currently taking Lisinopril/HCTZ 20/12.5 mg.

Discuss Ms. Jones’ current hypertension regimen and explain what changes (if any) you would make and why. In addition to the textbook, please use the current AHA hypertension guidelines as a reference(s).

Concept Note on Tobacco Use among Adolescent Males in Indonesia

/0 Comments/in /by

QUESTION

In this Concept Note, you will concisely summarize the evidence from your readings and research to: 

Briefly describe the country context and how current prevalence of tobacco product use specifically contributes to the burden of disease in Indonesia.

Describe: the tobacco product you are examining; total population; population number of the group at-risk for using that product (e.g., % of the total population); and relevant demographic characteristics of that group; e.g., gender, age range, location, ethnicity, etc.

Using IHME and other data, provide data on the prevalence of tobacco product use by this at-risk group, and the current tobacco-related morbidity and mortality suffered by that group.

Describe the system elements that contribute to the current prevenance of tobacco product use: i.e., individual risk factors, Social Determinants of Health, Political and national environmental risk factors; and Macro-environmental issues (e.g., climate crisis; War/conflict; global air/water pollution, etc.).

Next, concisely discuss strengths and weakness of current polices in Indonesia that relate to the tobacco product you have selected, including any relevant policies that address the existing health impacts of the use of that tobacco product. E.g. current policies to: reduce tobacco consumption; reduce prevalence of tobacco-related NCDs; address major individual SDH or environmental risks that contribute to current use of tobacco products; etc.

  1. Clearly identify 2-4 leverage points that are both sufficiently specific and feasible for the MoH to address (e.g., MoH has adequate authority, capacity). 

Identify 3 policies that you will recommend to the MoH to reduce the prevalence of Tobacco-product use, specific to the risks identified  for your at-risk group.

  1. Provide an evidence-based rationale to support each policy recommendation, and show that it meets all 5 criteria for feasibility (See Annex 1)
  2. Place all Recommendations into a SMART format (See Annex #2).
  3. Using the 7 Health Systems Building Blocks as a guide, for each recommendation, briefly describe any specific bottlenecks to implementing that recommended policy. See Annex #3
  4. For at least 2 of your recommendations, show how your development partner (international NGOs) could support the MoH in Indonesia to implement the recommended policy.

Remember, Partners do NOT implement national health policies, only the MoH implements policies.

You must describe the specific types of support that the Partner could provide, that is consistent with the mission and strategic objectives of that partner, and the support must be consistent with a decolonized approach.

  1. Examples of support include: technical (e.g., to strengthen HS building blocks), policy guidance, financial, research support, support to engage other ministries/partners; etc.

Psychiatric Discharge Summary Note

/0 Comments/in /by

QUESTION

You must use an actual patient from your clinical experience but remove all identifying information (names, places, etc.) to be Health Insurance Portability and Accountability (HIPPA) compliant.

A Discharge Summary is created when a patient is discharged from an inpatient setting or outpatient program, and the patient’s case is closed. The note is, therefore, a communication between the treating clinician and the next provider or agency involved. Discharge summaries are also written when the patient is deceased.

You may use the format below for your note or the format you use at your clinical site.

EXAMPLE  

REASON FOR TRANSFER SUMMARY:  This is a transfer summary on XX as the patient will be leaving the x today and will be transitioned to X  

DATE OF ADMISSION:  MM/DD/YYYY  

DATE OF DISCHARGE:  MM/DD/YYYY  

DISCHARGE DIAGNOSES:  Medical and Psychiatric 

REASON FOR ADMISSION:  

The patient was admitted with a chief complaint of ____________. The patient was brought to the hospital after his guidance counselor found a note the patient wrote, which detailed to who he was giving away his possessions if he died. The patient told the counselor that he hears voices telling him to hurt himself and others. The patient reports over the last month, these symptoms have exacerbated. The patient had a fight in school recently, which the patient blames on the voices. Three weeks ago, he got pushed into a corner at school and threatened to shoot himself and others with a gun. The patient was suspended for that remark.  

PSYCHIATRIC HISTORY:  

Keep it brief but significant   

PROCEDURES AND TREATMENT:  

1. Individual and group psychotherapy. BE SPECIFIC  

2. Psychopharmacologic management. BE SPECIFIC  

3. The social work department conducted family therapy with the patient and the patient’s family for education and discharge planning.  

HOSPITAL COURSE:  

Brief discussion of hospitalization how things went. The patient responded well to individual and group psychotherapy, milieu therapy, and medication management. As stated, family therapy was conducted. HOW DID THESE ALL GO? Discuss all actions taken on behalf of the patient, results (medication trials; responses/ diagnostics, treatments)  

DISCHARGE ASSESSMENT:  

At discharge, the patient is alert and fully oriented. Mood euthymic. Affect a broad range. He denies any suicidal or homicidal ideation. IQ is at baseline. Memory is intact—insight and judgment are good.  

ASSETS and LIABILITIES:    

This is strengths/weaknesses/support system/Maslow. 

SHORT TERM GOALS and LONG-TERM GOALS:  

Determined by staff with patient input, address each goal and progress toward that goal  

Critical Thinking Question and Engaging Patient in Shared Decision-Making Case Study

/0 Comments/in /by

Question

Critical Thinking Questions

How important is it to understand the evidence related to enhancing evidence uptake?

What evidence needs to be generated to help advance our knowledge toward increasing evidence uptake?

How do individual barriers and facilitators interact with system-level barriers and facilitators of evidence uptake?

Do you think an individual can use evidence if the system does not support it in any way? Why, or why not?

engage patient in shared decision-making case study

  • Instructions
  • Using the case study provided, respond to the critical thinking questions. Each response should be original (in your own words) and a minimum of 2–3 sentences in length.
  • Case Study
  • You are a staff nurse caring for a patient in a critical care unit. The unit policy limits visitors to 10 minutes in the evening hours. You find yourself needing to frequently “bend the rules” because some families and their critically ill loved ones want to spend more time together, and they want more flexibility to visit. A systematic review of both quantitative and qualitative evidence related to visitation in critical care units came to these conclusions:

Flexible visiting hours are preferable to patients’ families.

Family members want to be close to the patient, speak to the physician every day, and have access to healthcare professionals with information to give them.

Nurses understand that flexible visiting hours can be beneficial. Still, they can impede workflow and increase workload. Nurses want to control the policy.

Hospital administrators should consider the nurses’ beliefs and attitudes when they create visiting policies.

Critical Thinking Questions

Given the evidence of visiting hours and the evidence related to the individual and system-level implementation of evidence, what are the key issues related to implementing appropriate visitation policies?

What might be key individual barriers to evidence implementation?

What are system-level barriers to evidence implementation?

What are evidence-based strategies that enhance evidence uptake at both the individual and system levels?

How might you design an evidence-implementation strategy to overcome barriers and maximize facilitators of evidence uptake?

  • Considering this case study, how important is it to understand the evidence related to enhancing evidence uptake?
  • Considering this case study, what evidence needs to be generated to help advance our knowledge toward increasing evidence uptake?
  • Considering this case study, how do individual barriers and facilitators interact with system-level barriers and facilitators of evidence uptake?
  • Considering this case study, do you think an individual can use evidence if the system does not support it in any way? Why, or why not?

NUR 640 clinicals

/0 Comments/in /by

Question

Comprehensive Psychotherapy Evaluation 2

Step 1: You will use the Graduate Comprehensive Psychotherapy Evaluation Template Download Graduate Comprehensive Psychotherapy Evaluation Templateto:

Compose a written comprehensive psychotherapy evaluation of a patient you have seen in the clinic.

Upload your completed comprehensive psychiatric evaluation as a Word doc. Scanned PDFs will not be accepted.

For the Comprehensive Psychotherapy Evaluation  Presentation Assignment: You will need to get it signed by your preceptor for the presentation (actual signature, not electronically typed).

Step 2: Each student will create a focused SOAP note video presentation in the next assignment. See Comprehensive Psychotherapy Evaluation Presentation 2 for more details.

SOAP is an acronym that stands for Subjective, Objective, Assessment, and Plan.  

S = 

Subjective data: Patient’s Chief Complaint (CC); History of the Present Illness (HPI)/ Demographics; History of the Present Illness (HPI) that includes the presenting problem and the 8 dimensions of the problem (OLDCARTS or PQRST); Review of Systems (ROS) 

O = 

Objective data: Medications; Allergies; Past medical history; Family psychiatric history; Past surgical history; Psychiatric history, Social history; Labs and screening tools; Vital signs; Physical exam, (Focused), and Mental Status Exam 

A = 

Assessment: Primary Diagnosis and two differential diagnoses including ICD-10 and DSM5 codes 

P = 

Plan: Pharmacologic and Non-pharmacologic treatment plan; diagnostic testing/screening tools, patient/family teaching, referral, and follow up 

  1. Other: Incorporate current clinical guidelines NIH Clinical GuidelinesLinks to an external site. or APA Clinical GuidelinesLinks to an external site., research articles, and the role of the PMHNP in your evaluation.   
  2. Psychiatric Assessment of Infants and ToddlersLinks to an external site. 

Psychiatric Assessment of Children and AdolescentsLinks to an external site. 

  • Reminder: It is important that you complete this assessment using your critical thinking skills.  You are expected to synthesize your clinical assessment, formulate a psychiatric diagnosis, and develop a treatment plan independently. It is not acceptable to document “my preceptor made this diagnosis.”  An example of the appropriate descriptors of the clinical evaluation is listed below.  It is not acceptable to document “within normal limits.”   

Graduate Mental Status Exam Guide Download Graduate Mental Status Exam Guide 

Successfully Capture HPI Elements in Psychiatry E/M NotesLinks to an external site.
AAPC Admin. (2013, August 1). Successfully capture HPI elements in psychiatry E/M notes. Advancing the Business of Healthcare. https://www.aapc.com/blog/25848-successfully-captu…

.

RJM2 — RJM2 TASK 1: CULTURAL AND RELIGIOUS DIVERSITY

/0 Comments/in /by

QUESTION

Differentiates Cultural and Religious Customs and Practices

The learner differentiates among diverse cultural and religious customs and practices.

INTRODUCTION

Christianity and Islam are the two most followed religions in the world and have influenced the art, politics, and culture of societies around the globe for the last 1,500 years. Over the centuries, these two Abrahamic religions, which share foundational beliefs, have evolved significantly as new adherents incorporated local customs into their religious practices and as divisions occurred over conflicting beliefs and leadership disputes.

In this task, you will examine how empires as well as knowledge and culture contributed to the spread of Islam and Christianity throughout Africa and Eurasia from each religion’s place of origin in the Middle East. You will also examine similarities between the beliefs and practices of the two religions.

REQUIREMENTS

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

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

Tasks may not be submitted as cloud links, such as links to Google Docs, Google Slides, OneDrive, etc., unless specified in the task requirements. All other submissions must be file types that are uploaded and submitted as attachments (e.g., .docx, .pdf, .ppt).

A.  Analyze how different contexts contributed to the spread of Christianity from its founding until 1500 CE by doing the following:

1.  Describe one example of how empires contributed to the spread of Christianity.

2.  Describe one example of how knowledge or culture contributed to the spread of Christianity.

B.  Analyze how different contexts contributed to the spread of Islam from its founding until 1500 CE by doing the following:

1.  Describe one example of how empires contributed to the spread of Islam.

2.  Describe one example of how knowledge or culture contributed to the spread of Islam.

C.  Describe one similarity between the beliefs or practices of Christianity and Islam from their founding until 1500 CE.

UTMB The nurse leader Your experience Organizational Analysis

/0 Comments/in /by

Question

Part 1:

Overview: Organizational Analysis The Organization

The major assignment for this course is analysis of your organization (or an organization that you have worked for if you aren’t currently employed). In this assignment, you will report the organization’s mission, philosophy, and administrative structure. You will compare and contrast what you find with the characteristics of organizations you have learned about in the lectures and presentations and in your own investigative reading.

Complete this assignment to demonstrate your analysis of the big picture of your organization.

Objectives

– Explain how organizations function.

– Compare and contrast characteristics of leadership and management.

– Apply trends, issues, theories, and evidence as guidelines for management decisions.

– Evaluate effectiveness of communication patterns using specific management situations.

Part 2: Overview: Organizational Analysis The Nurse Leader

The major assignment for this course is analysis of your organization. In this assignment, you will analyze your nurse leader’s characteristics and behaviors regarding others in managing, leading, and communicating. By respectfully, but critically, critiquing these attributes of the nurse leader you have been “shadowing,” you can identify the attributes that you consider most and least effective, and most and least similar to the way you see yourself managing, leading, and communicating.

Complete this document to record your analysis of your nurse leader.

Objectives

– Explain how organizations function.

– Compare and contrast characteristics of leadership and management.

– Apply trends, issues, theories, and evidence as guidelines for management decisions.

– Evaluate effectiveness of communication patterns using specific management situations

Part 3:

Overview: Organizational Analysis Your Experience

During the span of this course, you have been shadowing or have interviewed a nurse leader, observing and reflecting on skills, behaviors, and strategies that the leader exhibits. You have also assessed and reflected on your leadership and management styles and skills. Now you will gather those thoughts in a more formal retrospective of your experience in the course. You may notice that the rubric for the previous assignment is similar to the rubric for this assignment. Keep in mind that the previous assignment you were presenting an analysis of the leader/manager that you shadowed and with this assignment you are presenting an analysis of the overall experience (which does include the time spent with your leader/manager).

Objectives

– Explain how organizations function

– Compare and contrast characteristics of leadership and management

– Apply trends, issues, theories, and evidence as guidelines for management decisions.

– Evaluate effectiveness of communications patterns using specific management situations.