NUR 650 CLINICALS

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QUESTION

Step 1: You will use the Graduate Comprehensive Psychiatric/Psychotherapy Evaluation Template Download Graduate Comprehensive Psychiatric/Psychotherapy Evaluation Template to:

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 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 Evaluation Presentation 1 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 = 

  1. Assessment: Primary Diagnosis and two differential diagnoses including ICD-10 and DSM5 codes 
  2. P = 

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

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…

Discussion 2, Hematopoietic.

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QUESTION

J.D. is a 37 years old white woman who presents to her gynecologist complaining of a 2-month history of intermenstrual bleeding, menorrhagia, increased urinary frequency, mild incontinence, extreme fatigue, and weakness. Her menstrual period occurs every 28 days and lately there have been 6 days of heavy flow and cramping. She denies abdominal distension, back-ache, and constipation. She has not had her usual energy levels since before her last pregnancy. 

Past Medical History (PMH):
Upon reviewing her past medical history, the gynecologist notes that her patient is a G5P5with four pregnancies within four years, the last infant having been delivered vaginally four months ago. All five pregnancies were unremarkable and without delivery complications. All infants were born healthy. Patient history also reveals a 3-year history of osteoarthritis in the left knee, probably the result of sustaining significant trauma to her knee in an MVA when she was 9 years old. When asked what OTC medications she is currently taking for her pain and for how long she has been taking them, she reveals that she started taking ibuprofen, three tablets each day, about 2.5 years ago for her left knee. Due to a slowly progressive increase in pain and a loss of adequate relief with three tablets, she doubled the daily dose of ibuprofen. Upon the recommendation from her nurse practitioner and because long-term ibuprofen use can cause peptic ulcers, she began taking OTC omeprazole on a regular basis to prevent gastrointestinal bleeding. Patient history also reveals a 3-year history of HTN for which she is now being treated with a diuretic and a centrally acting antihypertensive drug. She has had no previous surgeries.

Case Study Questions

Name the contributing factors on J.D that might put her at risk to develop iron deficiency anemia.

Within the case study, describe the reasons why J.D. might be presenting constipation and or dehydration.

Why Vitamin B12 and folic acid are important on the erythropoiesis? What abnormalities their deficiency might cause on the red blood cells?

The gynecologist is suspecting that J.D. might be experiencing iron deficiency anemia.
In order to support the diagnosis, list and describe the clinical symptoms that J.D. might have positive for Iron deficiency anemia.

If the patient is diagnosed with iron deficiency anemia, what do you expect to find as signs of this type of anemia? List and describe.

PH 100 01

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QUESTION

Read the Commentary (9/29/16): “An Intriguing Link Between Police Shootings and Black Voter Registration”. This is an example of an ecological study. For your post, identify: what question is the study being discussed examining? What is the outcome and define how it is measured? What exposures are being examined (there are a few)?  What did the study demonstrate? What are your reactions to this study?

here is classmate post: ”This ecological study examines how Black Americans are impacted by police shootings in the United States by state, and why some states have higher rates than others. The study found that there is an “over-representation” ratio for fatal police shootings of Black Americans. This was measured by comparing the percentage of Black Americans killed by the police to the overall Black population in an area. In just a few examples throughout the country, there was a disproportionately high number of Black Americans killed by the police compared to the general Black population. The exposures examined are: eligible Black Americans registered to vote, the black-to-white incarceration ratio, median household income, income inequality according to the Gini index, and rates of those college-educated. Data was collected for each indicator regarding the specific area being studied.  The study demonstrated that higher voter registration rates among Black Americans go hand in hand with a lowered over-representation ratio in the area. Voter registration ranked #1 as a determinant of fatal police shootings of Black Americans in this study. Though voting came first, income inequality and higher education are also shown to be important factors as well. The findings of this study are quite surprising for me, as I did not think voter registration impacts much when it comes to police violence and fatalities for Black Americans. I think this information could be useful in advocating for more funding to increase voter registration for those eligible in communities with a large Black population. This could also be a call to those looking to change the high incidents of police violence locally and register to vote. A lot more research should be done on this topic, as well as a lot more advocacy could be put into fighting efforts of voter suppression by the government because voting effects a lot more than just who ends up in office.”

ResearchCritique

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QUESTION

The purpose of the critique assignment is to give the students an opportunity to critically appraise (critique) a nursing research article. This assignment will examine how you identify and appraise components of a research study. This assignment is NOT a critique of the topic- it is a critique of the research process used. Your job is to critique or evaluate the quality of the research study itself- like you have been doing all semester!

For example, is there enough evidence or what evidence do the researchers give to allow you to determine if sound research was conducted? For example, if a question asks “were the instruments reliable and valid for this population?” It is not sufficient to state only “yes” or “no”. You must support your opinion with information you learned in class (such as citing Cronbach alpha levels and/or construct validity or other measure / techniques that allowed you to determine if the instruments were reliable and/or valid). Think about everything we have talked about in class when you are formulating your answers to this assignment. By the end of this assignment, I need to see evidence that you understand the components of research and how they fit, or do not fit, together in your article. Dazzle me with your knowledge! You will be graded on how well you describe the components of research and how well you critique how the authors have conducted their study and presented it to the reader. Remember, not all research is good research. YOUR ARTICLE MUST BE QUANTITATIVE

Students should select an article from their area of interest that is QUANTITATIVE and discusses one single study.  Articles that look at multiple studies (meta-analysis, metasynthesis, etc.) are wonderful resources, but are not appropriate for this assignment, as we are learning to critique single studies.  Articles that are qualitative are also wonderful resources, but they do not align with the critique guidelines for this assignment and are not appropriate here.  What is the research design and method of my study?

Appropriate:  Randomized-controlled trial; descriptive survey; contains statistical analysis

Not appropriate:  Qualitative, Interview, mixed-method, case report/study; expert opinion; multiple article review (meta-synthesis or meta-analysis

1 Read all instructions on this page, including rubric.  

2.  Select a quantitative article.

3.  Make sure it is QUANTITATIVE!

Concept Map 2

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Question

Assignment 

Concept maps are visual representations of information. They can be charts, graphic organizers, tables, flowcharts, Venn Diagrams, timelines, or T-charts. Concept maps are handy for students who learn better visually, although they can benefit any learner. Using the DSM5-TR and evidence-based journals, construct a concept map for each case study. Follow these simple directions.

Identify a concept (Use the DSM5 and Identify the main diagnosis)

From memory, try creating a graphic organizer related to this concept. Starting from memory is an excellent way to assess what you already understand and what you need to review.

  • Review lecture notes, readings, and other resources to fill in the gaps.
  • Focus on how concepts relate and how the treatment refers to the symptoms. 
  • Review your classmate’s concept maps and make significant observations. 
  • Concept Map 2
  • Gary is a 19-year-old who withdrew from college after experiencing a manic episode during which he was brought to the attention of the Campus Police (“I took the responsibility to pull multiple fire alarms in my dorm to ensure that they worked, given the life or death nature of fires”). He had changed his major from engineering to philosophy and increasingly had reduced his sleep, spending long hours engaging his friends in conversations about the nature of reality. He had been convinced about the importance of his ideas, stating frequently that he was more learned and advanced than all his professors. He told others that he was on the verge of revolutionizing his new field, and he grew increasingly irritable and intolerant of any who disagreed with him. He also increased a number of high-risk behaviors drinking and engaging in sexual relations in a way that was unlike his previous history. At the present time, he has returned home and his been placed on a mood stabilizer (after a period of time on an antipsychotic). The patient’s parents are somewhat shocked by the diagnosis, but they acknowledge that Gary had early problems with anxiety during pre-adolescence, followed by some periods of withdrawal and depression during his adolescence. His parents are eager to be involved in treatment, if appropriate.

Concept Map Information

What is the Main diagnosis for Gary? 

What are the Key symptoms?

What differential diagnoses did you consider and why? 

  1. What is your treatment recommendation and why? 

What is the Prognosis?

EVIDENCE-BASED PROJECT, PART 4 (B)

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Question

EVIDENCE-BASED PROJECT, PART 4: RECOMMENDING AN EVIDENCE-BASED PRACTICE CHANGE

The collection of evidence is an activity that occurs with an endgame in mind. For example, law enforcement professionals collect evidence to support a decision to charge those accused of criminal activity. Similarly, evidence-based healthcare practitioners collect evidence to support decisions in pursuit of specific healthcare outcomes.

In this Assignment, you will identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach.

To Prepare:

Reflect on the four peer-reviewed articles you critically appraised in Module 4, related to your clinical topic of interest and PICOT.

Reflect on your current healthcare organization and think about potential opportunities for evidence-based change, using your topic of interest and PICOT as the basis for your reflection.

  • Consider the best method of disseminating the results of your presentation to an audience.
  • The Assignment: (Evidence-Based Project)
  • Part 4: Recommending an Evidence-Based Practice Change

Create an 8- to 9-slide narrated PowerPoint presentation in which you do the following:

Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)

Describe the current problem or opportunity for change. Include in this Question the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.

Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.

Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.

  • Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy.
  • Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.
  • Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.
  • Add a lessons learned section that includes the following:
  • A summary of the critical appraisal of the peer-reviewed articles you previously submitted
  • An explanation about what you learned from completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template (1-3 slides)

MSW 626 week 10 discussion post

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QUESTION

Transgenerational Trauma

Instructions

It is anticipated that the initial discussion post should be in the range of 250-300 words. Response posts to peers have no minimum word requirement but must demonstrate topic knowledge and scholarly engagement with peers. Substantive content is imperative for all posts. All discussion prompt elements for the topic must be addressed. Please proofread your response carefully for grammar and spelling. Do not upload any attachments unless specified in the instructions. All posts should be supported by a minimum of one scholarly resource, ideally within the last 5 years. Journals and websites must be cited appropriately. Citations and references must adhere to APA format.

Classroom Participation

Students are expected to address the initial discussion question by Wednesday of each week. Participation in the discussion forum requires a minimum of three (3) substantive postings (this includes your initial post and posting to two peers) on three (3) different days. Substantive means that you add something new to the discussion supported with citation(s) and reference(s), you are not just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion, however should be correlated to the literature.

All discussion boards will be evaluated utilizing rubric criterion inclusive of content, analysis, collaboration, writing and APA. If you fail to post an initial discussion or initial discussion is late, you will not receive points for content and analysis, you may however post to your peers for partial credit following the guidelines above.

Initial Response

Instructions:

Discuss the effects of transgenerational trauma.

Identify and discuss some of the major symptoms or reactions that can be expected from someone who has experienced historical trauma or lives in a trauma-affected community.

Discuss how these symptoms or reactions might manifest and identify effective counseling interventions 

Instructions:

Please read and respond to at least two of your peers’ initial postings. You may want to consider the following questions in your responses to your peers:

Compare and contrast your initial posting with those of your peers.  

How are they similar or how are they different?

What information can you add that would help support the responses of your peers?

Ask your peers a question for clarification about their post.

What most interests you about their responses? 

Peer Response to Tae

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Question

Peer Responses:

Relate to another journal reading

  • During my clinical experience, I’ve found two main resources indispensable for helping in diagnosis, assessment, and formulating appropriate treatment plans for patients. These resources are Epocrates and UpToDate, both of which I’ve incorporated into my daily practice. Epocrates has become my go-to resource for quickly checking drug interactions, understanding dosing guidelines, and identifying medications. Epocrates’s user-friendly interface is intuitive and perfect for quick referencing. It allows informed decision-making on the spot. I’ve had a great experience with Epocrates Plus, especially in terms of managing medication regimen. The convenience of quickly referencing the latest clinical guidelines is something I particularly value in Epocrates Plus. Additionally, the app offers links to the latest medical news, providing me with swift updates on the latest medical news in healthcare. The user experience is greatly enhanced by the “Saved” feature. With a simple tap on the favorites button, I can easily access the content I’ve previously saved, making it very convenient to review crucial information and guidelines whenever necessary (Epocrates, n.d.).
  • On the other hand, UpToDate, renowned as a highly credible reference source, acts as my go-to comprehensive guide for delving into in-depth clinical information whenever I seek deeper knowledge. Whether dealing with a rare condition or needing to confirm my assessment findings, UpToDate offers a wealth of peer-reviewed, evidence-based information that provides can trust. The extensive coverage of medical topics, from common illnesses to rare diseases, are remarkable.  Even though there’s a lot of information to keep up with, the regular updates ensure that I’m always equipped with the most current medical knowledge, which is crucial in the ever-evolving field of healthcare (Wolters Kluwer, n.d.).
                As we begin our journey as a Nurse Practitioner, embracing electronic knowledge resources is essential. These tools have shown a positive impact on clinician behaviors and patient outcomes. Research indicates a statistically significant association between the use of electronic resources and improvements in clinical practice and patient care. Compared to traditional resources, electronic tools excel in providing quick and successful answers to clinical questions. Integrating these technologies into daily practice not only enhances the ability to answer clinical queries but also contributes to more effective and efficient patient care (Maggio et al., 2019).

strategies to pursue in developing portfolios or portfolio elements that focus on academic achievements

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Question

Reflect      on strategies that you can pursue in developing portfolios or portfolio      elements that focus on academic achievements.

Review      one or more samples from your own research of resources focused on      portfolio development.

  • Post an explanation of at least two strategies for including academic activities and accomplishments into your professional development goals. Then, explain how those goals may align with the University’s emphasis on social change. Be specific and provide examples. (Walden University) 
  • 5 references required

Reflect      on strategies that you can pursue in developing portfolios or portfolio      elements that focus on academic achievements.

  • Review      one or more samples from your own research of resources focused on      portfolio development.

Post an explanation of at least two strategies for including academic activities and accomplishments into your professional development goals. Then, explain how those goals may align with the University’s emphasis on social change. Be specific and provide examples.

references are listed below. 

Burns, M. K. (2018). Creating a nursing portfolio. Ohio Nurses Review 

Links to an external site.,      93(3), 16-17.

Casey, D. & Egan,      D. (2013). The use of professional portfolios for career      enhancement. British Journal of Nursing 

Links to an external site.,      28(4), 35.

Leahy, R., &      Filiatrault, A. (2017). Employers’ perceptions of the benefits of      employment electronic portfolios. International Journal of      ePortfolio 

Links to an external site.,      7(2), 217-223.

McMillan, L. R.,      Parker, F., & Sport, A. (2014). Decisions, decisions! E-portfolio      as an effective hiring assessment tool 

Links to an external site.. Nursing      Management, 45(4), 52-54.

Walden University.      (n.d.). Walden University catalog. Retrieved October 4, 2019, from      https://catalog.waldenu.edu
     Select College of Health Professions, then Master of Science in Nursing (MSN). Review the MSN      Learning Outcomes 

Walden University. (n.d.). Field experience: College of Nursing: Student resources – Graduate courses 

Links to an external site.. Retrieved from https://academicguides.waldenu.edu/fieldexperience…

Health Care Policy Brief

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QUESTION

Health Policy Brief Part III

This assignment is a continuation and synthesis of parts I and II of the Health Policy Brief you developed in weeks 2 and 4. In this assignment, you will put together your information in a 2-3 page (maximum) issue brief. In other words, this Health Policy Brief will summarize and synthesize all the key points you drafted in papers I and II. This is an opportunity for you to share your findings and objective data to legislators and stakeholders in a succinct and cogent manner. A few examples on policy briefs are provided by the National Council on Aging titled, Issue Briefs and Fact Sheets. 

Submission Parameters:

Please use the following guidelines and criteria for this assignment. Also, please refer to the rubric for point allocation and assignment expectations. The expected length of the policy brief is approximately 2-3 pages, which does not include the cover page and reference page(s).

I.  This policy brief is not to be presented as an academic paper. In other words, the document is intended for you to share your findings and objective data to legislators and appropriate stakeholders. That said, please include a cover page and reference page, which will help faculty identify the author and references used for the final product.

II. This policy brief will summarize and synthesize all the key points you drafted in papers I and II. There should be limited additional research needed to complete this brief. That said, this is an opportunity for you to translate your first two academic papers into a succinct and cogent brief.

III. Well written briefs have included the following elements (you may use these as headings):

What is the aim of the policy brief?

What is the best hook for the audience?

What background information does the audience need?

What data are most important to include for your audience? How will you convey the data to your stakeholders (i.e. combination of in-text, bar graph, etc.)?

What are the policy options?

What are your recommendations?

IV. To summarize, please note that short policy briefs are useful tools to conveying research and scientific implications for policy development and implementation and clinical practice. Writing effective policy briefs requires a specific set of communication and collaboration skills.