Discussion Post

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 The case scenario provided will be used to answer the discussion questions that follow.

Case Scenario

Ms. G., a 23-year-old diabetic, is admitted to the hospital with a cellulitis of her left lower leg. She has been applying heating pads to the leg for the last 48 hours, but the leg has become more painful and she has developed chilling.

Subjective Data

  • Complains of pain and heaviness in her leg.
  • States she cannot bear weight on her leg and has been in bed for 3 days.
  • Lives alone and has not had anyone to help her with meals.

Objective Data

  • Round, yellow-red, 2 cm diameter, 1 cm deep, open wound above medial malleolus with moderate amount of thick yellow drainage
  • Left leg red from knee to ankle
  • Calf measurement on left 3 in > than right
  • Temperature: 38.9 degrees C
  • Height: 160 cm; Weight: 83.7 kg

Laboratory Results

  • WBC 18.3 x 10¹² / L; 80% neutrophils, 12% bands
  • Wound culture: Staphylococcus aureus

Critical Thinking Questions

  1. What clinical manifestations are present in Ms. G and what recommendations would you make for continued treatment? Provide rationale for your recommendations.
  2. Identify the muscle groups likely to be affected by Ms. G’s condition by referring to “ARC: Anatomy Resource Center.”
  3. What is the significance of the subjective and objective data provided with regard to follow-up diagnostic/laboratory testing, education, and future preventative care? Provide rationale for your answer.
  4. What factors are present in this situation that could delay wound healing, and what precautions are required to prevent delayed wound healing? Explain.

Executive Summary Of ACO

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Urban and rural health care organizations throughout the industry are working together to coordinate care for Medicare patients. Accountable Care Organization (ACO) programs were established by the Centers for Medicare and Medicaid Services to help facilitate this cooperation.

Select a type of health care organization that would accept Medicare patients (e.g., family practice, hospital, urgent care, or nursing home).

Write a 700- to 1,050-word executive summary that discusses the purpose of joining an ACO and the funding available through one. Include the following:

1. Describe the organization you selected and the general services that would be offered to Medicare patients.

2. Describe the types of ACOs recognized by the Centers for Medicare and Medicaid Services.

3. Evaluate industry dynamics that would influence your organization’s decision to participate in an ACO.

4. Identify the steps needed to participate in an ACO.

5. Justify participation in an ACO for your organization.

You can find ACO’s at this web site

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/

Cite 3 reputable references to support your assignment (e.g., trade or industry publications, government or agency websites, scholarly works, or other sources of similar quality).

Certification Plan

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Psychiatric/mental health nurse practitioners currently have only one choice for certification, which is through the American Nurses Credentialing Center (ANCC). The ANCC offers the “psychiatric/mental-health nurse practitioner (across the lifespan)” board certification (PMHNP-BC). In many states, board certification is needed as a prerequisite to being granted an NP license. Even if board certification is not a requirement for state licensure, it may be a requirement to receive privileges in various hospitals and other health care facilities. It may also be required by malpractice insurance providers prior to issuing coverage to NPs.

In this Practicum Journal Assignment, you will develop a plan, which will serve as the road map for you to follow to attain your certification.

                                            Learning Objectives

Students will:

· Analyze state restrictions or limitations for practice

· Compare PMHNP practice environments in various states

· Analyze clinical practice issues

· Create plans for passing national certification exams

                                  To prepare for this Practicum Journal

· Review the interactive nurse practitioner (NP) scope of practice law guide in

your Learning Resources.

· Review your state regulations and a neighboring state or state in which you

would like to practice.

· Reflect on how to approach relocating licensure from one state to another.

· Review certification exam requirements for PMHNPs.

            Write a 2- to 3-page paper in which you do the following: (Assignment)

· Describe the Psychiatric and Mental Health Nurse Practitioner (PMHNP)

practice environment for your home state (Texas), highlighting restrictions or

limitations for practice.

· Compare the PMHNP practice environment in your home state (Texas) with a

neighboring state (Louisiana) or a state in which you would like to practice.

· Describe a professional and/or clinical practice issue a new PMHNP will need to

consider and address with the certification, licensure, credentialing, or relocation

process.

· Develop a checklist for passing the national certification exam, including a

detailed timeline that includes academic preparation (study plan), registration,

financial preparation, etc.

NB: for this Assignment (Journal Entries)

 

· Include references  immediately following  the content.

· Use APA style for your journal entry and references less than 5 years old.

 

PLEASE INCLUDE INTRODUCTION, CONCLUSION AND REFERENCES LESS THAN 5 YEARS OLD

Learning Resources

Required Readings

Barton Associates. (2017). Nurse practitioner scope of practice laws. Retrieved from https://www.bartonassociates.com/locum-tenens-resources/nurse-practitioner-scope-of-practice-laws/

American Psychiatric Association. (2016). Practice guidelines for the psychiatric evaluation of adults. Retrieved from http://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760

Debate Issue And Case Study

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  1.  Review the Debate Issue on page 295. Describe the pros and cons of each stance described. Your answers should be a total of two to three paragraphs for each stance. Each paragraph should contain three to five complex sentences.
  2. Write your answers to the following questions about Case 18, “Managing the Risks of Bribery in Business,” beginning on page 583. Your answers should total one to two paragraphs for each question. Each paragraph should contain three to five complex sentences.
  1. What led to Pfizer’s, Siemens’, and Ralph Lauren’s violations of the Foreign Corrupt Practices Act?
  2. What are the differences between the provisions of the United States Foreign Corrupt Practices Act and the United Kingdom Bribery Act?
  3. Check for more recent situations where companies have been accused of violating the Foreign Corrupt Practices Act. Why do you think these companies chose to engage in bribery?
  4. Why is it so difficult to determine when a minor gift, an entertainment, or an incentive constitutes a bribe?
  5. What lessons can be learned from the companies described in this case study?

Type II Diabetes

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A 60 year old woman with a 10 year history of Type II diabetes presents with multiple complications including retinopathy, peripheral neuropathy and declining renal function.

She has not had the urge to eat as of recently she feels “full” after a few bites. The incidence of nausea and feeling bloated occurs at least twice a day and even after a glass of water she feels bloated. She also complains of fatigue and not been able to keep up with daily chores.

A radiographic gastric emptying study shows a prolonged gastric emptying time.

Assignment Questions

  1. What is the typical diagnosis for a patient who presents with this clinical picture?
  2. What is the likely pathophysiologic process responsible for the presenting symptom? Support your response with a credible source.
  3. What is the class of the drug used to treat the pathophysiolog?. Discuss the pharmacologic management plan for this patient.
  4. Outline the mechanism of action and any possible contraindications of the pharmacologic management plan that you identified for the patient.

Instructions

  • Prepare and submit a 3-4 page paper [total] in length (not including APA format).
  • Answer all the questions above.
  • Support your position with examples.
  • Please review the rubric to ensure that your assignment meets criteria.
  • Submit the following documents to the Submit Assignments/Assessments area:
    • Case Study: Gastrointestinal

NSG6005 Week 9 Assignment 3 Quiz

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Question 1. Jonathan has been diagnosed with strep throat and needs a prescription for an antibiotic. He says the last time he had penicillin he developed a red, blotchy rash. The appropriate antibiotic to prescribe would be:

Penicillin VK, since his rash does not sound like a serious rash

Amoxicillin

Cefadroxil (Duricef)

Erythromycin

Question 2. Tetracyclines are contraindicated in children younger than 8 years because of:

Risk of developing cartilage problems

Development of significant diarrhea

Risk of kernicterus

Adverse effects on bone growth

Question 3. Lisa is a healthy non-pregnant adult woman who recently had a UTI. She is asking about drinking cranberry juice to prevent a recurrence of the UTI. The answer to give her would be:

“Sixteen ounces per day of cranberry juice cocktail will prevent UTIs.”

“100% cranberry juice or cranberry juice extract may decrease UTIs in some patients.”

“There is no evidence that cranberry juice helps prevent UTIs.”

“Cranberry juice only works to prevent UTIs in children.”

Question 4. Rose is a 3 year old with an upper respiratory infection (URI). Treatment for her URI would include:

Amoxicillin

Diphenhydramine

Pseudoephedrine

Nasal saline spray

Question 5. Patient education for a patient who is prescribed antibiotics for sinusitis includes:

Use of nasal saline washes

Use of inhaled corticosteroids

Avoiding the use of ibuprofen while ill

Use of laxatives to treat constipation

Question 6. Patients who should be cautious about using decongestants for an upper respiratory infection include:

School-age children

Patients with asthma

Patients with cardiac disease

Patients with allergies

Question 7. Janet was recently treated with clindamycin for an infection. She calls the advice nurse because she is having frequent diarrhea that she thinks may have blood in it. What would be the appropriate care for her?

Encourage increased fluids and fiber

Assess for pseudomembranous colitis

Advise her to eat yogurt daily to help restore her gut bacteria

Start her on an antidiarrheal medication

Question 8. To prevent further development of antibacterial resistance it is recommended fluoroquinolones be reserved for treatment of:

Urinary tract infections in young women

Upper respiratory infections in adults

Skin and soft tissue infections in adults

Community-acquired pneumonia in patients with comorbidities

Question 9. Nicole is a 4-year-old female with a febrile urinary tract infection. She is generally healthy and has no drug allergies. Appropriate initial therapy for her UTI would be:

Azithromycin

Trimethoprim/sulfamethoxazole

Ceftriaxone

Ciprofloxacin

Question 10. Sally is a 16-year-old female with a urinary tract infection. She is healthy, afebrile, with no use of antibiotics in the previous 6 months and no drug allergies. An appropriate first-line antibiotic choice for her would be:

Azithromycin

Trimethoprim/sulfamethoxazole

Ceftriaxone

Levofloxacin

Psychodynamic Psychotherapy Introduction

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Literature in psychotherapy differs from other areas of clinical practice. Generally, there are no clinical trials in psychotherapy because it is often neither appropriate nor ethical to have controls in psychotherapy research. This sometimes makes it more difficult to translate research findings into practice. In your role, however, you must be able to synthesize current literature and apply it to your own clients. For this Assignment, you begin practicing this skill by examining current literature on psychodynamic therapy and considering how it might translate into your own clinical practice.

Learning Objective

· Evaluate the application of current literature to clinical practice

To prepare:

· Review and evaluate the psychodynamic therapy article attached in the file and reflect on the insights they provide.

The Assignment

In a 5- to 10-slide PowerPoint presentation, address the following:

· Provide an overview of the article you selected.

· What population is under consideration?

· What was the specific intervention that was used? Is this a new intervention or one that was already used?

· What were the author’s claims?

· Explain the findings/outcomes of the study in the article. Include whether this will translate into practice with your own clients. If so, how? If not, why?

· Explain whether the limitations of the study might impact your ability to use the findings/outcomes presented in the article. Support your position with evidence-based literature.

Note: The presentation should be 5-10 slides, not including the title and reference slides. Include presenter notes (no more than ½ page per slide) and use tables and/or diagrams where appropriate. Be sure to support your work with specific citations from the article you selected. Support your approach with evidence-based literature.

BELOW ARE THE ARTICLE TO SELECT FROM

Select one of the following articles on psychodynamic therapy to evaluate in your Assignment:

Aznar-Martinez, B., Perez-Testor, C., Davins, M., & Aramburu, I. (2016). Couple psychoanalytic psychotherapy as the treatment of choice: Indications, challenges, and benefits. Psychoanalytic Psychology, 33(1), 1–20. doi:10.1037/a0038503

Karbelnig, A. M. (2016). “The analyst is present”: Viewing the psychoanalytic process as performance art. Psychoanalytic Psychology, 33(supplement 1), S153–S172. doi:10.1037/a0037332

LaMothe, R. (2015). A future project of psychoanalytic psychotherapy: Revisiting the debate between classical/commitment and analytic therapies. Psychoanalytic Psychology, 32(2), 334–351. doi:10.1037/a0035982

Migone, P. (2013). Psychoanalysis on the Internet: A discussion of its theoretical implications for both online and offline therapeutic technique. Psychoanalytic Psychology, 30(2), 281–299. doi:10.1037/a0031507

Tummala-Narra, P. (2013). Psychoanalytic applications in a diverse society. Psychoanalytic Psychology, 30(3), 471–487. doi:10.1037/a0031375

Antipsychotic Therapy

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Week 6: Antipsychotic Therapy

According to the National Alliance on Mental Illness, approximately 100,000 people experience psychosis in the United States each year (NAMI, 2016). In practice, clients may present with delusions, hallucinations, disorganized thinking, disorganized or abnormal motor behavior, as well as other negative symptoms that can be disabling for these individuals. Not only are these symptoms one of the most challenging symptom clusters you will encounter, many are associated with other disorders such as depression, bipolar disorder, and disorders on the schizophrenia spectrum. As a psychiatric mental health nurse practitioner, you must understand the underlying neurobiology of these symptoms to select appropriate therapies and improve outcomes for clients.

This week, as you examine antipsychotic therapies, you explore the assessment and treatment of clients with psychosis and schizophrenia. You also consider ethical and legal implications of these therapies.

Photo Credit: Ingram Publishing/Getty Images

Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia

Psychosis and schizophrenia greatly impact the brain’s normal processes, which interferes with the ability to think clearly. When symptoms of these disorders are uncontrolled, clients may struggle to function in daily life. However, clients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. 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 psychosis and schizophrenia.

Learning Objectives

Students will:

·         Assess client factors and history to develop personalized plans of antipsychotic therapy for clients

·         Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring antipsychotic therapy

·         Evaluate efficacy of treatment plans

·         Analyze ethical and legal implications related to prescribing antipsychotic therapy to clients across the lifespan

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

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 chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

·         Chapter 4, “Psychosis and Schizophrenia”

·         Chapter 5, “Antipsychotic Agents”

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:

  • amisulpride
  • aripiprazole
  • asenapine
  • chlorpromazine
  • clozapine
  • flupenthixol
  • fluphenazine
  • haloperidol
  • iloperidone
  • loxapine
  • lurasidone
  • olanzapine
  • paliperidone
  • perphenazine
  • quetiapine
  • risperidone
  • sulpiride
  • thioridazine
  • thiothixene
  • trifluoperazine
  • ziprasidone

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

Note: Retrieved from Walden Library databases.

Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261-276.

Note: Retrieved from Walden Library databases.

 

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

 

Walden University. (2016). ASC success strategies: Studying for and taking a test. Retrieved from http://academicguides.waldenu.edu/ASCsuccess/ASCtesting

 

Required Media

 

Laureate Education. (2016j). Case study: Pakistani woman with delusional thought processes [Interactive media file]. Baltimore, MD: Author

 

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

 

Optional Resources

Chakos, M., Patel, J. K., Rosenheck, R., Glick, I. D., Hammer, M. B., Tapp, A., & … Miller, D. (2011). Concomitant psychotropic medication use during treatment of schizophrenia patients: Longitudinal results from the CATIE study. Clinical Schizophrenia & Related Psychoses, 5(3), 124-134. doi:10.3371/CSRP.5.3.2

Fangfang, S., Stock, E. M., Copeland, L. A., Zeber, J. E., Ahmedani, B. K., & Morissette, S. B. (2014). Polypharmacy with antipsychotic drugs in patients with schizophrenia: Trends in multiple health care systems. American Journal of Health-System Pharmacy, 71(9), 728-738. doi:10.2146/ajhp130471

Lin, L. A., Rosenheck, R., Sugar, C., & Zbrozek, A. (2015). Comparing antipsychotic treatments for schizophrenia: A health state approach. The Psychiatric Quarterly, 86(1), 107-121. doi:10.1007/s11126-014-9326-2

To prepare for this Assignment:

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

The Assignment

Examine Case Study: Pakistani Woman with Delusional Thought Processes. 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 stop to complete the following:

·         Decision #1

o    Which decision did you select?

o    Why did you select this decision? Support your response with evidence and references to the Learning Resources.

o    What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

o    Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

·         Decision #2

o    Why did you select this decision? Support your response with evidence and references to the Learning Resources.

o    What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

o    Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

·         Decision #3

o    Why did you select this decision? Support your response with evidence and references to the Learning Resources.

o    What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

o    Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients.

 

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

Discussion Thread

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These are discussion threads 2 paragraphs each. My practice is medical/surgical/observation unit. Below is the questions and where to get the information. Scholarly article 6-8 years old. Thank you.

Discussion 1 In one of the reading assignments this week you reviewed advance nurse practitioner (APN) roles and the application of project management concepts, one of the major elements of NI, but new to most nurses. Does this have an application to your practice? Why or why not?

 

 

Sipes, C. (2016). Project management for the advanced practice nurse, Springer.

•   Chapter 1: Basic Project Management for Advance Practice Nurses and Health Care Professionals; Examples of APN Projects/Roles. pp. 4-11

•   Chapter 1: Basic Project Management for Advance Practice Nurses and Health Care Professionals; Project Management: Why do we need it? Pp. 12

•   Chapter 2: Advanced practice nurse role description and application of project management concepts; Chapter 2, pp 16-24

Website Exploration:

Visit the following site http://www.fiercehealthit.com/ (explore healthcare technology news on CPOE, EMRs, E-prescribing, HIE, PHRs, HIT stimulus, and other health IT news)

Discussion 2 A new concept for some organizations is to allow nurses to bring in their own devices known as bring your own devices (BYOD) to use at work. What are some of the security issues you might encounter if this were allowed? How would you address these issues?

The Purnell Model for Cultural Competence

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The Purnell Model for Cultural Competence

Please read chapter 2 of the class textbook and review the attached Power Point Presentation.  Once done answer the following questions;

1.  In your own words discuss the empirical framework of the Purnell Model and what are the purposes of this model.

2.  Please mention and discuss the macro aspects of the model.

3.  What is the role of the head of household and genders according to this model?

4.  In your own words define the domain biocultural ecology and discuss one variation of this domain.

As indicated in the syllabus the assignment must be presented in an APA format, word document, Arial 12 font attached to the forum title “Week 2 discussion questions” in the discussion board.  A minimum of 2 evidence based references besides the class textbook no older than 5 years are required.    Assignment must contained a minimum of 500 words without counting the first and reference page.