Nursing homework help – Elite Custom Essays


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Post an explanation of your choice of a nursing specialty within the program. Describe any difficulties you had (or are having) in making your choice, and the factors that drove/are driving your decision. Identify at least one professional organization affiliated with your chosen specialty and provide details on becoming a member. Nursing homework help

 

 

3 sources APA format

 

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Respond to two peers and use two sources each

 

Peer 1

I had minimal difficulty making my choice about pursuing AGACNP. Emergency and critical care medicine have always fascinated me. I chose to get into emergency medicine to enhance my knowledge and skills to become an adequate provider. Working in the ICU at a Level II trauma center only increases my curiosity of wanting to learn more and strive to be a more vital provider. I enjoy being part of the interdisciplinary team collaborating ideas and theories on challenging cases. I am also attuned to my patients and their families to ensure their thoughts, feelings, and concerns are acknowledged. The difficulty I struggle with is not doing what I love sooner. In a way, it helps me strive for my current goals.
The professional organization I am affiliated with is the American Association of Critical-Care Nurses. The organization provides up-to-date article journals and initial and ongoing certifications for various nursing levels. AACN also offers continuing education opportunities (AACN, n.d.). According to the AACN website, to become a member, you must be a registered nurse with an unencumbered license within the United States and willing to pay an annual fee (n.d.).

 

 

Peer 2

Choosing the next step for continuing my education was not a particularly hard decision.  There is no doubt, continuing your education increases your knowledge and ability to care for patients, regardless of the role you choose, but choosing the role that is of interest to you is important.  My particular interest is to continue to care for patients and to do so in an advanced practice setting.  However, specifically related to providing care in a nurse practitioner role, I have multiple interest, primary and acute care.  For now, the specific specialty that I have chosen is family nurse practitioner.  Family nurse practitioners care for patients of all ages with acute and chronic illnesses, also including disease prevention, education, and community care (Population-Focused Competencies Task Force, 2013).

I did have a little difficulty making a choice for a particular MSN specialization since my interest are in both primary and acute care.  I recently made the decision to focus on primary care for now and completing a post degree program in acute care following the completion of this program.  My decision to focus on family practice for now was related to diverse environment and practice opportunities for family nurse practitioners, along with experience that may be obtained (Woroch & Bockwoldt, 2020).  A professional association related to my specific specialty is the American Association of Nurse Practitioners.  Benefits for being a member of this association include access to continuing education, scholarships and grants, board certification discounts, and access to employment opportunities with networking (American Association of Nurse Practitioners, n.d.).  In the near future, will explore different professional organizations to locate one with opportunities that best fit my needs.

 

 



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Recommending An Evidence-Based Practice Change


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. Recommending An Evidence-Based Practice Change

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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 description 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)



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Critical Appraisal of Research – Elite Custom Essays


Critical Appraisal of Research

 

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Critical Appraisal of Research

 

 

Critical Appraisal of Research

Part 3A: Critical appraisal

Violence against nurses is an issue that has been identified as a significant global problem. Registered nurses are the most affected people, and the violence may be physical assault, bullying, or verbal abuse. As presented in the article, “workplace violence in nursing: a concept analysis,” Al-Qadi (2021) clarifies the concept of workplace violence in an organized manner. The introduction makes it easier for any reader to capture the overall concept and how it needs to be solved. Also, the background information helps define the term violence and goes into depth by discussing the various types and how they can be reported. The method used to conduct the study and the results reveal the practice as a threat that causes injuries whenever it occurs. Critical Appraisal of Research

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This is also evident in the article “Workplace violence against emergency service nurses: an integrative review.” From this work, Jofre et al. (2020) present a review of the worldwide frequency of verbal and physical violence against nurses and the occupational and health impacts that it causes. The authors conduct a comprehensive study using library databases such as SciELO, CINAHL, LILACS, and MEDLINE. For any reader, this provides them with a direction on the best materials to consider when conducting research. From the article, the authors have established a technique that assists them in achieving the desired results. Most assault tends to occur in the emergency service, ranging from physical violence and verbal aggression. Also, the article presents a comprehensive conclusion that recommends the need to stop violence against nurses that affect their productivity. Therefore, it is easier for any reader to capture the required intention.

When nurses are assaulted, it may come from senior staff colleagues or patients. Therefore, there is a need to investigate the nature of violence nurses may face from various people. Electronic health records can assist in providing better care to patients, while the data can be used to study how patients assault their care providers (Mitchell et al., 2014). In their article, “Electronic Health Record Mortality Prediction Model for Targeted Palliative Care among Hospitalized Medical Patients: a Pilot Quasi-experimental Study,” Courtright et al. (2019) comprehensively present the reason behind EHR development. They represent the best research by describing how the EHR model approach can assist reduce the mortality rate among patients. The article helps inform the reader that the mortality rate can increase due to any incidence of violence against nurses, affecting their production rate. Also, the causes of reduced production among nurses are presented in an organized manner by Sisawo et al. (2017) in their article “Workplace violence against nurses in the Gambia: mixed methods design.”

The article presents an overview of workplace violence against nurses and the factors associated with the issue. Any reader of the article can assess the factors as lack of management attention, shortage of drugs and supplies, disagreements among clients and nurses, and security vacuum. Although the research study was conducted in the Gambia, it provides an understanding that the same factors can apply to any other nursing organization. The authors use the research technique that every researcher should emulate.

Part 3B: Best practice

The best practice is a research method that identifies, combines, describes, and distributes efficient strategies established by healthcare professionals or researchers to ensure effective delivery of care services. The article “Workplace violence against nurses in the Gambia: mixed methods design” presents the best practice so that a reader can capture and understand the concept behind workplace violence against nurses. The article utilizes a research technique that explores nursing violence.

Nurses’ violence is an issue that has persisted in most health care organizations. Therefore, addressing it would assist in improving nurses’ productivity, which is affected by burnout associated with violence. The article identifies various factors associated with violence. For instance, lack of security, staff and drug shortage, and poor workplace manners among nurses where nurses may utter indecent language towards their clients (Sisawo et al., 2017). The research uses qualitative and quantitative designs that assist in easier data collection. Hence, the research uses an evidence-based practice that uses interventions whose efficacy is well supported by numerous scholarly evidence.

The study proves the best practice by proposing various measures. For instance, the authors suggest the need to have interventions in the future that responds to the nursing staff’s needs to ensure workplace violence prevention. Also, the article suggests compulsory in-service education for nurses. It includes service behaviors, safety training, understanding of clients’ needs, and communication skills to effectively deal with workplace assaults that may arise on incoming nurses (Sisawo et al., 2017). Similarly, education can assist in heightening workplace violence in the workplace and improving nurses’ public image. Moreover, they suggest protecting staff by beefing up security at the various healthcare facilities. This is by assigning trained security guards, having patient visitors’ check-in procedures, and installing security video monitoring systems to reduce any violence in the workplace.

 

 

Al-Qadi, M. M. (2021). Workplace violence in nursing: A concept analysis. Journal of occupational health, 63(1), e12226. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8103077/

Contreras Jofre, P., Valenzuela Solís, Á., Pinto Soto, J., Mendoza Ponce, N., & López-Alegría, F. (2020). Workplace violence against emergency service nurses: an integrative review. Revista panamericana de salud publica, 44, e173-e173. 10.26633/RPSP.2020.173

Mitchell, A., Ahmed, A., & Szabo, C. (2014). Workplace violence among nurses, why are we still discussing this? Literature review. Journal of nursing education and practice, 4(4), 147-150. http://dx.doi.org/10.5430/jnep.v4n4p147

Sisawo, E. J., Ouédraogo, S. Y. Y. A., & Huang, S. L. (2017). Workplace violence against nurses in the Gambia: mixed methods design. BMC health services research, 17(1), 1-11. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-017-2258-4

 

 

 

 

 

 

 



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Adult Health Hypertension Case study Paper



Adult Health Hypertension Case study Paper ORDER A PLAGIARISM FREE PAPER NOW Don’t use plagiarized sources. Get Your Custom Essay on Adult Health Hypertension Case study Paper Just from $13/Page Order Essay Category Points Percentage Description Pathology:       15 pts       ·         Define the patient’s disease process Adult Health Hypertension Case study Paper   ·         Explain the etiology of the disease […]



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Adult Health Case study Hypertension


Adult Health Case study Hypertension

HPI:

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E.W.  is a 40-year old African American male, who has had difficulty controlling his HTN lately. He is visiting his primary care provider for a thorough physical examination and to renew a prescription to continue his blood pressure medication. Adult Health Case study Hypertension

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PMH:

 

  • Chronic sinus infections
  • Hypertension for approximately 11 years
  • Pneumonia 6 years ago that resolved with antibiotic therapy
  • One major episode of major depressive illness caused by the suicide of his wife of 15 years, 5 years ago.
  • No surgeries
  • Allergies to Penicillin (Rash)

 

FH:

 

  • Father died at age 49 from AMI; had HTN
  • Mother has DM and HTN
  • Brother died at age 20 from complication of CF
  • Two younger sisters are A & W

SH:

 

The patient is a widower and lives alone. He has a 15-year-old son who lives with a maternal aunt. He has not spoken with his son for four years. The patient is an air traffic controller at the local airport. He smoked cigarettes for approximately 10 years but stopped smoking when he was diagnosed with HTN.  He drinks “several beers every evening to relax” and does not pay particular attention to the sodium, fat or carbohydrate content of the foods that he eats. He admits to “salting almost everything he eats, sometimes even before tasting it.” He denies ever having dieted. He takes an occasional walk but has no regular daily exercise program. Adult Health Case study Hypertension

 

Meds:

  • Hydrochlorothiazide 50 mg PO QD
  • Pseudoephedrine hydrochloride 60 mg PO Q6hr prn
  • Beclomethasone dipropionate 1 spray into each nostril Q6 hr prn

 

Review of Systems:

 

  • States that his overall health has been fair to good during the past 12 months
  • Weight has increased by approximately 20 pounds during the last year
  • Denies chest pain, shortness of breath at rest, headaches, nocturia, nosebleeds, and hemoptysis
  • Reports some shortness of breath with activity, especially when climbing stairs, and that breathing difficulties are getting worse
  • Denies any nausea, vomiting, diarrhea, or blood in the stool
  • Self-treats occasional right knee pain with OTC extra-strength acetaminophen
  • Denies any genitourinary symptoms

 

Physical Exam and Lab tests

 

General:

The patient is an obese black man in no apparent distress. He appears to be his stated age.

 

Vital Signs:

BP: 155/96 sitting

HR: 73, regular

RR: 15, unlabored

Temp: 98.8 degrees F

Height: 5’11”

Weight: 221 lb

BMI: 31.

 

HEENT:

 

  • Tympanic membrane intact and clear throughout
  • No nasal drainage
  • No exudates or erythema in oropharynx
  • PERRLA, pupil diameter 3. mm bilaterally
  • Sclera without icterus
  • EOMI
  • Fundoscopy reveals mild arteriolar narrowing with no nicking, hemorrhages, exudates, or papilledema.

Supple without masses or bruits

Thyroid normal

Negative lymphadenopathy

 

Lungs:

Mild basilar crackles bilaterally

No wheezes

 

Heart:

RRR

Prominent S3 sound

No murmurs or rubs

 

ABD:

 

Soft and nondistended

Non tender with no guarding or rebound

No masses, bruits, or organomegaly

Normal bowel sounds

 

Rectal/GU

 

Normal size prostate without nodules or asymmetry

Heme negative stool

Normal penis and testes

 

Ext:

No CCE

Limited ROM right knee

 

Neuro

 

No sensory or motor abnormalities

CNs II-XII intact

Negative Babinski

DTRs=2+

Muscle tone = 5/5 throughout

 

Laboratory tests

Na                      139meq/L RBC                    5.9mil/mm33 Mg                           2.4mg/dL
K                          3.9meq/L WBC                   7,100/mm3 P04                          3.9mg/dL
Cl                        102meq/L AST                   29 IU/L Uric acid                 7.3mg/dL
HCO3                  27 meq/L ALT                   43 IU/L Glu, fasting            110mg/dL
BUN                     17mg/dL ALK phos       123 IU/L T. Chol                 275mg/dL
Cr                          1.0mg/dL GGT               119 IU/L HDL                      31mg/dL
HgB                      16.9g/dL T. Bilirubin      0.9mg/dL LDL                     179mg/dL
Hct                         48% T. protein      6.0g/dL Trig                      290mg/dL
Plt                   235,000/mm3 Ca                  9.3mg/dL PSA                    1.3ng/mL

 

Urinalysis results:

Appearance- clear, amber in color

Specific gravity- 1.017

Ph- 5.3

Protein- negative

 

RBC- 0

WBC- 0

Bacteria- negative

 

ECG:

Increased QRS voltage suggestive of LVH

 

ECHO:

Moderate LVH with EF = 46%

 



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Nursing homework help



Nursing homework help The Lab Assignment  Don’t use plagiarized sources. Get Your Custom Essay on Nursing homework help Just from $13/Page Order Essay   CASE STUDY   GENITALIA ASSESSMENT Subjective: CC: dysuria and urinary frequency HPI: RG is a 30 year old female with increase urinary frequency and dysuria that began 3 days ago. Pain is intermittent and described a burning only in urination, but c/o flank […]



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Assessing and Diagnosing Patients with Neurocognitive and Neurodevelopmental


Assessing and Diagnosing Patients with Neurocognitive and Neurodevelopmental

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Neurodevelopmental disorders begin in the developmental period of childhood and may continue through adulthood. They may range from the very specific to a general or global impairment, and often co-occur (APA, 2013). They include specific learning and language disorders, attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, and intellectual disabilities. Neurocognitive disorders, on the other hand, represent a decline in one or more areas of prior mental function that is significant enough to impact independent functioning. They may occur at any time in life and be caused by factors such brain injury; diseases such as Alzheimer’s, Parkinson’s, or Huntington’s; infection; or stroke, among others.

For this Assignment, you will assess a patient in a case study who presents with a neurocognitive or neurodevelopmental disorder. Assessing and Diagnosing Patients with Neurocognitive and Neurodevelopmental 

 

Assignment Instructions:

 

  • Use the Comprehensive Psychiatric Evaluation Template (Attached) to complete this Assignment.

 

  • Review the Comprehensive Psychiatric Evaluation Exemplar (Attached) to see an example of a completed evaluation document. 

 

  • Select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. Video # 50 (See the transcript).

 

  • Consider what history would be necessary to collect from this patient.

 

  • Consider what interview questions you would need to ask this patient.

f

  • Identify at least three possible differential diagnoses for the patient. 

 

  • Complete and submit your Comprehensive Psychiatric Evaluation (attached), including your differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into your responses in the template:

 

  • Subjective:What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life? 

 

  • Objective:What observations did you make during the psychiatric assessment?

 

  • Assessment:Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis.

Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.

 

  • Reflection notes:What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

 

 



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Nursing homework help – Elite Custom Essays


Nursing homework help

Training Title 50

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Name: Harold Griffin

Gender: male Age:58 years old

T- 98.8 P- 86 R 18 134/88 Ht 5’11 Wt 180lbs

Background: Has bachelor’s degree in engineering. He is homosexual and dates casually, never married, no children. Has one younger sister. Sleeps 4-6 hours, appetite good. Denied legal issues; MOCA 27/30 difficulty with attention and delayed recall; ASRS-5 20/24; denied hx of drug use; enjoys one scotch drink on the weekends with a cigar. Allergies Morphine; history HTN blood pressure controlled with losartan 100mg daily, angina prescribed ASA 81mg po daily, metoprolol 25mg twice daily. Hypertriglyceridemia prescribed fenofibrate 160mg daily, has BPH prescribed tamsulosin 0.4mg po bedtime. Nursing homework help

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Symptom Media. (Producer). (2017). Training title 50 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-50TRANSCRIPT OF VIDEO FILE # 50

____________________________________________________________________________

_____________________________________________________________________________

 

00:00:00

BEGIN TRANSCRIPT:

 

00:00:00

[sil.]

 

00:00:15

OFF CAMERA So, you told your supervisor you were having difficulty with concentration, and then it was your supervisor who set up this appointment, right, is it?

 

00:00:25

HAROLD Yeah, I, I work at this large architectural engineering firm and it’s all great. Except, they’ve accelerated the deadlines now and it just puts a lot of pressure on. And I, I just can’t concentrate. I mean, everyone else is, doesn’t have a problem with it. But, but I just, I just can’t seem to be able to do the same job they’re doing.

 

00:00:50

OFF CAMERA Okay, tell me about your problem with concentration.

 

00:00:55

HAROLD Well, um, you know it’s just… Perfect example is, is they wanted me to design um, air ducts.

 

00:01:05

OFF CAMERA Right.

 

00:01:05

HAROLD Air ducts, simple. But I designed them through solid wall, a fire wall, and a supporting wall and I didn’t even realize what I was doing.

 

00:01:15

OFF CAMERA Uh-huh.

 

00:01:15

HAROLD You know, I mean, um, I’m making silly mistakes like that because, another time we had these windows, we already bought them, design, beautiful, they’re going to be in this entire building.

 

00:01:30

OFF CAMERA Right.

 

00:01:30

HAROLD Every floor. Well, I drew the window opening way too small. Now, I mean, if that would have gone ahead, it would have cost millions. I just, it’s, it’s just silly things like that.

 

00:01:45

OFF CAMERA Uh-huh, is this a new kind of problem for you?

 

00:01:45

HAROLD Well, I mean, I didn’t seem to have a problem when everything was relaxed, and the deadlines were normal.

 

00:01:50

OFF CAMERA Right.

 

00:01:55

HAROLD I could do the job. Everything was fine. But now we’re on these, these ridiculously tight deadlines and, and I just, can’t seem to do it. Everyone else can. It’s, there’s not a problem for them. And I end up like I’m not pulling my weight.

 

00:02:10

OFF CAMERA Uh-huh.

 

00:02:10

HAROLD And they think that and it’s true, I’m not.

 

00:02:10

OFF CAMERA Now did you have these, uh, similar kind of problems back in school?

 

00:02:15

HAROLD Well, yeah, I mean, in school everyone would go to the library to cram for big exams, so, I mean.

 

00:02:20

OFF CAMERA Right.

 

00:02:20

HAROLD That was a normal thing. And, yeah, I’d go but I’d end up looking out the window. Look it’s snowing, oh, it’s spring time. I’ll go for a walk. And, and if someone is whispering in a library well, I have to go to the other side. All my friends could study anywhere.

 

00:02:35

OFF CAMERA Uh-huh, but, what other kind of difficulties do you seem to have?

 

00:02:40

HAROLD Well, at the job we have, these uh, lectures, you know.

 

00:02:45

OFF CAMERA Right.

 

00:02:45

HAROLD We’d get together, it’s groups. This is the lectures by the chief of the department gets together with all the architects and engineers and he talks about the mission of the day. What we’re trying to work for, our goals.

 

00:02:55

OFF CAMERA Right.

 

00:03:00

HAROLD Do I listen? I’m thinking, maybe, my dog needs a bath. Or what am I going to have for lunch? Or, you know, anything other than what he’s saying.

 

00:03:05

OFF CAMERA Mm-hmm.

 

00:03:10

HAROLD And because of that, you know, it’s not a good idea.

 

00:03:15

OFF CAMERA So, so, is it difficult to sit and listen?

 

00:03:20

HAROLD Yeah, I mean, okay, we were suppose to be designing this other, on top of this penthouse, this, kind of, a patio, party area.

 

00:03:30

OFF CAMERA Right.

 

00:03:30

HAROLD And the gutters around it just to make sure everything was very comfortable for everyone. Well, I got up there and I’m designing and the gutters are here, and no, wait a minute, there’s Italian, tile floor. Doesn’t look like it’s tilted the correct way. So I started studying that and there were already two people assigned to study that. To fix that problem, not me.

 

00:03:50

OFF CAMERA Mm-hmm.

 

00:03:55

HAROLD I got in a lot of trouble for that one.

 

00:03:55

OFF CAMERA Do you have any problems organizing?

 

00:04:00

HAROLD At home or the office?

 

00:04:00

OFF CAMERA Uh, either.

 

00:04:05

HAROLD I’m a bit of a mess. I mean, and I’m messy. I will forget my shoes, my socks, my phone, my jacket, I, I can’t find them. I’m not that organized. And I have a calendar. One of my coworkers, actually bought me a calendar to motivate me.

 

00:04:20

OFF CAMERA Yeah.

 

00:04:25

HAROLD To get more organized. So, I started writing down all the important dates and events, but then do I ever look at that calendar? No, I don’t. So, it’s a complete waste of time.

 

00:04:35

OFF CAMERA What about problems paying bills?

 

00:04:40

HAROLD Bills, I mean, yeah they get paid. After two or three times of the threatening calls or letters. And then I have to pay the penalties.

 

00:04:50

OFF CAMERA Hmm, what about hyperactivity?

 

00:04:50

HAROLD You know, I mean, I’m, sometimes I’m a little more uncomfortable in a chair or you know. But I don’t think that’s that big a deal. I mean, I used to be a lot worse. I mean, uh, there was a time when I was in school, I would get marked down for citizenship because I never raised my hand and I talked out of class and, and I just, couldn’t seem to stay focused. But I’m a lot better now.

 

00:05:20

OFF CAMERA Mm-hmm, were you ever um, treated with medications or behavioral therapies for ADHD?

 

00:05:25

HAROLD No, no. My mother threatened that one time, but I was never evaluated. Never went, uh, I’m kind of amazed she never just dragged me into a doctor’s office, but she never did.

 

00:05:40

OFF CAMERA Do you drink any caffeinated drinks?

 

00:05:45

HAROLD Coffee, soda, you know, once in a while. But when I was a kid, my mother said no caffeine, no sugar, cause you’ll climb the walls. I was already doing it anyway and so she, I uh, once and a while I’ll have a little caffeine now and it kind of helps me focus a little but, sugar, I stay away from that. It’s just not a good idea.

 

00:06:05

END TRANSCRIPT



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NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar


NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar

INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLY

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If you are struggling with the format or remembering what to include, follow the Comprehensive Psychiatric Evaluation Template AND the Rubric as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. Below highlights by category are taken directly from the grading rubric for the assignment in Weeks 4–10. After reviewing the full details of the rubric, you can use it as a guide. NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar

In the Subjective section, provide:

  • Chief complaint
  • History of present illness (HPI)
  • Past psychiatric history
  • Medication trials and current medications
  • Psychotherapy or previous psychiatric diagnosis
  • Pertinent substance use, family psychiatric/substance use, social, and medical history
  • Allergies
  • ROS
  • Read rating descriptions to see the grading standards!

In the Objective section, provide:

  • Physical exam documentation of systems pertinent to the chief complaint, HPI, and history
  • Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.
  • Read rating descriptions to see the grading standards!

In the Assessment section, provide: NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar

  • Results of the mental status examination, presented in paragraph form.
  • At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
  • Read rating descriptions to see the grading standards!

Reflect on this case. Include: Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

(The comprehensive evaluation is typically the initial new patient evaluation. You will practice writing this type of note in this course. You will be ruling out other mental illnesses so often you will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for all illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.)

EXEMPLAR BEGINS HERE

CC (chief complaint): A brief statement identifying why the patient is here. This statement is verbatim of the patient’s own words about why presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member.

HPI: Begin this section with patient’s initials, age, race, gender, purpose of evaluation, current medication and referral reason. For example:

N.M. is a 34-year-old Asian male presents for psychiatric evaluation for anxiety. He is currently prescribed sertraline which he finds ineffective. His PCP referred him for evaluation and treatment.

Or

P.H., a 16-year-old Hispanic female, presents for psychiatric evaluation for concentration difficulty. She is not currently prescribed psychotropic medications. She is referred by her therapist for medication evaluation and treatment.

Then, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis.

Paint a picture of what is wrong with the patient. First what is bringing the patient to your evaluation.  Then, include a PSYCHIATRIC REVIEW OF SYMPTOMS.  The symptoms onset, duration, frequency, severity, and impact. Your description here will guide your differential diagnoses. You are seeking symptoms that may align with many DSM-5 diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders.

Past Psychiatric History: This section documents the patient’s past treatments. Use the mnemonic Go Cha MP. 

General Statement: Typically, this is a statement of the patients first treatment experience. For example: The patient entered treatment at the age of 10 with counseling for depression during her parents’ divorce. OR The patient entered treatment for detox at age 26 after abusing alcohol since age 13.

Caregivers are listed if applicable.

Hospitalizations: How many hospitalizations? When and where was last hospitalization? How many detox? How many residential treatments? When and where was last detox/residential treatment? Any history of suicidal or homicidal behaviors? Any history of self-harm behaviors?

Medication trials: What are the previous psychotropic medications the patient has tried and what was their reaction? Effective, Not Effective, Adverse Reaction? Some examples: Haloperidol (dystonic reaction), risperidone (hyperprolactinemia), olanzapine (effective, insurance wouldn’t pay for it)

Psychotherapy or Previous Psychiatric Diagnosis: This section can be completed one of two ways depending on what you want to capture to support the evaluation. First, does the patient know what type? Did they find psychotherapy helpful or not? Why? Second, what are the previous diagnosis for the client noted from previous treatments and other providers. Thirdly, you could document both.

Substance Use History: This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures.

Family Psychiatric/Substance Use History: This section contains any family history of psychiatric illness, substance use illnesses, and family suicides. You may choose to use a genogram to depict this information. Be sure to include a reader’s key to your genogram or write up in narrative form.

Social History: This section may be lengthy if completing an evaluation for psychotherapy or shorter if completing an evaluation for psychopharmacology.  However, at a minimum, please include:

Where patient was born, who raised the patient

Number of brothers/sisters (what order is the patient within siblings)

Who the patient currently lives with in a home? Are they single, married, divorced, widowed? How many children?

Educational Level

Hobbies:

Work History: currently working/profession, disabled, unemployed, retired?

Legal history: past hx, any current issues?

Trauma history: Any childhood or adult history of trauma?

Violence Hx: Concern or issues about safety (personal, home, community, sexual (current & historical)

Medical History: This section contains any illnesses, surgeries, include any hx of seizures, head injuries.

 

Current Medications: Include dosage, frequency, length of time used, and reason for use. Also include OTC or homeopathic products.

Allergies: Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance.

Reproductive Hx: Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse:  oral, anal, vaginal, other, any sexual concerns

ROS: Cover all body systems that may help you include or rule out a differential diagnosis.  Please note: THIS IS DIFFERENT from a physical examination!

You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe.

Example of Complete ROS:

GENERAL: No weight loss, fever, chills, weakness, or fatigue.

HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

SKIN: No rash or itching.

CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.

RESPIRATORY: No shortness of breath, cough, or sputum.

GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.

GENITOURINARY: Burning on urination, urgency, hesitancy, odor, odd color

NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.

HEMATOLOGIC: No anemia, bleeding, or bruising.

LYMPHATICS: No enlarged nodes. No history of splenectomy.

ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.

Physical exam (If applicable and if you have opportunity to perform—document if exam is completed by PCP): From head to toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head-to-toe format i.e., General: Head: EENT: etc.

Diagnostic results: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines).

Assessment

Mental Status Examination: For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudohallucinations, illusions, etc.)., cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements—DO NOT just copy the example. You may use a preceptor’s way of organizing the information if the MSE is in paragraph form.

He is an 8-year-old African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking.   He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good.

Differential Diagnoses: You must have at least three differentials with supporting evidence. Explain what rules each differential in or out and justify your primary diagnosis selection. You will use supporting evidence from the literature to support your rationale. Include pertinent positives and pertinent negatives for the specific patient case.

 

Also included in this section is the reflection. Reflect on this case and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently?

Also include in your reflection a discussion related to legal/ethical considerations (demonstrating critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

References (move to begin on next page)

You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.

 

 



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Assessment and Description: PICOT Question


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PICOT Question

Does using electronic medication compared to education and training of nurses reduce adverse drug events over a three-month period? Assessment and Description: PICOT Question

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Problem being investigated

            The existing problem is Adverse Drug Events (ADEs). The problem accounts for significant patient morbidity and mortality and legal, operational, and patient care costs (Mills et al., 2008). Medications that result in most ADEs include narcotics, chemotherapy, and diabetic and cardiovascular medications (Mills et al., 2008). Issues that cause most ADEs include wrong doses, wrong medication, missed medication, prescribing drugs to the wrong patients, and many prescribers for one patient.

The patient population under consideration is elders. The elderly population is at an increased risk of experiencing ADEs after medication. Available data shows that 15% or more of the elderly experience ADEs (Pretorius et al., 2013). The ADEs in the elderly population are manifested in various forms, including falls, orthostatic hypotension, heart failure, and delirium. Some ADEs, mainly gastrointestinal or intracranial bleeding and renal failure, result in mortalities. Effects of ADEs in hospitals include increased costs of operation, reduced effectiveness, and increased LOS. Adverse drug outcomes can be mediated using different strategies such as discontinuing medications, prescribing new medications sparingly, reducing the number of prescribers, and frequently reconciling medications.

Evidence-based Interventions for Reducing ADEs

The PICOT question compares two nursing interventions that can be applied to reduce ADEs among the elderly population. They are electronic medication and educational programs and training for nurses. Electronic medication system supports the improved quality, safety, and effectiveness of medication management within hospitals by enabling digital prescription, ordering, checking, reconciling, dispensing, and recording the medication. On the other hand, education and training involve equipping nurses with the requisite skills to reduce ADEs among elderly patients. The training can involve proper prescription and documentation of the drug.

Different scholars in the nursing field have published ample evidence on the efficacy of these interventions. In particular, (Wu et al., 2007) investigated the cost-effectiveness of introducing an electronic medication ordering and administration system and its potential impact on reducing ADEs. Their findings revealed that an electronic medication order entry and administration system could improve care by reducing adverse events (Wu et al., 2007). Thus, electronic medication is an evidence-based intervention.

Another study to assess the efficacy of electronic medication in reducing ADEs was done by Truitt et al., (2016). The authors analyzed the effects of implementing barcode medication administration (BCMA) and electronic medication administration record (eMAR) technology on ADEs. Data were analyzed using descriptive statistics, and findings showed that eMAR and BCMA technology improved patient safety by decreasing the overall rate of ADEs and the rate of transcription errors (Truitt et al., 2016). The two studies by Truitt et al., (2016) and Wu et al., (2007) agree that electronic medication can lower ADEs’ prevalence among the elderly population.

            Scholarly evidence in support of the educational program to reduce ADEs also exists. (Trivalle et al., 2010) analyzed the impact of educational intervention in decreasing ADEs in elderly patients in a hospital setting using a randomized prospective study. Five hundred twenty-six patients included in the study were 65 years and above, while the study period was four weeks. The data collected showed that educational intervention program led to fewer ADEs in the intervention group (n = 38, 22%) than in the control group (n = 63, 36%; p = 0.004) (Trivalle et al., 2010). (Martin et al., 2018) also investigated the effects of a pharmacist-led education intervention on reducing ADEs among patients aged 65 and above. The outcomes indicated that pharmacist-led education reduced ADEs.

Summary

The two interventions for reducing ADEs among the elderly population are electronic medication and educational programs for healthcare providers. Based on the existing evidence, electronic medication is the best intervention because it is more feasible and can have a huge health impact.

 

 

References

Martin, P., Tamblyn, R., Benedetti, A., Ahmed, S., & Tannenbaum, C. (2018). Effect of a pharmacist-led educational intervention on inappropriate medication prescriptions in older adults. JAMA, 320(18), 1889. https://doi.org/10.1001/jama.2018.16131

Mills, P. D., Neily, J., Kinney, L. M., Bagian, J., & Weeks, W. B. (2008). Effective interventions and implementation strategies to reduce adverse drug events in the Veterans Affairs (VA) system. Quality and Safety in Health Care, 17(1), 37–46. https://doi.org/10.1136/qshc.2006.021816

Pretorius, R. W., Gataric, G., Swedlund, S. K., & Miller, J. R. (2013). Reducing the Risk of Adverse Drug Events in Older Adults. American Family Physician, 87(5), 331–336. https://www.aafp.org/afp/2013/0301/p331.html

Trivalle, C., Cartier, T., Verny, C., Mathieu, A.-M., Davrinche, P., Agostini, H., Becquemont, L., & Demolis, P. (2010). Identifying and preventing adverse drug events in elderly hospitalised patients: A randomised trial of a program to reduce adverse drug effects. The Journal of Nutrition, Health & Aging, 14(1), 57–61. https://doi.org/10.1007/s12603-010-0010-4

Truitt, E., Thompson, R., Blazey-Martin, D., Nisai, D., & Salem, D. (2016). Effect of the implementation of Barcode Technology and an electronic medication administration record on Adverse Drug Events. Hospital Pharmacy, 51(6), 474–483. https://doi.org/10.1310/hpj5106-474

Wu, R. C., Laporte, A., & Ungar, W. J. (2007). Cost-effectiveness of an electronic medication ordering and administration system in reducing adverse drug events. Journal of Evaluation in Clinical Practice, 13(3), 440–448. https://doi.org/10.1111/j.1365-2753.2006.00738.x

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



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