Research the delivery, finance, management, and sustainability methods of the U.S. health care system. Evaluate the effectiveness of one or more of these areas on quality patient care and health outcomes. Propose a potential health care reform solution to improve effectiveness in the area you evaluated and predict the expected effect. Describe the effect of health care reform on the U.S. health care system and its respective stakeholders. Support your post with a peer-reviewed journal article. 

 

In this course, we consider vulnerable populations and Health Promotion and Disease Prevention standards. We look at content through the lens of pediatrics, women’s health, adults, mental health, and the elderly. Having just completed exercises related to the five levels of prevention in Week 1, consider what you have learned and how to apply Quaternary Prevention. Watch the following video and write a one-page journal submission regarding your thoughts about the use of palliative and hospice care as an option for health promotion. In what scenario(s) might this be applicable? Have you ever thought about palliative and hospice care promoting health? Why or why not?  

• End Of Life | Aging Matters | NPT Reports
  • End of Life Aging Matters Video Transcript.

You may journal in first person, and this assignment does not require references as it is your thoughts; however, be sure to review the rubric, as a minimum of one reference is required to be considered exemplary work. If you choose to use quotes or citable material, you are expected to follow APA formatting.

Grading Rubric:

 

Journal Rubric

Note: Scholarly resources are defined as evidence-based practice, peer-reviewed journals; textbook (do not rely solely on your textbook as a reference); and National Standard Guidelines. Review assignment instructions, as this will provide any additional requirements that are not specifically listed on the rubric.

Journal Rubric – 100 PointsCriteriaExemplary
Exceeds ExpectationsAdvanced
Meets ExpectationsIntermediate
Needs ImprovementNovice
InadequateTotal PointsFocus and ContentIn addition to self-reflection, the journal components are provided along with clear examples supported by course content and references that speak to how the journal content relates to the questions posed within the assignment.

Cites one or more references.

All instruction requirements noted.

45 pointsComponents of the journal are topic focused and accurately and thoroughly presented via self-reflective explanations and application of knowledge to personal and/or professional life.

All instruction requirements noted.

40 pointsComponents of the journal are summarized with minimal self-reflection or application to personal or professional life.

Synthesis of course content is present but missing depth and/or development.

Missing some instruction requirements.

35 pointsCourse content is present but there is no self-reflection noted within the journal.

Demonstrates incomplete understanding of content and/or inadequate preparation.

Missing several instruction requirements.

Submits assignment late.

31 points45Application of Knowledge through Critical ThinkingCritical analysis is supported with information from scholarly resource(s), offering new insight into the context of the assignment.

Student indicates how the experience will have an impact on their professional practice.

All instruction requirements noted.

45 pointsThe journal submission presents findings and knowledge gained from the assignment. An obvious link between the assignment and nursing is noted.

Submission provides clarification of the assignment by answering all posed questions.

All instruction requirements noted.

40 pointsJournal content may be confusing, unclear, or incomplete–lacking clarification or new information.

The student alluded to a practice application, but the information provided was not clear.

Not all questions posed are addressed.

Missing some instruction requirements.

35 pointsSubmission is primarily a summation of the assignment without further synthesis or analysis of course content.

Application of knowledge is limited, with no direct application to clinical practice discussed.

Demonstrates incomplete understanding of content and/or inadequate preparation.

More than one question posed is not addressed.

Missing several instruction requirements.

Submits assignment late.

31 points45OrganizationWell-organized content with a clear and complex purpose statement and argument content. Writing is concise with a logical flow of ideas.

5 pointsOrganized content with an informative purpose statement, supportive content, and summary statement. Argument content is developed with minimal issues in content flow.

4 pointsPoor organization and flow of ideas distract from content. Narrative is difficult to follow and frequently causes reader to reread work.

Purpose statement is noted.

3 pointsIllogical flow of ideas. Prose rambles. Purpose statement is unclear or missing.

Demonstrates incomplete understanding of content and/or inadequate preparation.

No purpose statement.

Submits assignment late.

2 points5APA Referencing, Grammar, and SpellingCorrect applicable APA formatting with no errors.

The writer correctly identifies reading audience, as demonstrated by appropriate language (avoids jargon and simplifies complex concepts appropriately).

There are no spelling, punctuation, or word-usage errors.

5 pointsThe writer demonstrates correct usage of formal English language in sentence construction.

There are minimal to no grammar, punctuation, or word-usage errors.

4 pointsThe writer occasionally uses awkward sentence structure. Problems with word usage (evidence of incorrect use of thesaurus) and punctuation persist, often causing some difficulties with grammar.

Multiple grammar, punctuation, or word usage errors.

3 pointsThe writer struggles with limited vocabulary and has difficulty conveying meaning such that only the broadest, most general messages are presented.

Grammar and punctuation are consistently incorrect. Spelling errors are numerous.

Submits assignment late.

2 points 

  

The Assignment

Examine Case Study: A Young Caucasian Girl With ADHD 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:

At each decision point stop to complete the following:

• Decision #1
  • Which decision did you select?
  • Why did you select this decision? Support your       response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this       decision? Support your response with evidence and references to the       Learning Resources.
  • Explain any difference between what you expected to       achieve with Decision #1 and the results of the decision. Why were they       different?
• Decision #2
  • Why did you select this decision? Support your       response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this       decision? Support your response with evidence and references to the       Learning Resources.
  • Explain any difference between what you expected to       achieve with Decision #2 and the results of the decision. Why were they       different?
• Decision #3
  • Why did you select this decision? Support your       response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this       decision? Support your response with evidence and references to the       Learning Resources.
  • Explain any difference between what you expected to       achieve with Decision #3 and the results of the decision. Why were they       different?

case Study and the decisions

BACKGROUND

Katie is an 8 year old Caucasian female who is brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katie’s teacher suggested that she may have ADHD. Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine whether or not she has this condition.

The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised”. This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their family primary care provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. The teacher opined that she lacks interest in school work and is easily distracted. Katie is also noted to start things but never finish them, and seldom follows through on instructions and fails to finish her school work.

Katie’s parents actively deny that Katie has ADHD. “She would be running around like a wild person if she had ADHD” reports her mother. “She is never defiant or has temper outburst” adds her father.

SUBJECTIVE

Katie reports that she doesn’t know what the “big deal” is. She states that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds her other subjects boring, and sometimes hard because she feels “lost”. She admits that her mind does wander during class to things that she thinks of as more fun. “Sometimes” Katie reports “I will just be thinking about nothing and the teacher will call my name and I don’t know what they were talking about.”

Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. Offers no other concerns at this time.

MENTAL STATUS EXAM

The client is an 8 year old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. Affect is bright. Katie denies visual or auditory hallucinations, no delusional or paranoid thought processes readily appreciated. Attention and concentration are grossly intact based on Katie’s attending to the clinical interview and her ability to count backwards from 100 by serial 2’s and 5’s. Insight and judgment appear age appropriate. Katie denies any suicidal or homicidal ideation.

Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation

Decision Point One

Select what the PMHNP should do:

Begin Wellbutrin (bupropion) XL 150 mg orally daily

Begin Intuniv extended release 1 mg orally at BEDTIME

Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING

Decision Point Two

Select what the PMHNP should do next:

Continue same dose of Ritalin and re-evaluate in 4 week

Change to Ritalin LA 20 mg orally daily in the MORNING

Discontinue Ritalin and begin Adderall XR 15 mg orally daily

Decision Point Three

Select what the PMHNP should do next:

Maintain current dose of Ritalin LA and reevaluate in 4 weeks

Increase Ritalin LA to 30 mg orally daily

Obtain EKG based on current heart rate

Decision Point One

Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING

RESULTS OF DECISION POINT ONE

• Client      returns to clinic in four weeks
• Katie’s      parents report that they spoke with Katie’s teacher who notices that her      symptoms are much better in the morning, which has resulted in improvement      in her overall academic performance. However, by the afternoon, Katie is      “staring off into space” and “daydreaming” again
• Katie’s      parents are very concerned, however, because Katie reported that her      “heart felt funny.” You obtain a pulse rate and find that Katie’s heart is      beating about 130 beats per minute

Decision Point Two

Change to Ritalin LA 20 mg orally daily in the MORNING

RESULTS OF DECISION POINT TWO

• Client      returns to clinic in four weeks
• Katie’s      academic performance is still improved, and the switch to the LA      preparation is lasting Katie throughout the school day
• Katie’s      reports of her heart feeling “funny” have gone away. Pulse was 92 during      today’s office visit

Decision Point Three

Maintain current dose of Ritalin LA and reevaluate in 4 weeks

Guidance to Student

 

At this point, Katie’s symptoms are well controlled (her attention is sustained throughout the school day) and her side effects have gone away following change to a long-acting preparation. There is no indication at this point that the dose should be increased as it is always advisable to use the lowest effective dose of stimulant medication. Katie’s heart rate is appropriate for an 8 year old girl and an EKG would not be indicated based on her heart rate.

 Reflecting on week 4’s lessons in the syllabus, select a patient population (pediatric, young adult, adult or geriatric), and briefly analyze a chronic cardiovascular disease(HTN, Heart failure, Dyslipidemia, Heart murmur etc.…), that may affect this population. Briefly tell how it impacts the patient’s quality of life and analyze the current research evidence on this topic and gold standard of care if any for your chosen population. (You may use an example from your clinical rotation (past or present) that you have encountered). Describe how you, the FNP, can/or have made a difference in the care of patients with this specific disease and tell of one specific patient care teaching that he/she may do to help minimize disease symptoms. Please post your CS directly in the thread so that your colleagues can see it and be sure to read and respond/comment on one of your  

Develop a concept map of the responses of the assigned system to burn injury. identify aspects important to patient survival during the resuscitation and acute phase of the burn injury , Include lab values that may be impacted one of the following body systems:

 Respiratory

 Cardiovascular

 Neurological

 Gastrointestinal

 Renal

 Psychosocial