Substance abuse as a Community Health Problem.

Violence and Nursing Response.

1.  Click on the link and read the Health People 2020 topic (goal and objective) regarding substance abuse. 

https://www.healthypeople.gov/2020/topics-objectives/topic/substance-abuse

2.  Identify current events a the local or national level related to substance use/abuse laws, policies lawsuits or other legal issues.  Discuss the application of such laws/policies to the individual freedom of people. 

3.  In your own words define the term violence and the role of the nurse in responding to acts of violence outrages. 

4.  Do you think is there any relationship between substance abuse and violence.  Give at least one example. 

As stated in the syllabus the assignment must be presented in an APA format word document, Arial 12 font attached to the forum on the discussion board.  A minimum of 3 evidenced-based references must be used and 2 replies to any of your peers sustained with the appropriate references must be posted.  Only the assignment must be attached in a word document in the forum, replies do not.  References must be no older than 5 years.  A minimum of 700 words is required.  

  

Complex Patient Case Study B

Overview

Joan is a 78-year-old female who is scheduled with you today because she needs refills for her blood pressure medication. When you look at her record, you notice that she has not been in for 14 months. You notice that there are a number of missed appointments on record, but that she has been calling in for refills for her meds. During the last call, the office nurse told her she would need to come in for a visit to obtain the refills. Her record indicates that her medications at her last visit included Lisinopril/hctz 10/12.5 and simvastatin 20mg daily.

She reports that she takes her blood pressure medication “most of the time” but doesn’t take the simvastatin regularly because her neighbor developed liver problems from it. She remembers in the past that she was told she has a “touch of sugar.” She feels good but she wants to get checked out and wants to “get her act together” and start taking care of herself because her brother, who is 48, just found out that he has “clogged arteries.” She would like some help with quitting smoking as well. She also tells you that she had a “little heart attack” when she was 72.

Her vital signs are: BP: 168/94, pulse: 84 and regular, resp: 18

Height: 5’9” Weight: 221lbs

1. What additional subjective information do you need to      obtain? Be specific to her medical history and reason for presentation      today.
2. What objective information do you need to obtain? Be      specific to her medical history and reason for presentation today.
3. What labs/diagnostic tests are indicated and why?      Include references for your rationales.

You conduct the visit. The review of systems and physical exam, with the exception of her blood pressure and weight, are normal. The diagnostic tests and laboratory test you ordered were normal with the exception of the following:

• EKG – Afib with a rate of 82
• Fasting Lipids: Total cholesterol: 242, LDL: 176, HDL:       36, triglycerides: 250
• Fasting glucose: 162
• HgbA1c – 7.4

1. What is your complete diagnosis list for this patient?
2. How will you manage her blood pressure      pharmacologically? Provide a rationale for your choice and include      references.
3. How will you manage her cholesterol pharmacologically?      Provide a rationale for your choice and include references.
4. What is Joan’s CHADS-Vasc score? What is her yearly      risk for stroke? What treatment will you recommend based on her score and      why? Remember to include references for your rationales.
5. Estimate Joan’s 10-year ASCVD.
6. During the follow up visit, you discuss her lab results      and their implications. What will you tell her?

Please refer to the Grading Rubric for details on how this activity will be graded.

• S Question 1
• O Question 2, 3
• A Question 4
• P Question 5, 6, 7, 8, 9

 

Develop a 6-slide Microsoft® PowerPoint® presentation on the organizational structure of the rehabilitation center described in the scenario. Create the presentation for the audience of a REHABILITATION DIRECTOR.

Address the following in your presentation:

• The steps involved in organizational planning and functions of management
• Explain the administrative process needed to track outcomes and improve quality and safety

List the major points on the slides. The slide count excludes the title and reference slides.

Include detailed explanations that correlate to each point in the speaker notes.

Include videos, photos, diagrams, graphs, or audio as appropriate.

Include at least a minimum of 2 references to support your presentation.

Format your presentation according to APA guidelines.

 

Discussion Question:

Research two advanced degrees that you would be interested in if time and money was not a factor. What are the education requirements (how long, on-line or on campus, clinical hours, dissertation, etc.)? What is the average salary? What is the average number of graduates from these programs and the ten year outlook? After completing the research explain why you are or are not interested in pursuing one of these degrees.

Your initial posting should be 400 words in length and utilize at least one scholarly source other than the textbook

  

Delusional Disorders

 Examine Case Study: Pakistani Female With Delusional Thought Processes

BACKGROUND:

The client is a 34-year-old Pakistani female who moved to the United States in her late teens/early 20s. She is currently in an “arranged” marriage (her husband was selected for her since she was 9 years old). She presents to your office today following a 21 day hospitalization for what was diagnosed as “brief psychotic disorder.” She was given this diagnosis as her symptoms have persisted for less than 1 month.

Prior to admission, she was reporting visions of Allah, and over the course of a week, she believed that she was the prophet Mohammad. She believed that she would deliver the world from sin. Her husband became concerned about her behavior to the point that he was afraid of leaving their 4 children with her. One evening, she was “out of control” which resulted in his calling the police and her subsequent admission to an inpatient psych unit.

During today’s assessment, she appears quite calm, and insists that the entire incident was “blown out of proportion.” She denies that she believed herself to be the prophet Mohammad and states that her husband was just out to get her because he never loved her and wanted an “American wife” instead of her. She tells you that she knows this because the television is telling her so.

She currently weighs 140 lbs, and is 5’ 5”

SUBJECTIVE:

Client reports that her mood is “good.” She denies auditory/visual hallucinations, but believes that the television does talk to her. She believes that Allah sends her messages through the TV. At times throughout the clinical interview, she becomes hostile towards the PMHNP, but then calms down.

You reviewed her hospital records and find that she has been medically worked up by a physician who reported her to be in overall good health. Lab studies were all within normal limits.

Client admits that she stopped taking her Risperdal about a week after she got out of the hospital because she thinks her husband is going to poison her so that he can marry an American woman.

MENTAL STATUS EXAM:

The client is alert, 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. Her speech is slow and at times, interrupted by periods of silence. Self-reported mood is euthymic. Affect constricted. Although the client denies visual or auditory hallucinations, she appears to be “listening” to something. Delusional and paranoid thought processes as described, above. Insight and judgment are impaired. She is currently denying suicidal or homicidal ideation.

The PMHNP administers the PANSS which reveals the following scores:

-40 for the positive symptoms scale

-20 for the negative symptom scale

-60 for general psychopathology scale

Diagnosis: Schizophrenia, paranoid type

The Assignment: 

With Introduction and a Conclusion. 

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 to five academic resources no more than five years old.