Comprehensive Health History in which you examine how social determinants of health such as age, gender, ethnicity, and environmental situations impact the health and risk assessment of the patients you serve. Also, consider how social determinants of health influence your interview and communication techniques as you work in partnership with a patient to gather data to build an accurate health history.

take on the role of a clinician who is building a health history for a particular new patient assigned by your Instructor.

With the information presented in Chapter 1 of Ball et al. in mind, consider the following:

• How would your communication and interview techniques for building a health history differ with each patient?
• How might you target your questions for building a health history based on the patient’s social determinants of health?
• What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?
• Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.
• Select one of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the Seidel’s Guide to Physical Examination text, or another tool with which you are familiar, related to your selected patient.
• Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.

Post a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.

APA citation 3 to 4 References within 5 years

 

Respond to at least two of your    colleagues who were assigned to a different case than you. Explain how    you might apply knowledge gained from your colleagues’ case studies  to   you own practice in clinical settings. 

 

NOTE: Positive comment

                                             Main Post

 Case  Study: Volume 2, Case #21 focuses on the treatment of an adult  client  diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).   

 

Questions 

Question 1: Are you having problems with your loved one’s due being “argumentative and temperamental”?  

Rationale:  The client may have additional stress due to broken  relationships and  this could be due to his disorder.  “Emotional  dysregulation is  increasingly recognized as a core feature of ADHD”  (Stralen, 2016).  Signs of ADHD include low frustration tolerance and  explosive behavior  (Stralen, 2016).  

Question 2: 

What causes you the most anxiety?

It  is important to determine the triggers of the anxiety to help the   patient prepare for times when he is likely to be in high stress   situations. Planning a response when feeling overwhelmed can help the   patient remain in control of his emotions and allow the patient to   monitor his behavior. 

Question 3: 

You  stated that your father was abusive, was this physical or verbal  abuse  or both? Do you contribute some of your anxiety from previous  issues  with your father? 

It  is important for the provider to understand the client’s point of  view  in regards to his upbringing. He realizes it has affected in him  in some  way, as he has obtained psychotherapy in the past. I would want  to know  if he has ever spoken to his father about this and if his  father has  ever apologized for his actions. 

Questions for family

I  would want to talk with his mother to ask her how he did as a  child in  school and at home in regards to schoolwork, chores and would  want to  know if he had friends. Although  social problems are not part  of the diagnostic criteria for ADHD, the  peer relationship difficulties  faced by youth with this disorder are  profound (Hoza, 2007)

Diagnostics & Exams

A  full psychiatric evaluation which would include the Adult  Self-Report  Scale (ASRS). ASRS was been developed by the World Health  Organization  to determine if an individual (adult) may have ADHD. The  scale is made  up of 6 questions, and if a client has at least 4 of 6  symptoms, there  may need to be a diagnosis of ADHD made by a  professional (ADDA, 2018). Seay  et al. (2009) suggests the PMHNP should  utilize intelligence test,  broad-spectrum scales, tests of specific  abilities, and brain scans to  confirm the diagnosis and to rule out  other disabilities, autism,  auditory processing disorders or mood  disorders. In addition, a full medical work-up by a PCP in order to rule  out other medical conditions that could present similarly to ADHD. 

Differential DX

General Anxiety Disorder: The  patient exhibits symptoms of  generalized anxiety disorder, DSM-5 300.02  (F14.1). He has had the  symptoms for greater than six months with the  symptoms being severe  enough to interfere with the patient’s daily  functioning. The patient  complains of feels of worry that is difficult  to control, irritability,  restlessness, difficulty concentrating and  feeling on edge. The  patient symptoms have not been linked to a physical  condition or to  substance use (Reynolds & Kamphaus,2013).

ADHD:  client consistently complains of feeling tense, irritable, and  anxious  (Stahl Online, 2019).  Questions arise once the general  anxiety symptoms  are resolved and the client is left feeling  hyperactive, inattentive,  and the inability to focus (Stahl Online).

Post-Traumatic  Stress Disorder: The client’s diagnosis of anxiety  may have been  related to underlying issues related to a traumatic event  that he  experienced as a child. The client’s father was verbally  abusive to him  and was an alcoholic. It is a possibility that the  client’s issues could  have some relations to previous exposure as a  child. Post-Traumatic  Stress Disorder is a serious condition that can  occur in clients who  have experienced various incidents including abuse  (PTSD, 2018).

Medications

The  case states by year six the client has failed to achieve  remission on  an SSRI, a 5-HT1A receptor partial agonist, an  antihistamine anxiolytic  and an SGRI (Stahl Online, 2019).

Based on the pharmacological agents, I would select either  Cymbalta  60mg or Effexor XR 150mg.  Cymbalta did illicit a response,  but side  effects prevented the escalation of the dosage.  Augmenting  with  guanfacine an alpha-adrenergic agonist proved to be the therapy  that  elicited remission for this client.

Lessons Learned

I  learned to always consider additional differential diagnosis and   evaluate and re-evaluate every situation separately to be sure of the   correct diagnosis.  Patient’s  often have comorbid diagnosis and  treating both is vital to a  successful outcome for the patient.  Symptoms of mental illness change  overtime making continued care  necessary for the patient. The provider  must always be approachable and  helpful for the client to feel  comfortable in his/her presence. 

                                                References

Attention Deficit Disorder Association. (2018). Adult ADHD Test. Retrieved from https://add.org/adhd-test/

Generalized Anxiety Disorder. (2018). Anxiety and Depression Association of America. Retrieved from https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad

Posttraumatic Stress Disorder. (2018). Anxiety and Depression Association of America. Retrieved from https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd

Seay, B., McCarthy, L. F., and Williams, P. (2009). Your complete ADHD/ADD diagnosis guide.

            Retrieved from https://www.additudemag.com/adhd-testing-diagnosis-guide/

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical

            Applications (4th ed.). New York, NY: Cambridge University Press.

Stralen, J. W. (2016). Emotional dysregulation in children with attention-deficit/hyperactive disorder.

            Attention Deficit Hyperactivity Disorder. 8(4). p. 175-187. Retrieved from

            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5110580/

Hoza  B, Mrug S, Gerdes AC, Bukowski WM, Kraemer HC, Wigal T, et al.  What  aspects of peer relationships are impaired in children with   attention-deficit/hyperactivity disorder? Journal of Consulting and  Clinical Psychology. 2005b;73:411–423. 

Reynolds, C. & Kampaus, R. (2013). Generalized Anxiety Disorder. Pearson. Retrieved from:

www.images.pearsonclinical.com/images/assets/basc-3/basc3resources/DMS-5_

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Mucor is a mold that causes a serious fungal infection. Mucormycosis most commonly affects the sinuses or lungs and affects people with weakened immune systems.  It infects the sinuses or lungs after inhaling fungal spores from the air, or can enter the skin through a cut, scrape, burn, or other skin injury.  This group of fungi lives in most soil, especially decaying leaves, composite piles, or rotten wood.  People come in contact with this frequently but may do not often develop mucormycosis unless they are immune compromised, then the fungi gets into their sinuses or lungs, develops an infection and spreads to other areas of the body and they are unable to fight it off (Cdcgov. (2015)).  The infection starts with signs of a fever, cough sometimes with dark or bloody sputum, and shortness of breath, it then progresses and rapidly multiplies in blood vessel walls.  When the fungus reaches the alveoli in the lungs, it travels into the spaces between the cells and the connecting pores.  The immune system is then triggered to send the white blood cells (neutrophils) to try and fight off the invasion of the fungus.  The neutrophils then try to do their job while at the same time are releasing cytokines which activate the immune system.  This is when the pneumonia sets in and just continues to take over as the alveoli fill with fluid leaking from the surrounding blood vessels which results in impaired oxygen transportation (Wikipediaorg. (2018)).

Medical/Nursing interventions:

1)      Educate the patient on the importance of taking their medication as prescribed and to finish the entire dose.

2)      Apply Oxygen as needed to help ease the symptoms of dyspnea

3)      Control any underlying immune compromised condition if possible

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The attending physician will prescribe an antifungal treatment for mucormycosis. Prescription antifungals will be used such as amphotericin B, posaconazole or isavulcaonazole (CDC, 2015). Antifungal therapies can be administered IV and oral depending on the medication. Treatment can also involve surgical debridement of the infected area. The chest X-ray in the case study shows areas in the lungs that are infected and potentially necrotic, requiring surgical intervention. Lastly, appropriate treatment of any other debilitating diseases should be addressed, such as diabetes and infections, other than mucormycosis.

 

 

Ministry of Health (MOH) Vision and Strategy 

For this assignment, you will write a research paper exploring the Ministry of Health’s vision and strategy to improve healthcare delivery for all citizens throughout the Kingdom of Saudi Arabia 

Choose three out of the four topics below:

1. Interoperable electronic health records,
2. Equitable care standards,
3. Quality and performance standards, or
4. Governance and accountability.

For each selected topic:

1. Provide an overview of the MOH vision and strategy for that topic.
2. Explain the importance of the topic and how it will improve healthcare quality and safety in Saudi Arabia.

Your well-written paper should meet the following requirements:

1. Four to five pages in length, not including the cover or reference pages.
2. Formatted per APA writing standards
3. Provide support for your work with in-text citations from a minimum of four scholarly articles. Two of these sources may be from the class readings, textbook, or lectures, but two must be external. 
4. Provide full APA references for the sources used, along with appropriate in-text citations.
5. Utilize headings to organize the content in your work ( introduction , the three topics chosen above then a final conclusion)
6. More citation through the text
7. No plagiarism
8. The references not more than 5 years ago

 

Write a 500‐750‐word essay on the Stages‐of‐Life and the influence of age in health care from a patient’s perspective. Interview a friend or family member about that person’s experiences with the health care system. You may develop your own list of questions.

Suggested questions:

1. Do you feel that your stage‐of‐life had any effect on your interaction with health care professionals?
2. Which areas of the hospital or clinic were most concerned with your well‐being and feelings?
3. Was your family with you during this hospital stay or outpatient visit?
4. Was your family included in your treatment, such as post‐procedure instructions?

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.