Watch the “Diary of Medical Mission Trip” videos dealing with the catastrophic earthquake in Haiti in 2010. Reflect on this natural disaster by answering the following questions:

1. Propose one example of a nursing intervention related to the disaster from each of the following levels: primary prevention, secondary prevention, and tertiary prevention. Provide innovative examples that have not been discussed by previous students.
2. Under which phase of the disaster do the three proposed interventions fall? Explain why you chose that phase.
3. With what people or agencies would you work in facilitating the proposed interventions and why?

 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

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      Case #13 the 8-year-old girl who was naughty  

This  case study will examine an 8-year-old girl who initially presents to  the pediatrician’s office with complaints of a fever and sore throat.  After further examination, the client is diagnosed with attention  deficit hyperactivity disorder (ADHD) and oppositional defiant disorder  (ODD). According to Ghosh, Ray, & Basu (2017), characteristics of  ODD include persistent anger or irritable mood, argumentativeness,  defiance, and vindictiveness for at least 6 months. ADHD is  characterized by a pattern of inattention, hyperactivity, and  impulsivity that interferes with daily functioning or development  (American Psychiatric Association, 2013). 

3 Additional Assessment Questions for the Client:

1.  I would ask the client and her mother how often her daughter displays  symptoms that are congruent with ODD and? According to the authors  Ghosh, Ray, & Basu (2017), the occurrence of ODD symptoms must be  disproportionate to the child’s developmental stage and age. 

2. I  would ask the client if she had trouble learning in class when she was  younger. The onset of ADHD symptoms usually occurs before a child  reaches age 12, and in some children, these symptoms are noticeable at  age 3 (Sibley, Rohde, & Swanson, 2017). 

3. A  final question that I would ask the client is if she interrupts her  classmates when they are speaking. Children suffering from ADHD feel the  need to be constantly active and struggle with controlling impulsive  behaviors (American Psychiatric Association, 2013).  

Feedback From the Client’s Loved Ones

The  first person in this client’s life that I would like to further  interview is the client’s mother. According to Stahl (2019), the  client’s mother is 26 years old and is a single parent of two children,  ages 8 and 6. I would want to ask the client’s mother more about her  daughter’s academic performance in earlier grades. Identifying the  precise onset of the client’s ADHD symptoms will assist the provider in  creating the most appropriate treatment for the client (Stahl, 2014). I  would also like to interview the client’s teacher in order to gain  another perspective on the client’s behavior in the classroom. The  client’s teacher did use an ADHD rating scale, but scales of that nature  are very broad and do not elaborate on the child’s specific classroom  behaviors. A third person that I would interview is the client’s  6-year-old sister. According to Stahl (2019), the client began  displaying signs of anger and resentfulness when her sister was born. I  would ask the client’s sister if she felt safe at home and if she and  her sister fought often, in order to determine if the home environment  is safe for both children. 

Physical Exams and Diagnostic Tests

The  physical assessment of the client is essential for developing an  appropriate diagnosis and treatment plan. Visual assessment of the  client’s behaviors during the physical assessment will be extremely  useful to the provider. The provider would also want to obtain and  review the client’s report cards along with any behavior reports, and  attendance records from the client’s school (Adesman, 2011). The  healthcare provider should also review the client’s pediatric health  records to see if her symptoms are congruent with a learning disability,  auditory processing disorder, signs of language delay, spacial  orientation confusion, and complete a more thorough family history  involving learning disabilities (Adesman, 2011). A complete blood count  should be down to rule out physical illness as a causetive factor for  the client’s ODD symptoms. The client is currently suffering from a  fever and sore throat, which could be an indicator of PANDAS (pediatric  autoimmune neuropsychiatric disorder associated with streptococcal  infections). Since  the client does have a current sore throat, a rapid strep test should  be ordered. If the client does test positive for strep, it could explain  the client’s symptomologies impulsivity, temper tantrums, and aggressiveness.  

Differential Diagnoses

Autism Spectrum Disorder: there  are deficits in social-emotional reciprocity, ranging from an abnormal  social approach and failure to communicate in a standard back-and-forth  conversation (American Psychiatric Association, 2013). There is also a  reduced sharing of interests, emotions, or affect, along with a failure  of the patient to initiate or respond during social interactions (American Psychiatric Association, 2013). The client’s history does not show any indication of impaired communication. 

Conduct Disorder:  characterized by behavior that violates either the rights of others or  major societal norms, the symptoms must be present for at least 3 months  with one symptom having been present in the past 6 months. The symptoms  of conduct disorder must cause significant impairment in social,  academic or occupational functioning (American Psychiatric Association,  2013). Per the client’s medical record, her symptoms fit the time frame  for conduct disorder, however, her behavior is not this severe in  nature. 

ADHD with Co-occurring ODD: The authors Ghosh, Ray, & Basu (2017), describe the characteristics  of ODD as persistent anger or irritable mood, argumentativeness,  defiance, and vindictiveness for at least 6 months. ADHD is  characterized by a pattern of inattention, hyperactivity,  and impulsivity that interferes with daily functioning or development  (American Psychiatric Association, 2013). The client’s behavior is  congruent with ADHD with co-occurring ODD.

Pharmacological Agents for ADHD/ODD Therapy: 

Risperdal  is the first pharmacological agent that I would choose for this client.  This medication is not listed on the suggested medication list of the  case study, however, the medication list does list “other” as a possible  choice. According to Stahl (2014), Risperidone  is also used to treat behavior problems such as aggression,  self-injury, and sudden mood changes in teenagers and children 5 to 16  years of age. Risperidone  is in a class of medications called atypical antipsychotics. It works  by changing the activity of certain natural substances in the brain. The  second medication that was chosen for this client is Vyvanse.  Vyvanse increases norepinephrine and dopamine actions by blocking their  reuptake and creating an environment that allows their release (Stahl,  2013). Vyvanse also causes an enhancement of dopamine and  norepinephrine in specific areas of the brain that may improve  attention, concentration, executive dysfunction, and wakefulness (Stahl,  2013). According to Stahl (2014), it is thought that the increased  dopamine action caused by Vyvanse, may help with hyperactivity. I would  initially start this client on Vyvanse due to its efficacy in treating  symptoms of ADHD. If the child’s academic performance and classroom  behavior improve, perhaps ODD symptoms will improve. 

CheckPoints: 

According  to Stahl (2019), the closest child psychotherapist is an hour away,  therefore the client did not receive therapy. I would refer the client  and her mother to case management in order to connect the client with  resources that are closer to her home. I would also ask the client’s  school what type of resources are available in terms of psychotherapy.

Lessons Learned: 

Through  this case study I have learned that co-occurring childhood disorders  can be difficult to treat. Pediatric clients can respond differently to  medication dosages than adults, so careful dose titration is essential.  Pediatric clients also rely on their parents or caregivers to provide  them with their prescribed medications and transportation to medical  appointments. It is essential that the healthcare provider conveys how  important treatment regime compliance is to both the client and their  caregiver.

Adesman, A. R. (2011). The Diagnosis and Management of Attention-Deficit/Hyperactivity Disorder in 

    

           Pediatric Patients. Primary care companion to the Journal of clinical psychiatry, 3(2), 66-77. 

    

           https://doi.org/10.4088/pcc.v03n0204 

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(5th ed.). Washington, DC: Author.

Ghosh, A., Ray, A., & Basu, A. (2017). Oppositional defiant disorder: current insight. Psychology 

    

 research and behavior management, 10, 353-367. https://doi.org/10.2147/PRBM.S120582 

Sibley, M. H., Rohde, L. A., & Swanson, J. M. (2017). Late-Onset ADHD Reconsidered with 

    

            Comprehensive Repeated Assessments between Ages 10 and 25. American journal of psychiatry, 

    

 175(2), 140-149. https://doi.org/10.1176/appi.ajp.2017.17030298 

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (fourth ed.). New York, NY: Cambridge University Press.

Stahl, S. M. (2014). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Stahl Online. (2019). Volume 1 case #5: The sleepy woman with anxiety. (PDF file). 

Retrievedfrom http://stahlonline.cambridge.org.ezp.waldenulibrary.org/viewPdf?p

age=csEP_05.pdf                

Assignment 2 – Due

•      Powerpoint (PPT)  presentation
  Assignment Description:
  The student will critique the assigned journal article using a narrated power point presentation. Other forms of presentation styles are available but these are easier to upload through dropbox. If there is another presentation style you would like to use please make your request known for consideration.
  This assignment addresses the formal analysis and critique of a journal article. Additional references must be used  to support your critique position. The presentation will be voice narrated with no more than 10 slides in length, excluding cover page, references, and appendix (if applicable). You may use screen-o-matic (http://screencast-o-matic.com/home) to narrate PPT slide for easier upload through dropbox. If using prezi or another form of presentation style, submit your references on separate document. The presentation and references must be APA format 6th ed., using peer-reviewed journals of 5 years or less (minimum 6 references), unless there is a historical reference. Wikipedia or dictionary sites are unacceptable references. Peer-reviewed articles are located within professional organization periodicals such as American Nurse Association journal. They allow other peers to critique submitted articles.
  Other non-healthcare related professional journals or articles may be used. Include any conceptual models in the appendix.
  Rubric:
  5% ____ Introduction
  10%_____ Background of the project
  45%_____ Body of the presentation must address these components:
   
  1. Overview/summary of article ( quantitative or qualitative research,empirical data to support article)
  2. Relevance to promoting healthcare leadership best practices
  3. Relevance to organizational growth
  4. Conceptual model/framework to support the article
  5. Translation into your practice
  6. 10% _____ Critique- what you learned from this project
     5%_____  Conclusion
     5% _____   APA format and reference
     10% ____   Grammar, organization, construction
     10%_____  voice narration for each slide of presentation
     This assignment addresses course outcome #3 and allows the student evaluate and analyze journal articles relevant to the growth of healthcare professionals. This assignment represents 33% of your grade

 What is evidence-based practice and why is it important?

The discussion posts are assigned to encourage reflection, critical thinking, engagement and interaction within the course. There will be two discussion post to participate in. The initial reply should be 200 words and should include at least one peer-reviewed journal article reference and should reflect a good understanding and considerable thought on the assigned readings and topic. please follow the rubric. 

Participate in the following discussion:

Differentiate and discuss the difference between research, evidence-based practice and improvement processes. Discuss the role each plays in the nursing profession and provide an example of each. 

dvanced Primary Care of Family

1. The clinical interventions for patients unwilling to quit cigarette smoking include the use of the motivational treatments, such as brief motivational interventions that are founded on the tenets of Motivational Interviewing (MI). The four general principles of MI are “the expression of empathy, developing discrepancy, rolling with resistance, and supporting self-efficacy are used to tailor-make MI counseling strategies to suit each patient’s needs” (Fiore, et al. 2008). Consequently, MI is a patient-centered counseling intervention that was proven to be successful in intensifying future attempts of smokers to quit the habit.

2. The best strategies to help clients to quit smoking include counseling and clinical interventions. According to the guidelines, clinicians strongly advocate for the use of intensive counseling regarding tobacco dependence, in addition to medication treatments to their patients who are addicted to tobacco. In addition to these intervention methods, patients should be provided with problem-solving or skills training during counseling sessions will help patients to develop methods of overcoming the tobacco addiction on their own too (Fiore, et al. 2008). In this regard, the guideline also recommends that health systems, insurers, and purchasers should be in a position to collaborate with the clinicians to make these suggested intervention treatments affordable and accessible to the tobacco smokers.

3. The guideline indicates that there are particular smoking cessation suggestions for special populations like the elderly. The special recommendations for the elderly include implementing the “4 As,” which are “ask, advise, assist, and arrange to follow up in patients who are over fifty years old aged 50 and older” (Fiore, et al. 2008). In addition to this fact, advice from physicians, telephone counseling, support programs from peers, counseling, the nicotine patch, as well as self-help materials that are specifically tailored to meet the demands of the aged were proven to be effective in treating tobacco use in adults aged 50 years and older. In this instance, clinicians are advised to provide counseling interventions for adolescent smokers to encourage them to stop smoking or abstain from tobacco use (Fiore, et al. 2008). Therefore, intervention methods for special populations, such as adolescents, are quite different from that of other special populations, such as the elderly people.

References

Fiore M., C., Jaén, C., R., Baker,  T., B., et al. (2008). Treating tobacco use and dependence: 2008 update. Clinical Practice Guideline. U.S. Department of Health and Human Services. Public Health Service. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK63952/