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

RESOURCES

§ Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261-276.

§ Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine. Retrieved from https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf

§ Paz, Z., Nalls, M. & Ziv, E. (2011). The genetics of benign neutropenia. Israel Medical Association Journal. 13. 625-629.

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

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?

Also include how ethical considerations might impact your treatment plan and communication with clients.

 

Write a paper (2,000-2,500 words) in which you apply the concepts of epidemiology and nursing research to a communicable disease. Refer to “Communicable Disease Chain,” “Chain of Infection,” and the CDC website for assistance when completing this assignment.

Communicable Disease Selection

1. Chickenpox
2. Tuberculosis
3. Influenza
4. Mononucleosis
5. Hepatitis B
6. HIV
7. Ebola
8. Measles
9. Polio
10. Influenza

Epidemiology Paper Requirements

1. Describe the chosen communicable disease, including causes, symptoms, mode of transmission, complications, treatment, and the demographic of interest (mortality, morbidity, incidence, and prevalence). Is this a reportable disease? If so, provide details about reporting time, whom to report to, etc.
2. Describe the social determinants of health and explain how those factors contribute to the development of this disease.
3. Discuss the epidemiologic triangle as it relates to the communicable disease you have selected. Include the host factors, agent factors (presence or absence), and environmental factors. Are there any special considerations or notifications for the community, schools, or general population?
4. Explain the role of the community health nurse (case finding, reporting, data collection, data analysis, and follow-up) and why demographic data are necessary to the health of the community.
5. Identify at least one national agency or organization that addresses the communicable disease chosen and describe how the organizations contribute to resolving or reducing the impact of disease.
6. Discuss a global implication of the disease. How is this addressed in other countries or cultures? Is this disease endemic to a particular area? Provide an example.

A minimum of three peer-reviewed or professional references is required.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

When a patient presents to a primary care provider with a complaint of abdominal pain, there are a number of possibilities that must be considered. Discuss the first three steps you would complete in assessing a patient with this complaint. Then, discuss at least two differential diagnoses for a patient with abdominal pain. How would the treatment and intervention course differ for each diagnosis?

Your initial posting should be 200 to 300 words in length and utilize at least one scholarly source other than the textbook.

    

The final submission is basically the combination of the other four phases into one paper. This paper will need to be corrected with all of the feedback provided from previous papers. Include on this paper a conclusion and learning experiences from the essentials and from the class. 

  

Phase 1-Planning (Due by WEEK 4):

Phase 1 is the planning stage of a research project; students are to prepare a 4-5 page paper identifying a specific topic that you would like to investigates and relates to transitional nursing. You will provide a brief introduction to the situation by utilizing published nursing research articles to support your statement. This paper will also include 

1- Introduction to the Problem

2- Clearly Identify the Problem

3- Significance of the problem to Nursing

4- Purpose of the research

5- Research questions

6- Master’s Essentials that aligned with your topic

  

Phase 2-Design (Due by WEEK 6)

Students will continue their research topic, in this paper students will perform a brief literature review on the topic (Will need at least 5 support articles) and provide the desired methodology for the project. Paper will be approximately 5-6 pages. 

1- Brief literature review

2- Methodology and design of the study (Be as detailed as possible)

3- Sampling methodology

4- Necessary tools

5- Any algorithms or flow maps created

  

Phase 3-Implementation (Due by WEEK 9)

Phase 3 of the research project is the implementation phase. The implementation phase will be written in the future state as we will not be implementing the actual project. This phase focuses on providing steps by steps instructions on how the program will be implemented, a table describing the time frame of the project, if there is any budget that needs to be taking into account, and any resources or statistically tools required. The length of this paper should be around 5-6 pages.

  

Phase 4-Results (Due by WEEK 11)

Phase 4 is all about results, this part of the paper will be based on the hypothetical analysis. Meaning since we will not be actually implementing the process, the results described will be based on whatever the students would like the research results to be. You will need to provide results for all of the statistical tools mentioned and provide descriptive data (demographics of the population, different descriptive data points, etc.). Make sure to also include research limitations to improve for future studies. Approximately 6 pages.

 

Please ensure that you read chapters 27 and 28 in your Smith and Parker (2015) textbooks.

Reflection 

In your reflection paper discuss concepts related to this week nursing theorists that are presented in chapters 27 and 28. The reflective statements are to help students recognize and understand the nature, scope and limits of scientific thinking and research. Your paper should be limited to no more than 2-3 paragraphs.