Fundamentals Clinical Makeup Assignment

Summer 2021

Student Name:

Assessment

1. Make a list of variables that may impair a nurse’s ability to gather data that are complete, accurate, factual, and relevant.

2. In a brief report, describe the purpose of the four types of nursing assessments (initial assessment, focused assessment, emergency assessment, time-lapsed assessment), and give an example of a case in which each would be conducted.

Diagnosing

3. Explain the following statement: The etiology of the problem directs the nursing intervention.

4. Case Study: A 16-year-old girl delivers her baby at home in her bedroom. Her parents find her and bring her and her baby to the emergency department. The baby is premature and in respiratory distress, and the mother has uncontrolled bleeding. The mother blames the situation on her daughter’s boyfriend, a fellow classmate, who denies any responsibility for the baby.

Make a list of one of the following areas:

(a) patient strengths:

(b) patient problem areas:

(c) potential patient problems:

Outcome Identification and Planning

5. Read the following situation and respond in writing to the accompanying questions:

A client is a 49-year-old homemaker seen in the emergency department to rule out fractures. She states that she lost her balance and fell down her basement stairs. Her husband is constantly at her side, and she appears fearful. You recall previous admissions for lacerations, bruises, and a fracture.

· How would you develop and prioritize the patient’s nursing diagnoses?

· What would be appropriate long- and short-term goals for the priority nursing diagnosis?

· What would be appropriate nursing orders for the priority nursing diagnosis?

Implementing

6. Using the Internet (must be a credible source- include citation and reference list), research a new nursing strategy or practice that has proven effective and write a paragraph about how you could incorporate this into your own nursing practice.

Evaluating

7. Describe how you use your weekly clinical experiences to develop self-awareness of your clinical strengths and weaknesses. What would be your plan for self-improvement? Then, discuss the value of reflection and self-awareness.

8. Discuss the following statement and its implications: We owe it to our patients to be the best nurses we can be.

Case Studies, Urinary Elimination

1. You are a hospital nurse caring for a 62-year-old accountant who was admitted following a motor vehicle accident. During her hospitalization, a significant lack of urination was detected. Her primary care physician has ordered significant testing while the patient is recovering from her injuries.

a. What circumstances could be causing her infrequent urination?

b. How can infrequent urination negatively impact a patient’s health?

c. Outline how urination may be affected by the effects of aging.

d. Describe the effects of decreased bladder and sphincter tone on urination.

e. What can cause decreased urinary structure muscle tone?

2. You are a urologic nurse whose patient has voiced concern over his kidneys losing their function within the past few weeks. He has maintained a log of the past week, recording his urination and fluid intake. He has a history of diabetes mellitus and hypertension, which are treated with medication.

a. In your patient interview, how would you define renal failure for your patient?

b. Which diseases could be included as possible etiologies for renal failure?

c. What data should be included in a complete urinary system assessment?

d. How might an accurate urinary output measurement be obtained?

e. What is important to remember when collecting a 24-hour urine specimen?

Case Studies, Bowel Elimination

3. You are a visiting nurse checking in on your patient, a 93-year-old retired steelworker who lives alone with his two cats. You visit him on a weekly basis to monitor his blood glucose levels and refill his insulin syringes for his self-medicating throughout the week, as he is visually impaired. During your interview, he indicates that he has been experiencing irregularity and is quite anxious over developing a bowel obstruction.

f. How would you assess his bowel elimination patterns?

g. Describe foods that impact bowel elimination either positively or negatively.

h. What activities could you recommend to maintain adequate bowel function?

i. Outline how fiber and fluid intake facilitate bowel elimination.

j. Which mechanical function of the bowel causes constipation?

4. You are a nurse in a medical-surgical hospital unit caring for a patient who had an open cholecystectomy 3 days earlier. Subsequently, the patient developed a paralytic ileus. Additional complications require continued postoperative antibiotic infusions.

a. What nursing assessment finding could indicate the presence of a paralytic ileus?

b. Which medical interventions could have contributed to the development of your patient’s paralytic ileus?

c. How long would you expect the paralytic ileus to last?

d. In what ways would you expect a paralytic ileus to resolve?

e. List possible nursing diagnoses for this patient related to the surgical procedure and postoperative complications.

Case Study: Death and dying- Read and review Chapter 43- (Loss, Grief, & Dying).

Simulation Scenario: Patient is wheezing, Sats drop to 89%, skin is mottled, patient is full code. You will need to apply oxygen and titrate the amount of oxygen up from nasal cannula, to simple face mask, to non-rebreather mask. You will then give an S.B.A.R. report to the provider. You will administer a nebulizer treatment. While the nebulizer is going, your patient’s family has a care conference with palliative care providers and they decide to back off on aggressive cares and move to a comfort care approach. You will need to use what you learned in Chapter 43- Loss, Grief, and dying along with other resources to alter your plan of care for your patient once the family and patient have decided to switch to comfort care.

Review the signs of impending death. Review the likely goals a person will have when changing from acute care to hospice/comfort care or palliative care according to Maslow’s Hierarchy of Needs.

What is the difference between hospice and palliative care? ___________________________________________________________ ______________________________________________________________________________________________________________________

What happens physiologically in each major body system when a person dies? _____________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What are the rights of a dying person?

____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

“It is well within the scope of your professional practice as a competent nurse to provide counseling and death education, especially when the patient asks for it and indicates an unmet need for such information” (Taylor, Lillis & Lynn, 2015, p. 1618).

When should you call in family and notify them of impending death?

What is involved in post-mortem care?

Caring for the body- _______________________________________________________________________________________________________________________________________________________________________________________________

Caring for the family- _____________________________________________________________________________________________________________________________________________________

Due: In an effort to facilitate scholarly discourse, create your initial post by Tuesday, and reply to at least two of your classmates, on two separate days, by Friday.

Grading Category: Discussions

Initial Post

Knowledge and application of development theory constitutes a foundational component of the PMHNP role. You will need to expand your knowledge of theories for professional practice. This week you will choose an attachment, behavioral, cognitive, humanistic, or biological developmental theory.

For this discussion forum, using your chosen theory, identify what happens as individuals move through developmental stages. Address the following in your initial post:

• How can interruptions in the achievement of developmental stages affect an individual?
• According to your theory, identify the developmental vulnerabilities that could precipitate mental health symptoms.

Replies

Reply to at least two of your classmates. In your reply posts, you should compare and contrast your own viewpoints to your peer’s post.

Your response should include evidence-based research to support your statements using proper citations and APA format.

   

Assessment and Diagnosis of the Psychiatric Patient

A sensitively crafted intake assessment can be a powerful therapeutic tool. It can establish rapport between patient and therapist, further the therapeutic alliance, alleviate anxiety, provide reassurance, and facilitate the flow of information necessary for an accurate diagnosis and appropriate treatment plan.

—Pamela Bjorklund, clinical psychologist

Whether you are treating patients for physical ailments or clients for mental health issues, the assessment process is an inextricable part of health care. To properly diagnose clients and develop treatment plans, you must have a strong foundation in assessment. This includes a working knowledge of assessments that are available to aid in diagnosis, how to use these assessments, and how to select the most appropriate assessment based on a client’s presentation.

This week, as you explore assessment and diagnosis of patients in mental health settings, you examine assessment tools, including their psychometric properties and appropriate uses. You also familiarize yourself with the DSM-5 classification system.

Reference: Bjorklund, P. (2013). Assessment and diagnosis. In K. Wheeler (Ed.), Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.) (pp. 95–168). Springer Publishing Company.

Learning Objectives

Students will:

•  Evaluate elements of the psychiatric interview, history, and examination

•  Analyze psychometric properties of psychiatric rating scales

• Justify appropriate use of psychiatric rating scales in advanced practice nursing

Learning Resources

https://dsm-psychiatryonline-org.ezp.waldenulibrary.org/doi/full/10.5555/appi.books.9780890425596.Section1

Carlat, D. J. (2017). The psychiatric interview (4th ed.). Wolters Kluwer.

• Chapter 34, Writing Up the Results of the Interview

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

   

• Chapter 5, Examination and Diagnosis of the Psychiatric Patient

• Chapter 6, Classification in Psychiatry

• Chapter 31, Child Psychiatry (Sections 31.1 and 31.2 only)

American Academy of Child and Adolescent Psychiatry (1995). Practice parameters for the assessment and treatment of children and adolescents. https://www.aacap.org/App_Themes/AACAP/docs/practice_parameters/psychiatric_assessment_practice_parameter.pdf

American Psychiatric Association. (2016). Practice guidelines for the psychiatric evaluation of adults (3rd ed.). https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Classification in psychiatry. In Kaplan and Sadock’s Concise Textbook of Clinical Psychiatry (4th ed., pp. 1–8). Wolters Kluwer.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Psychiatric interview, history, and mental status examination. In Kaplan and Sadock’s Concise Textbook of Clinical Psychiatry (4th ed., pp. 9–15). Wolters Kluwer.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Medical assessment and laboratory testing in psychiatry. In Kaplan and Sadock’s Concise Textbook of Clinical Psychiatry (4th ed., pp. 16–21). Wolters Kluwer.

   

Required Media (click to expand/reduce)

https://www.aacap.org/App_Themes/AACAP/docs/practice_parameters/psychiatric_assessment_practice_parameter.pdf

https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760

https://ebookcentral.proquest.com/lib/waldenu/reader.action?docID=5340671&ppg=20

https://ebookcentral.proquest.com/lib/waldenu/reader.action?docID=5340671&ppg=39

https://ebookcentral.proquest.com/lib/waldenu/reader.action?docID=5340671&ppg=53

https://ezp.waldenulibrary.org/login?qurl=https://video.alexanderstreet.com/watch/diagnostic-criteria

https://www.youtube.com/watch?v=U5KwDgWX8L8

https://www.youtube.com/watch?v=IRiCntvec5U

Getting Started With the DSM-5

This is not unlike what has occurred in the process of classifying mental disorders. A system that provides enough specificity to appropriately classify a large variety of mental disorders while also attempting to include all of the possible symptoms, many of which can change over time, is a daunting task when used by a variety of specialists, doctors, and other professionals with varied experience, cultures, expertise, and beliefs. The DSM has undergone many transformations since it was first published in 1952. Many of these changes occurred because the uses for the DSM changed. However, the greatest changes began with the use of extensive empirical research to guide the creation of the classification system and its continued revisions.

In order to assess and diagnose patients, you must learn to use the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, usually abbreviated as the DSM-5, to render a diagnosis. In this second week of the course, you will examine how DSM-5 is organized and how clinicians use it to render diagnoses. 

Review the Learning Resources this week, with special emphasis on viewing the Diagnostic Criteria video. This video explains the purpose and organization of the DSM-5 classification system, the purpose of the ICD-10 coding system, their relationship to one another, and the importance to the PMHNP role. 

Discussion: The Psychiatric Evaluation and Evidence-Based Rating Scales

Assessment tools have two primary purposes: 1) to measure illness and diagnose clients, and 2) to measure a client’s response to treatment. Often, you will find that multiple assessment tools are designed to measure the same condition or response. Not all tools, however, are appropriate for use in all clinical situations. You must consider the strengths and weaknesses of each tool to select the appropriate assessment tool for your client. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor, consider its use in psychotherapy.

To Prepare:

• Review this week’s Learning Resources and reflect on the insights they provide regarding psychiatric assessment and diagnosis.

• Consider the elements of the psychiatric interview, history, and examination.

• Consider the assessment tool assigned to you by the Course Instructor.

By Day 3 of Week 2

Post a brief explanation of three important components of the psychiatric interview and why you consider these elements important. Explain the psychometric properties of the rating scale you were assigned. Explain when it is appropriate to use this rating scale with clients during the psychiatric interview and how the scale is helpful to a nurse practitioner’s psychiatric assessment. Support your approach with evidence-based literature.

Diagnostic Tool

Beck Depression Inventory, 2nd Revision   

At least 3 citations

he purpose of this assignment is to provide a brief explanation of three important components of the psychiatric interview and why I would consider these elements important. Additionally, I will provide an explanation of the psychometric properties of the rating scale NICHQ Vanderbilt Assessment Scale. Moreover, I will explain when it is appropriate to use the NICHQ Vanderbilt Assessment Scale with clients during the psychiatric interview and how the scale is helpful to a nurse practitioner’s psychiatric assessment. 

The Psychiatric Evaluation 

There are several components of the psychiatric interview that are vital to ensure optimal patient outcomes. For example, it is imperative to establish the reason for the visit (i.e., chief complaint), history and present illness, and the mental status examination in my opinion are key elements of the psychiatric interview. Because without this information it would be difficult to diagnosis and treat the patient adequately (Opler, D. J. (2017). The identifying data gives you the basic information about a patient such as race, sex, marital status, and other social information. The chief complaint (CC) is important to recognize as it conveys to the provider the reason the patient is present, seeking treatment. Of course, knowing this is imperative as it can help guide the interview. 

Week 6 Discussion

For this assignment, you will review the latest evidence-based guidelines in the links provided below. Please make sure you are using scholarly references and they should not be older than 5 years. The posts/references must be in APA format. 

Apply the information from the Aquifer case study to answer the following questions: 

1: Which essential questions will you ask this pediatric patient or his/her caregiver during this well-child check? Why are these questions important? What lab tests or diagnostic studies will you order and why?

2: What diagnoses would you give the patient in this case? Include the findings that support the diagnoses.

3: What is your treatment recommendation and education for the patient and family? Why? Include anticipatory guidance.