Discussion Board 2025

Chief complaint: “I’m here for a medication refill because I ran out of my medicines”. HPI: Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home. She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway. PMH: Primary Hypertension, Previous history of MI 1 year ago Surgeries: 1 year ago-Left Anterior Descending (LAD) cardiac stent placement Allergies : Penicillin Vaccination History: Up-to-date Social history: High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago. Family history: Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52. ROS: Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks. Psychiatric: Non-contributory. Physical examination: Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored HEENT : Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease. NECK : Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS : + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART : Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally. ABDOMEN : No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY : No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL : + Heberden’s nodes at the DIP joints, hands. + Crepitus, bilateral knees. Slow gait but steady. No Kyphosis. PSYCH : Normal affect. Cooperative. SKIN : No rashes. Positive for dry skin. Labs : Hgb 13.2, Hct 38%, K+ 4.0, Na+137, Cholesterol 228, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98. A: Primary Diagnosis: Congestive Heart Failure (CHF) Secondary Diagnoses: Primary Hypertension, Obesity, Osteoarthritis (OA) Differential Diagnosis: Peripheral Vascular Disease (PVD) Plan: Medications: Tylenol 650 mg PO Q4 hours as needed for arthritis pain Labs: UA; Brain natriuretic peptide (BNP); LFTs and TSH; 12-lead EKG, Chest X-ray; Initial 2D echo with Doppler; Ankle-brachial index. Additional lab results : Echo results 1 week ago: Left ventricular EJ Fraction decreased to 35 % BNP – not available. As a future FNP, you need to determine the medications for CHF/ASCVD. (Arteriosclerotic Cardiovascular Disease). Questions: 1. According to the ACC/AHA guidelines, what medications should this patient be prescribed? 2. Does he need medication(s) given his history of MI?

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Discussion: Building A Health History 2025

Effective communication is vital to constructing an accurate and detailed patient history. A patient’s health or illness is influenced by many factors, including age, gender, ethnicity, and environmental setting. As an advanced practice nurse, you must be aware of these factors and tailor your communication techniques accordingly. Doing so will not only help you establish rapport with your patients, but it will also enable you to more effectively gather the information needed to assess your patients’ health risks. For this Discussion, you will take on the role of a clinician who is building a health history for a particular new patient assigned by your Instructor. Photo Credit: Getty Images/Caiaimage To prepare: With the information presented in Chapter 1 of Ball et al. in mind, consider the following: By Day 1 of this week, you will be assigned a new patient profile by your Instructor for this Discussion. Note : Please see the “Course Announcements” section of the classroom for your new patient profile assignment. Case study : 16-year-old white pregnant female living in an inner-city neighborhood 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. at least four references

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Ethical And Legal Nursing X 2 ( Due: 24 Hours) 2025

********you need to answer the same question 2 times (copy and paste is not accepted) you must answer the question 2 times on different pages in the same document (Word) 1) **********minimum 2 full pages ( not words)**************************** ( cover or reference page not included) 2)¨**********APA norms (All paragraphs must be narrative and cited in the text) 3)********** It will be verified by Turnitin and SafeAssign 4) References not older than 5 years 5) Do not copy the questions in the document. Identify your answer to the questions with numbers. Example: 1) The areas are………………… 2) Goals are……………… 3)……………………. __________________________________________________________ Read well. ********you need to answer the same question 2 times (copy and paste is not accepted) you must answer the question 2 times on different pages in the same document (Word) _________________________________________________________ Questions: A nurse manager is reviewing occurrence reports of medical errors over the last six months. The nurse manager knows that medical errors are not the only indicator of quality of care. They are, however, a pervasive problem in the current health care system and one of the greatest threats to quality health care. The nurse manager is putting together a list of possible solutions to decrease the number of occurrences of medication errors. 1. Recognizing that health care errors affect at least one in every 10 patients around the world, the World Health Organization’s World Alliance for Patient Safety and the Collaborating Centre identified priority program areas related to patient safety. What are the patient safety program areas the nurse manager should consider for implementation? 2. Describe the Joint Commission 2017 National Patient Safety Goals for Hospitals. 3. Discuss the Institute of Medicine’s four-pronged approach to reducing medical mistakes?

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Issue Of Quality And Safety 2025

1. In the last century, what historical, social, political, and economic trends and issues have influenced today’s health-care system? 2. What is the purpose and process of evaluating the three aspects of health care: structure, process, and outcome? 3. How does technology improve patient outcomes and the health-care system? 4. How can you intervene to improve quality of care and safety within the health-care system and at the bedside? 2. Select one nonprofit organization or one government agencies that influences and advocates for quality improvement in the health-care system. Explore the Web site for your selected organization/agency and answer the following questions: • What does the organization/agency do that supports the hallmarks of quality? • What have been the results of their efforts for patients, facilities, the health-care delivery system, or the nursing profession? • How has the organization/agency affected facilities where you are practicing and your own professional practice?

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Psychotherapy 2025

Does Psychotherapy Have a Biological Basis? Many studies have found that psychotherapy is as effective as psychopharmacology in terms of influencing changes in behaviors, symptoms of anxiety, and changes in mental state. Changes influenced by psychopharmacology can be explained by the biological basis of treatments. But how does psychotherapy achieve these changes? Does psychotherapy share common neuronal pathways with psychopharmacology? For this Discussion, consider whether psychotherapy also has a biological basis. Learning Objectives Students will: · Evaluate biological basis of psychotherapy treatments · Analyze influences of culture, religion, and socioeconomics on personal perspectives of psychotherapy treatments To prepare: · Review this week’s Learning Resources. · Reflect on foundational concepts of psychotherapy. Post an explanation of whether psychotherapy has a biological basis. Explain how culture, religion, and socioeconomics might influence one’s perspective of the value of psychotherapy treatments. Support your rationale with evidence-based literature. Resources for reference ( 3 reference needed). American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.) . Washington, DC: Author. Standard 1 “Assessment” (pages 44 & 45) Wheeler, K. (Eds.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company. Chapter 1, “The Nurse Psychotherapist and a Framework for Practice” (pp. 3–52) Fournier, J. C., & Price, R. B. (2014). Psychotherapy and neuroimaging. Psychotherapy: New Evidence and New Approaches, 12 (3), 290–298. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207360/ Holttum, S. (2014). When bad things happen our brains change but psychotherapy and support can help the recovery of our brains and our lives. Mental Health and Social Inclusion, 18 (2), 52–58. doi:10.1108/MHSI-02-2014-0006 Petiprin, A. (2016). Psychiatric and mental health nursing. Nursing Theory . Retrieved from http://www.nursing-theory.org/theories-and-models/psychiatric-and-mental-health-nursing.php Fisher, M. A. (2016). Introduction. In Confidentiality limits in psychotherapy: Ethics checklists for mental health professionals (pp. 3–12). Washington, DC: American Psychological Association. doi:10.1037/14860-001

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