Case 2: Volume 1, Case #7: The case of physician do not heal thyself

Major depressive disorder is one of the most prevalent disorders you will see in clinical practice. Treatment for this disorder, however, can vary greatly depending on client factors, such as ethnicity and culture. As a psychiatric mental health professional, you must understand the influence of these factors to select appropriate psychopharmacologic interventions. For this Discussion, consider how you might assess and treat the individuals in the case studies based on the provided client factors, including ethnicity and culture.

To Prepare:

· Review this week’s Learning Resources and reflect on the insights they provide.

· Go to the Stahl Online website and examine the case study you were assigned ( Above)

· Take the pretest for the case study.

· Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.

· Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).

· Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.

· Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.

· Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.

· Review the posttest for the case study.

Write a response to the following:

· Provide the case number in the subject line of the Discussion thread ( Case # 7)

· List three questions you might ask the patient if he or she were in your office. Provide a rationale for why you might ask these questions.

· Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.

· Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.

· List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.

· List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.

· For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?

· If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided.

· Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations

Resources ( 3 + reference needed)

Required Readings

Note: All Stahl resources can be accessed through this link provided https://stahlonline.cambridge.org/

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

• Chapter 6, “Mood Disorders”

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

Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Howland, R. H. (2008). Sequenced Treatment Alternatives to Relieve Depression (STAR*D). Part 1: Study design. Journal of Psychosocial Nursing and Mental Health Services, 46(9), 21-24. doi:02793695-20081001-0510.3928/02793695-20080901-06

Howland, R. H. (2008). Sequenced Treatment Alternatives to Relieve Depression (STAR*D). Part 2: Study outcomes. Journal of Psychosocial Nursing and Mental Health Services, 46(10), 21-24. doi:02793695-20081001-0510.3928/02793695-20080901-06

Yasuda, S.U., Zhang, L. & Huang, S.-M. (2008). The role of ethnicity in variability in response to drugs: Focus on clinical pharmacology studies. Clinical Pharmacology & Therapeutics, 84(3), 417–423. Retrieved from https://web.archive.org/web/20170809004704/https://www.fda.gov/downloads/Drugs/ScienceResearch/…/UCM085502.pdf

  

 

1) **********minimum 10 full pages (5 pages each document) ( not words)**************************** (cover or reference page not included)

2)¨**********APA norms  (All paragraphs must be narrative and cited in the text- each paragraphs)

3)********** It will be verified by Turnitin and SafeAssign 

4) Minimum 5 references not older than 5 years

5) Each answer must be identified according to the question number. Check the list of questions. Your answer should start objectively answering the question

Question:

1)…………

2)…………

3)…………

Answer:

1)…………

2)…………

3)…………

_______________________________________________________

You must answer (4) points 2 times. 

You must submit 2 documents (each one 5 pages).

Copy and paste will not be admitted. 

You should address the questions with different wording, different references, but always, objectively answering the questions.

____________________________________________________________

1)Identify and discuss conflicts that exist between ethics and healthcare reform that has been brought upon the execution of the affordable care act aka Obamacare/Trumpcare.  

2) Explain how nurses should negotiate such conflicts. 

3) Consider how nurses have historically handled conflicts between ethics and their profession in a time where health care reform was obsolete. 

4) What happens to those patients that still don’t have insurance?  

Professional Development Exercises :

• Read the case study presented at the end of Chapter 17 (Guido, p. 362)
  • Was the nurse negligent for unlocking the bath-room door and allowing Judy to shower by herself?
  • Was it below the standard of care for the nurse to leave the bathroom door unlocked when the psychiatrist came to see Judy?
  • How significant are the hospital policy and procedures in this instance?
  • How would you decide this case?
• Read the case study presented at the end of Chapter 18 (Guido, p. 393)
  • Was the nurse negligent in the advice she gave Mr. Gonzales concerning his condition?
  • Did the nurse exceed her scope of practice in the advice she gave the patient?
  • Should the nurse have instructed Mr. Gonzales to go immediately to the local emergency center?
  • How would you decide this case? Who, if anyone, is liable in this case?
• Read the case study presented at the end of Chapter 20 (Guido, p. 439)
  • What should the standards of care be for such a patient?
  • Even though the nursing care plan did not specify that the wound should be checked hourly, how should the prudent nurse have acted?
  • Should the lawsuit center primarily on the surgeon for allowing this patient to be sent back to the nursing home for post- operative care rather than insisting he be kept for 24 hours in an acute care facility post-operatively?
  • How would you decide this case?

Please add an introduction and conclusion:  Submit only the assignments corresponding to the module in this section.

You are not required to adhere to the 500-1000 word count for each of the responses, but please be thorough in your responses so that you adequately address all aspects of each question.

 

. Describe what drew you to pursue nursing as a career, and how you see yourself contributing to the nursing profession over the next 5-10 years. (approximately 200 words)
2. Describe how your values align with the mission of Creighton University. (approximately 200 words)
3. Describe an uncomfortable situation or ethical dilemma you encountered. What was your response in the situation, and what (if anything) would you do differently and why? (approximately 200 words)
4. The 12-month Accelerated BSN is an academically rigorous program during which much of a student’s time is occupied with school obligations. Describe the strategies you plan to use to successfully complete this challenging program given the competing demands on your time. (approximately 200 words)
5. If applicable, provide a rationale for any of the following discrepancies on your transcripts. Part of this rationale should provide an explanation of what has changed to promote success in this program.

• Grades that are lower than a C
• Courses with a W (withdrawals)
• Semesters in which you were not a full-time student
• Other considerations (extended leaves, previous enrollment in professional programs, misconducts, dismissals)