Your written assignment for this module should be a 2-3 page paper (not including title page and reference page).

A 78-year old woman is admitted to a Medical unit directly from her physician’s office for evaluation and management of congestive heart failure. She has a history of systemic hypertension.

The initial assessment completed by the RN of the assigned patient reveals a pulse rate that is rapid and very irregular. The patient is restless, her skin is pale and cool, she states she is dizzy when she stands up and she is slightly short of breath and anxious. Her BP is 106/88. Her ECG monitor pattern shows uncontrolled atrial fibrillation with a heart rate ranging from 150 -170 beats/min. Her respirations are 20/min and her O2 saturation is 90%.

1. Given the findings, what should be the first action of the practical nurse?
2. What additional data would the practical nurse collect?
3. Discuss the potential complications of cardioversion and patient preparation for an elective cardioversion. Because the length of time the patient has been in atrial fibrillation is unknown, what adverse reaction may occur?

Later that evening the patient calls the nurse because she feels “like something terrible is going to happen.” She reports chest pain, has increased shortness of breath, and has coughed up blood-tinged sputum.

1. Based on these symptoms, what might you suspect is happening?
2. What is the first thing the practical nurse should do and what further information would you expect to be collected?

You should include a minimum of 3 references. Include a title page, in-text citations, and a reference page in APA format.

ASSIGNMENT: Secondary Data Sources

CAHIIM Competency: Subdomain I.E. Secondary Data Sources

• Validate data from secondary sources to include in the patient’s record, including personal health records

Preparation: Read the Processing and Maintenance of Secondary Databases section of Chapter 6 in the Oachs and Watters text. (Page 191-193 in the 5th edition)

While the reading focusses on data from patient health records being abstracted or moving electronically into secondary data source systems, more and more we are having to consider data from secondary data sources being used to add to the primary health record. Examples:

1. A patient brings in their personal health record that contains health information from 2 other primary care providers at local clinics. They want this information added to their health record at your hospital.
2. Inbound HIE data from an earlier encounter from an unrelated provider is electronically received for a patient’s health records
3. Inbound data from the patient portal is received many times a day as patients update their demographic or insurance information on the patient portal
4. Data is received from smart devices such as ambulatory heart monitors or insulin monitors and is downloaded into patient records

It would be inefficient for all of this inpatient data to be manually checked for validity. Please describe in 2-3 paragraphs (400-500 words, 1-2 pages, APA format with a title page, body, and references) how a healthcare organization could assure that this incoming data is valid and accurate. Be sure to specifically address how systems would be set up, as well as standards and policies that would need to be set.  Please use reputable references, and ensure you have 3 or more from professional organizations, .gov sources, or peer-reviewed journal articles.

Being able to articulate your personal worldview can help you formulate a personal philosophy of practice and enhance your influence on patients and the industry. In this assignment, you will have an opportunity to reflect on your current and future practice, and the ways worldview and nursing theory influence that practice.   

Draft a 1,000-1,250 word paper in which you:

1. Describe your personal worldview, including the religious, spiritual, and cultural elements that you think most influence your personal philosophy of practice and attitude towards patient care.
2. Choose a specific nursing theory that is most in line with your personal philosophy of practice and approach to patient care and discuss the similarities. Explain how the nursing theory reinforces your approach to care.
3. Include in your explanation a specific example of a past or current practice and how your worldview and the nursing theory could assist you in resolving this issue.
4. Finally, explain how your worldview and the nursing theory will assist you in further developing your future practice.

Address Questions 1 through 4

You are required to cite five to 10 sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Instructor’s Comment 

I think you might have misunderstood the assignment. None of the theories from class were used to analyze the case study. As it is, I cannot award many points. Can you please redo this with the 5 theories from the lecture included? 

I have uploaded assignment named Reflection.

Based on “Case Study: Fetal Abnormality” and other required topic study materials, write a 750-1,000-word reflection that answers the following questions:

1. What is the Christian view of the nature of human persons, and which theory of moral status is it compatible with? How is this related to the intrinsic human value and dignity?
2. Which theory or theories are being used by Jessica, Marco, Maria, and Dr. Wilson to determine the moral status of the fetus? What from the case study specifically leads you to believe that they hold the theory you selected?
3. How does the theory determine or influence each of their recommendations for action?
4. What theory do you agree with? Why? How would that theory determine or influence the recommendation for action?

Remember to support your responses with the topic study materials.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. 

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Rubric

Explanation of the Christian view of the nature of human persons and the theory of moral status that it is compatible is clear, thorough, and explained with a deep understanding of the connection between them. Explanation is supported by topic study materials. 30%

The theory or theories that are used by each person to determine the moral status of the fetus is explained clearly and draws insightful relevant conclusions. Rationale for choices made is clearly supported by topic study materials and case study examples. 15%

Explanation of how the theory determines or influences each of their recommendations for action is clear, insightful, and demonstrates a deep understanding of the theory and its impact on recommendation for action. Explanation is supported by topic study materials. 15%

Evaluation of which theory is preferable within personal practice along with how that theory would influence personal recommendations for action is clear, relevant, and insightful. 10%

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

Writer is clearly in command of standard, written, academic English.

All format elements are correct.

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

Here is a link to the Khan video on Moral Status. It will help explain the five theories discussed in the lecture: 

https://www.khanacademy.org/partner-content/wi-phi/wiphi-value-theory/wiphi-ethics/v/moral-status 

THE JOB IS TO REPLY WITH A COMMENT TO EACH POST, POST 1 AND POST 2. WITH 2 COMPLETED (EDUCATIONAL  REFERENCE) includidig retrival or doi, IN APA WITH CITATION ABOVE 2013 PER COMMENT.

  POST 1

Comprehensive Integrated Psychiatric Assessment

Following recent research, the level of mental health problems among children and adolescents has risen dramatically (American Psychiatric Association, 2013). The present-day life and current associations within the society contribute greatly to these adversities. Culture, environmental exposure, social and economic status are frequent predisposing factors to mental and behavioral disorders. For example, domestic violence, sexual assault and the rising prevalence of divorces are the most common causes of mental health problems among the youth (American Psychiatric Association, 2013. Nonetheless, assessing and treating children and adolescents is very challenging. Psychiatric mental health nursing practitioners (PMHNPs) ought to be patient and diligent when practicing mental assessments to this type of clients.

Based on the YMH Boston Vignette 4 Video

What did the practitioner do well?

At the beginning of the session, the nursing practitioner expresses his respect for the nursing code of ethics, conduct and autonomy. This is a good approach since it assures the client of his protection and the nondisclosure of his/her health information. Additionally, the nursing practitioner was keen to establish a sense of rapport between himself and his client. This was necessary to necessitate voluntary and ease of information sharing.

In what areas can the practitioner improve?

The nursing practitioner fails to warm-up the client at the start of the interview. It is advisable to start with a casual conversation before jumping into the main point (Kaplan, 2016). Failure to this (as evident in the Boston Vignette 4 Video) the patient keeps his guard up and even suggest that his mother should answer some of the PMHNP’s question. Also, it is imperative to

apply cognitive testing to help determine the client’s mental status at the time of visit (Kaplan, 2016). Contrary to this aspect, the PMHNP appears more interested in the patient’s history than his current status. Ideally, the PMHNP should improve on the areas noted above.

At this point in the clinical interview, do you have any compelling concerns? If so, what are they?

 The nursing practitioner in the YMH Boston Vignette 4 Video seats causally and speaks rather sparingly. In comparison to the PMHNP in the YMH Boston vignette 1 video the practitioner seats and speaks directly to the client to capture his attention and cognitive status. This makes his client attentive unlike the patient in video 4. As a matter of facts, the practitioner shares a little enthusiasm in the client’s interests (basketball) to help improve the mood of the interview and consequently, derive more information (Merrell, 2013).

What would be your next question and why?

Question: Do you often lose temper on people other than your mum?

This question is necessary to help determine the specific triggers of the client’s anger. If the answer is ‘NO’, then it’s true that the mum triggers his anger through excessive pressure and nagging. However, if the answer is ‘YES’, then the frequent loss of temper would qualify as one of the symptom for mental health conditions such as intermittent explosive disorder (Kulper, Kleiman, McCloskey, Berman & Coccaro 2015).

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Kaplan, B. J. (2016). Kaplan and Sadock’s Synopsis of Psychiatry. Behavioral Sciences/Clinical Psychiatry. Tijdschrift voor Psychiatrie, 58(1), 78-79.

Kulper, D. A., Kleiman, E. M., McCloskey, M. S., Berman, M. E., & Coccaro, E. F. (2015). The experience of aggressive outbursts in intermittent explosive disorder. Psychiatry research, 225(3), 710-715.

Merrell, K. (2013). Behavioral, social, and emotional assessment of children and adolescents. Routledge.

POST 2

Comprehensive Integrated Psychiatric Assessment of an adolescent

What did the practitioner do well?

In the YMH Boston Vignette 4 YouTube Video, the therapist was professional by telling the teenager at the beginning of the session of the right of confidentiality and privacy unless he has suicidal or homicidal thoughts. This information built a good rapport and trust with the client which then enabled him to share his feelings. The adolescent may be worried about confidentiality, and clinicians can reassure them that approval will be requested from them before any detailed information is shared with parents, except situations involving danger to self or others (Price, 2017). The practitioner built a good rapport with the client by making good eye contact, trying to focus more on the client and not the parents, as well as asking him about his hobbies. Rapport is built by enabling patients to feel easiness during stressful situations. The practitioner also does a good job as he allows the client to explore his feelings. “When adolescents become able to cope with the controversial and problematic situations, anger affects self-perception because it is displayed in a situation where individuals are restrained or challenged” (Lok & Bademli, 2018). Moreover, the practitioner asked about his school and by asking him about what he liked doing after school.

In what areas can the practitioner improve?

The therapist needs improvement is communication because he did not introduce himself to the patient at the beginning of the video. In addition, the therapist was not firm with his statements as he agreed mostly with the client putting faults oh his mother. The client just wants someone to listen to him which explains why he praised his girlfriend because she listens to him. The practitioner failed to find out why the client thinks his mom is irritating. Moreover, the practitioner needs to improve on listening skills as a lot of time was spent taking notes during the interview which can be distracting for both the therapist and the patients. The practitioner could have politely asked the patient if it is okay for him to take notes during the session and explain the reason for that.

At this point in the clinical interview, do you have any compelling concerns? If so, what are they?

A very important compelling concern is to inquire if the client feels safe at home with his mother. In addition, medications being taken by the client and psychiatric history and, lastly coping skills.

What would be your next question, and why?

I would ask the client about the possibility of having a family session which could be beneficial by making the people involved understand themselves more. It is important for the therapist to remain neutral and validate each family member`s feeling with the goal to improve communication among them and enable the therapist to develop an appropriate care plan for the client (Renee, & Ballas, 2018). Lastly, the next question would have been the practitioner to find out if the client is using drugs or having any suicidal or homicidal thoughts.

References

Lok, N., Bademli, K. (2018). The effects of anger management education on adolescents’ manner of displaying anger and self-esteem: A randomized controlled trial. Archives of Psychiatric Nursing. 32(1), p. 75-81.

Price, B. (2017). Developing patient rapport, trust, and therapeutic relationships. Nursing Standard. 31(50), p. 52-65.

Renee, W., & Ballas, P. (2018). Comprehensive Psychiatric Evaluation for Children. N.p.: University of Rochester Medical Center. Retrieved from https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02564