The Assignment

Examine Case Study: A Young Caucasian Girl with ADHD 

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 there will be three decisions. I will choose one out of the three and give the outcome. At each decision point these are the thoughts to ponder:

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.***

Finally: 1. Complete the decision tree (keep track of what you selected. come up with a rational reason why you chose it. Come up with patient specific rational reason behind not choosing the other two options not chosen).

2. Write paper addressing all section listed based on the decision tree.

Case Study: A Caucasian Man with Hip Pain

BACKGROUND

Katie is an 8 year old Caucasian female who is brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katie’s teacher suggested that she may have ADHD. Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine whether or not she has this condition.

The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised”. This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their family primary care provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. The teacher opined that she lacks interest in school work and is easily distracted. Katie is also noted to start things but never finish them, and seldom follows through on instructions and fails to finish her school work.

Katie’s parents actively deny that Katie has ADHD. “She would be running around like a wild person if she had ADHD” reports her mother. “She is never defiant or has temper outburst” adds her father.

SUBJECTIVE

Katie reports that she doesn’t know what the “big deal” is. She states that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds her other subjects boring, and sometimes hard because she feels “lost”. She admits that her mind does wander during class to things that she thinks of as more fun. “Sometimes” Katie reports “I will just be thinking about nothing and the teacher will call my name and I don’t know what they were talking about.”

Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. Offers no other concerns at this time.

MENTAL STATUS EXAM

The client is an 8 year old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately 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. Self-reported mood is euthymic. Affect is bright. Katie denies visual or auditory hallucinations, no delusional or paranoid thought processes readily appreciated. Attention and concentration are grossly intact based on Katie’s attending to the clinical interview and her ability to count backwards from 100 by serial 2’s and 5’s. Insight and judgment appear age appropriate. Katie denies any suicidal or homicidal ideation.

Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation

Decisions Made and Outcomes (Needed to formulate the paper) (Must use and formulate paper based off of the chosen decision. Then tell why the other two decision were not a good choice with in-text citations noted for each.) 

Choices for Decision 1: Select what the PMHNP should do: 

1.  Begin Wellbutrin (bupropion) XL 150 mg orally daily
2.  Begin Intuniv extended release 1 mg orally at BEDTIME
3.  Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING

Decision Choice Chosen: Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING

***Explain why other two choice were rejected (not adequate choices)***

Outcome: RESULTS OF DECISION POINT ONE: 

• Client returns to clinic in four weeks
• Katie’s parents report that they spoke with Katie’s teacher who notices that her symptoms are much better in the morning, which has resulted in improvement in her overall academic performance. However, by the afternoon, Katie is “staring off into space” and “daydreaming” again
• Katie’s parents are very concerned, however, because Katie reported that her “heart felt funny.” You obtain a pulse rate and find that Katie’s heart is beating about 130 beats per minute

Choices for Decision 2: Select what the PMHNP should do: 

1.   Continue same dose of Ritalin and re-evaluate in 4 weeks
2.  Change to Ritalin LA 20 mg orally daily in the MORNING
3.  Discontinue Ritalin and begin Adderall XR 15 mg orally daily

Decision Choice Chosen: Change to Ritalin LA 20 mg orally daily in the MORNING

***Explain why other two choice were rejected (not adequate choices)***

Outcome: RESULTS OF DECISION POINT TWO: 

• Client returns to clinic in four weeks
• Katie’s academic performance is still improved, and the switch to the LA preparation is lasting Katie throughout the school day
• Katie’s reports of her heart feeling “funny” have gone away. Pulse was 92 during today’s office visit

Choices for Decision 3: Decision Point Three Select what the PMHNP should do next: 

1.   Maintain current dose of Ritalin LA and reevaluate in 4 weeks
2. Increase Ritalin LA to 30 mg orally daily
3. Obtain EKG based on current heart rate

Decision Choice Chosen:  Maintain current dose of Ritalin LA and reevaluate in 4 weeks

***Explain why other two choice were rejected (not adequate choices)***

Outcome: Guidance to Student

RESULT FROM CHOOSING TO MAINTAIN CURRENT DOES OF RITALIN LA AND REEVALUATE IN 4 WEEKS

Guidance to Student

At this point, Katie’s symptoms are well controlled (her attention is sustained throughout the school day) and her side effects have gone away following change to a long-acting preparation. There is no indication at this point that the dose should be increased as it is always advisable to use the lowest effective dose of stimulant medication. Katie’s heart rate is appropriate for an 8 year old girl and an EKG would not be indicated based on her heart rate.

***Write on each decision. Make sure that in each decision choice that you explain why the other two decisions were not good choices. Use cited sources to validate points. Make sure that this paper has at least 7 References. Please use in-text citations for each section of each decision. Don’t forget the ethical considerations for this assignment. Make it a section by itself.***

***Also please make sure when looking at the ethical consideration for this assignment that you look at how the Caucasian (male) ethnicity and pain medications interact.***

Please use the following format when formulating the paragraphs for each section. Don’t forget the intext citations. Remember to use at least 7 references.

Introduction

Decision #1 

Reasons for Choosing the Decision (Why is it the best choice out of the 3 choices) 

Anticipated Results (of Chosen Decision)

Difference in Results (Anticipated VS Actual)

Decision #2 

Reasons for Choosing the Decision (Why is it the best choice out of the 3 choices) 

Anticipated Results (of Chosen Decision)

Difference in Results (Anticipated VS Actual)

Decision #3 

Reasons for Choosing the Decision (Why is it the best choice out of the 3 choices) 

Anticipated Results (of Chosen Decision)

Difference in Results (Anticipated VS Actual)

Ethical Considerations 

Conclusion

References

 

Demonstration of Proficiency

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

• Competency 1: Analyze the elements of a successful quality improvement initiative.     
  • Explain evidence-based and best-practice solutions to improve patient safety related to a specific patient safety risk and reduce costs.
• Competency 2: Analyze factors that lead to patient safety risks.     
  • Explain factors leading to a specific patient safety risk.
• Competency 4: Explain the nurse’s role in coordinating care to enhance quality and reduce costs.     
  • Explain how nurses can help coordinate care to increase patient safety and reduce costs.
  • Identify stakeholders with whom nurses would need to coordinate to drive quality and safety enhancements.
• Competency 5: Apply professional, scholarly, evidence-based strategies to communicate in a manner that supports safe and effective patient care.     
  • Communicate using writing that is clear, logical, and professional with correct grammar and spelling using current APA style.

References

Allen, M. (2013). How many die from medical mistakes in U.S. hospitals? Retrieved from https://www.npr.org/sections/health-shots/2013/09/20/224507654/how-many-die-from-medical-mistakes-in-u-s-hospitals.

Kohn, L. T., Corrigan, J., & Donaldson, M. S. (Eds.). (2000). To err is human: Building a safer health system. Washington, DC: National Academy Press.

Professional Context

As a baccalaureate-prepared nurse, you will be responsible for implementing quality improvement (QI) and patient safety measures in health care settings. Effective quality improvement measures result in systemic and organizational changes, ultimately leading to the development of a patient safety culture.

Scenario

Consider the hospital-acquired conditions that are not reimbursed under Medicare/Medicaid, some of which are specific safety issues such as infections, falls, medication errors, and other concerns that could have been prevented or alleviated with the use of evidence-based guidelines.

Choose a specific condition of interest and incorporate evidence-based strategies to support communication and ensure safe and effective care.

For this assessment, consider using one of the following approaches:

1. Expand on the scenario presented in Vila Health: Identifying Patient Safety Concerns and analyze a quality improvement (QI) initiative.
2. Analyze a current issue in clinical practice and identify a quality improvement (QI) initiative in the health care setting.

Instructions

The purpose of this assessment is to better understand the role of the baccalaureate-prepared nurse in enhancing quality improvement (QI) measures that address safety risk. This will be within the specific context of patient safety risks at a health care setting of your choice. You will do this by exploring the professional guidelines and best practices for improving and maintaining patient safety in health care settings from organizations such as QSEN and the IOM. Looking through the lens of these professional best practices to examine the current policies and procedures currently in place at your chosen organization and the impact on safety measures for patients, you will consider the role of the nurse in driving quality and safety improvements. You will identify stakeholders in QI improvement and safety measures as well as consider evidence-based strategies to enhance quality of care and promote safety in the context of your chosen health care setting.

Be sure that your plan addresses the following, which corresponds to the grading criteria in the scoring guide. Please study the scoring guide carefully so that you know what is needed for a distinguished score.

• Explain factors leading to a specific patient-safety risk.
• Explain evidence-based and best-practice solutions to improve patient safety related to a specific patient-safety risk and reduce costs.
• Explain how nurses can help coordinate care to increase patient safety and reduce costs. 
• Identify stakeholders with whom nurses would coordinate to drive safety enhancements. 
• Communicate using writing that is clear, logical, and professional, with correct grammar and spelling, using current APA style.

Additional Requirements

• Length of submission: 3–5 pages, plus title and reference pages.
• Number of references: Cite a minimum of 4 sources of scholarly or professional evidence that support your findings and considerations. Resources should be no more than 5 years old.
• APA formatting: References and citations are formatted according to current APA style 

Demonstration of Proficiency

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

• Competency 1: Analyze the elements of a successful quality improvement initiative.     
  • Explain evidence-based and best-practice solutions to improve patient safety related to a specific patient safety risk and reduce costs.
• Competency 2: Analyze factors that lead to patient safety risks.     
  • Explain factors leading to a specific patient safety risk.
• Competency 4: Explain the nurse’s role in coordinating care to enhance quality and reduce costs.     
  • Explain how nurses can help coordinate care to increase patient safety and reduce costs.
  • Identify stakeholders with whom nurses would need to coordinate to drive quality and safety enhancements.
• Competency 5: Apply professional, scholarly, evidence-based strategies to communicate in a manner that supports safe and effective patient care.     
  • Communicate using writing that is clear, logical, and professional with correct grammar and spelling using current APA style.

References

Allen, M. (2013). How many die from medical mistakes in U.S. hospitals? Retrieved from https://www.npr.org/sections/health-shots/2013/09/20/224507654/how-many-die-from-medical-mistakes-in-u-s-hospitals.

Kohn, L. T., Corrigan, J., & Donaldson, M. S. (Eds.). (2000). To err is human: Building a safer health system. Washington, DC: National Academy Press.

Professional Context

As a baccalaureate-prepared nurse, you will be responsible for implementing quality improvement (QI) and patient safety measures in health care settings. Effective quality improvement measures result in systemic and organizational changes, ultimately leading to the development of a patient safety culture.

Scenario

Consider the hospital-acquired conditions that are not reimbursed under Medicare/Medicaid, some of which are specific safety issues such as infections, falls, medication errors, and other concerns that could have been prevented or alleviated with the use of evidence-based guidelines.

Choose a specific condition of interest and incorporate evidence-based strategies to support communication and ensure safe and effective care.

For this assessment, consider using one of the following approaches:

1. Expand on the scenario presented in Vila Health: Identifying Patient Safety Concerns and analyze a quality improvement (QI) initiative.
2. Analyze a current issue in clinical practice and identify a quality improvement (QI) initiative in the health care setting.

Instructions

The purpose of this assessment is to better understand the role of the baccalaureate-prepared nurse in enhancing quality improvement (QI) measures that address safety risk. This will be within the specific context of patient safety risks at a health care setting of your choice. You will do this by exploring the professional guidelines and best practices for improving and maintaining patient safety in health care settings from organizations such as QSEN and the IOM. Looking through the lens of these professional best practices to examine the current policies and procedures currently in place at your chosen organization and the impact on safety measures for patients, you will consider the role of the nurse in driving quality and safety improvements. You will identify stakeholders in QI improvement and safety measures as well as consider evidence-based strategies to enhance quality of care and promote safety in the context of your chosen health care setting.

Be sure that your plan addresses the following, which corresponds to the grading criteria in the scoring guide. Please study the scoring guide carefully so that you know what is needed for a distinguished score.

• Explain factors leading to a specific patient-safety risk.
• Explain evidence-based and best-practice solutions to improve patient safety related to a specific patient-safety risk and reduce costs.
• Explain how nurses can help coordinate care to increase patient safety and reduce costs. 
• Identify stakeholders with whom nurses would coordinate to drive safety enhancements. 
• Communicate using writing that is clear, logical, and professional, with correct grammar and spelling, using current APA style.

Additional Requirements

• Length of submission: 3–5 pages, plus title and reference pages.
• Number of references: Cite a minimum of 4 sources of scholarly or professional evidence that support your findings and considerations. Resources should be no more than 5 years old.
• APA formatting: References and citations are formatted according to current APA style

I have a home assessment assignment. This is supposed to be submitted on turn-it-in with absolutely no plagiarism. I would like to receive this no later than Friday, February 28, 2020, to review.  Please follow the rubric exactly. Kindly pay attention to the marks for each section to give you an idea of the work entailed. Serious People only. Also, I will need this in APA 6th ed. format with reference.

APA format. I has to be 3-4 pages (  The title and reference page does not count). This is very important , please read the require information that is needed in the paper.  I have add all the references . Please ask questions if needed. 

Information that is required in the paper.

Submit a 3- to 4-page paper that includes the following:

• A summary of the article, including the title and author    
  • Identify the title of the article with in-text citation and corresponding reference in reference list
• The relationship among causal agents, susceptible persons, and environmental factors (epidemiological triangle)
• The role of the nurse in addressing the outbreak
• Possible health promotion/health protection strategies that could have been implemented by nurses to mitigate the outbreak  

Assignment: Epidemiology in Public and Global HealBy Day 7 -page paper that includes the followingA summary of the artic

References:

Holtz, C. (2017). Global health care: Issues and policies (3rd ed.). Burlington, MA: Jones & Bartlett.
Chapter 9, “Infectious Diseases from a Global Perspective” (pp. 229-254)
Chapter 13, “Global Perspectives on Violence, Injury, and Occupational Health” (pp. 347-378)
Chapter 7, “Global Perspectives on Mental Health” (pp. 173-196)
 

Stanhope, M., & Lancaster, J. (2016). Public health nursing: Population-centered health care in the community (9th ed.). St. Louis, MO: Elsevier.
Chapter 13, “Infectious Disease Prevention and Control” (pp. 286–318)

Public Health Nursing: Population-Centered Health Care in the Community, 9th Ed. by Stanhope, M., & Lancaster, J. Copyright 2015 by Elsevier Health Science Books. Reprinted by permission of Elsevier Health Science Books via the Copyright Clearance Center.
 

Stanhope, M., & Lancaster, J. (2016). Public health nursing: Population-centered health care in the community (9th ed.). St. Louis, MO: Elsevier.
Chapter 12, “Epidemiology” (pp. 256–285)

Stanhope, M., & Lancaster, J. (2016). Public health nursing: Population-centered health care in the community (9th ed.). St. Louis, MO: Elsevier.
Chapter 24, “Public Health Surveillance and Outbreak Investigation” (pp. 529–544)

Public Health Nursing: Population-Centered Health Care in the Community, 9th Ed. by Stanhope, M., & Lancaster, J. Copyright 2015 by Elsevier Health Science Books. Reprinted by permission of Elsevier Health Science Books via the Copyright Clearance Center.
 

HealthyPeople.gov. (2016). Global health. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/global-health

 

Please discuss for this weeks assignment what your steps would be to address this scenario:

a 78-year-old man on the medical floor continues to take his gown off after you have replaced it at least 7 times. the last time he took his gown off, he ripped out his iv and you had to start a new one.

* What is your solution to this problem?

* using the nursing process, describe how you came to this decision.

* what questions you would need to be answered to make a better decision?

For this assignment, you need to use your textbook as your reference. 

All citations should come from the textbook. It can only be your Fundamentals textbook 9th edition ONLY!(fundamental of nursing 9th edition by Patricia A. Potter)

Below is the rubric I will be using to grade. Please use this as a guide when writing your post.

Category

Point Values

Content; Fully met  8-10 points The post is original and contributes a factual answer, a new idea and an example that adds value to the discussion as well as responding to 2 classmates. 

The entry provides answers to the question but does not provide a new idea.

Entry significantly misses a key question and does not answer the important question.

Fluency; Good grammar, sentence structure, and spelling.

APA/Word Count; Properly cited references and correct in text citations using the minimum amount of resources and 350 words or better.

Participation/Reply; Student answered instructor question and answer shows thoughtful responses linked to the experiences in the field AND connection to course material.