Read Chapter 4

1-which of the following behaviors may be (1) ethical but illegal, (2) legal but unethical, (3) illegal and unethical, and (4) legal and ethical.

A. Working in a clinic that performs abortions

b. Respecting the wishes of a client suffering from ALS that he be permitted to die with dignity and not placed on “breathing machines”

c. Respecting the health surrogate’s wishes regarding termination of life support of her friend

d. Observing a coworker take out two tablets of oxycodone as ordered for pain management for his patient but keeping one for himself, administering only one tablet to the patient.

2-differentiate among the following: deontological theories, utilitarianism, and principlism.

3-what do you think about health-care professionals disclosing information to clients about a poor prognosis, even though the information may cause severe distress.

4-What do they think about health-care professionals disclosing information to clients against family wishes?

5. You see a colleague use another nurse’s password to access the medication administration system and take out a narcotic. What would you do?

6.Your colleague’s child fell and was brought to the emergency department. She comes back up to the unit and tells you that they cleaned and debrided the wound, and she needs to change the dressings twice a day using a wet to dry method. You see her go into the supply system and remove the dressings and saline using a patient’s identification number. What would you do?

7. You are caring for a patient who has a terminal disease. He asks you if he is dying. Would you tell him? If yes, how? If no, what might you say? .

8-You are administering hydromorphone to a patient. The patient asks you what you are administering. Would you tell the patient about the medication?

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Assignment 4.1: Urinary System Anatomy and Physiology

This assignment supports the following lesson objectives:

• Identify the anatomical structures of the urinary system and their functions
• Describe the composition of urine
• Explain the physiology of the urinary system

Assignment Overview

This presentation assignment explores the anatomy and physiology of the urinary system.

Deliverables

·       A five-slide PowerPoint presentation

Activity Details

Perform the following tasks:

Step 1: Create a PowerPoint presentation

Create a five-slide PowerPoint presentation that covers the following topics:

o   Anatomy of the urinary system

o   Path of urine formation

o   Composition of urine

Conduct research as necessary and include images in your slides (cite your sources). Be concise. Put detailed notes in the notes section of each slide.

PLEASE I NEED A RESPONSE TO THIS ASSIGNMENT

ZERO PLAGIARISM

THREE REFERENCES

Three Questions I might ask the client

1. Have you had any thoughts of suicide or causing harm to yourself or others in the past month? I am asking this question because if the client has major depressive disorder and the client is currently taking Paxil which can increase the risk for suicide in adults (Wiese, 2011).
2. How would you describe your sleeping patterns? The client stated she was abused as a child, therefore I want to establish if she is having nightmares or trouble sleeping related to the memories and flashbacks. This question can also help me establish if the client may have a sleeping disorder as well.
3. Do you have friends or close family members that you spend time with? Or friends that you go out with? Depression can have an impact on the client’s daily lifestyle which means she may not participate in her usual activities. The client may also withdraw from social activities and become uninterested in spending time with people.

Identify People in the client’s life I need to speak to

The client’s family history includes having family members with major depressive disorder (MDD) which means that her family members are the first people to interview to gain better insight about her behavior and patterns. The interviews can focus on past psychiatric history and if they are aware of anything she may have left out from her statements or medical history. I think it may be beneficial to interview the attending physician to see if he has something to add to her initial evaluation notes. The primary care physician can help if she has pre-existing conditions that may contribute to her current psychiatric symptoms. The client also mentioned attending psychotherapy sessions. I would want to interview the therapists to know if the patient is compliant with therapy goals and medication regimen during treatment. The purpose of the interviews it to develop an effective treatment plan for the client.

Diagnostic Tests and Physical Exams

The client has a history of substance abuse and has been attending support groups but it is still important to get a urine drug screen. The thyroid stimulating hormone (TSH) levels should be checked due to the thyroid gland being linked to having an influence on the brain with impacting the mood (Pilhatsch, Marxen, Winter, Smolka, & Bauer, 2011). The client should also receive a mental health examination considering we are trying to rule out different diagnosis and it is our first time with the client. The mental health examination will help establish a baseline like an annual physical.

Differential Diagnosis

1. Post-Traumatic Stress Disorder – According to the American Psychiatric Association (2013) PTSD involves exposure and serious injury which client experienced abuse as a child. The client reported having nightmares and flashbacks. PTSD symptoms also exist with other conditions such as the client’s history of alcohol and substance abuse (National Alliance on Mental Illness, 2017). I feel that the client mostly identifies with this diagnosis.
2. Major Depressive Disorder – The client’s PTSD and agitation are causing her to be depressed. Her depression is secondary and triggered by her nightmares. A persistent feeling of sadness and loss of interest that interferes with the client’s daily functioning.
3. Substance Use Disorder – The client has used alcohol and other substances to cope with her PTSD symptoms. The use of alcohol and other substances is commonly seen with individual’s that experience PTSD symptoms as a coping mechanism. Half of the individuals seeking treatment for SUD have symptoms of PTSD (Berenz, 2012).

Two Pharmacologic Agents

Sertraline – The medication is indicated for use with major depression disorder and posttraumatic stress disorder. The medication should be started at 25mg orally daily and then re-evaluated at the follow up appointment in 4 weeks. One of the side effects is weight gain so the client would need diet and exercise counseling as well.

Wellbutrin – This medication would be good to add as an augmenting agent to be taken in the morning daily. The extended release tablet can be started at 150mg. The client should be able to report a decrease in insomnia symptoms. The preferred combination treatment by some clinicians is to use Wellbutrin and Zoloft together to improve symptoms (Stahl, 2013).

Follow up checkpoints

I believe the client would have benefited from Sertraline and received a more positive outcome at the follow up visits. Sertraline combined with the Wellbutrin would have been more effective with treating the depressive symptoms and PTSD.  The follow up appointments revealed that the client’s appetite was curved and there were no problems with weight gain. The medication was also treating her depressive symptoms. The client should still be monitored for suicidal thoughts because she is always at risk for suicide while having depressive episodes and taking antidepressant medications.

Lesson Learned

Client safety is always the goal when prescribing medications for treatment. The PMHNP should fully understand that monotherapy may not be effective to treat the symptoms and to consider combination therapy for certain clients. The client has more than one disorder showing that polypharmacy may be indicated for more effective results in treatment. The treatment plan should be revisited at every follow up appointment and make the necessary changes as needed dependent on how the client is responding to the current treatment. The PMHNP will take into consideration how the client feels and any decisions she may have about her treatment.

References

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

Berenz, E. (2012). Treatment of co-occurring posttraumatic stress disorder and substance use disorders. Current Psychiatry Reports, 14(5), 469-477. doi: 10.1007/s11920-012-0300-0

National Alliance on Mental Illness. (2017). Posttraumatic Stress Disorder. Retrieved from https://www.nami.org/learn-more/mental-health-conditions/posttraumatic-stress-disorder

Pilhatsch, M., Marxen, M., Winter, C., Smolka, M., & Bauer, M. (2011). Hypothyroidism and mood disorders: Integrating novel insights from brain imaging techiniques. Thyroid Research, 4(S3). Retrieved from https://thyroidresearchjournal.biomedcentral.com/articles/10.1186/1756-6614-4-S1-S3

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

Wiese, B. (2011). Geriatric depression: The use of antidepressants in the elderly. BC Medical Journal, 53(47), 341-347. Retrieved from https://www.bcmj.org/articles/geriatric-depression-use-antidepressants-elderly

May 2012, Alice Randall wrote an article for The New York Times on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012).

   
 

Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the healthcare field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and healthcare professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.

In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds. Your Instructor will assign a case study to you for this Discussion.

Case study:

EB is a 68-year-old black female who comes in for follow-up of hypertension. She has glaucoma and her vision has been worsening during the past few years. She lives alone and is prescribed four hypertension medications (Hydralazine 50 mg PO Q8H, Metoprolol  XL 200 mg PO Q12H, Lisinopril 40 mg PO daily, and HCTZ 25mg PO daily ). She brings in her medication bottles and she has some medication bottles from the previous year full of medications. She is missing one medication she had been prescribed and says she  may have forgotten it at home. Her BP in clinic today is 182/99 with HR of 84.

an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

Rubric:

Answers all parts of the Discussion question(s) with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.   Supported by at least three current, credible sources.  Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

References:

At least 3 references:

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

• Chapter 1, “The History and Interviewing Process”  (Previously read in Week 1)

This chapter highlights history and interviewing processes. The authors explore a variety of communication techniques, professionalism, and functional assessment concepts when developing relationships with patients.

• Chapter 2, “Cultural Competency”

This chapter highlights the importance of cultural awareness when conducting health assessments. The authors explore the impact of culture on health beliefs and practices.

• CO4 Investigate safeguards and decision-making support tools embedded in patient care technologies and information systems to support a safe practice environment for both patients and healthcare workers. (PO 4)
• CO5 Identify patient care technologies, information systems, and communication devices that support safe nursing practice. (PO 5)

Case Study: A 65-year-old woman was just been diagnosed with Stage 3 non-Hodgkin’s lymphoma. She was informed of this diagnosis in her primary care physician’s office. She leaves her physician’s office and goes home to review all of her tests and lab results with her family. She goes home and logs into her PHR. She is only able to pull up a portion of her test results. She calls her physician’s office with concern. The office staff discussed that she had gone to receive part of her lab work at a lab not connected to the organization, part was completed at the emergency room, and part was completed in the lab that is part of the doctor’s office organization.

The above scenario might be a scenario that you have commonly worked with in clinical practice. For many reasons, patients often receive healthcare from multiple organizations that might have different systems.

As you review this scenario, reflect and answer these questions for this discussion.

• What are the pros and cons of the situation in the case study?
• What safeguards are included in patient portals and PHRs to help patients and healthcare professionals ensure safety?
• Do you agree or disagree with this process?
• What are challenges for patients that do not have access to all of the EHRs? Remember, only portions of the EHRs are typically included in the PHRs.