Respond to at least two of your   colleagues who were assigned to a different case than you. Explain how   you might apply knowledge gained from your colleagues’ case studies to   you own practice in clinical settings.  

NOTE: Positive comment

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 Case  Study: Volume 2, Case #21 focuses on the treatment of an adult client  diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).  

Questions 

Question 1: Are you having problems with your loved one’s due being “argumentative and temperamental”?  

Rationale:  The client may have additional stress due to broken relationships and  this could be due to his disorder.  “Emotional dysregulation is  increasingly recognized as a core feature of ADHD” (Stralen, 2016).  Signs of ADHD include low frustration tolerance and explosive behavior  (Stralen, 2016).  

Question 2: 

What causes you the most anxiety?

It  is important to determine the triggers of the anxiety to help the  patient prepare for times when he is likely to be in high stress  situations. Planning a response when feeling overwhelmed can help the  patient remain in control of his emotions and allow the patient to  monitor his behavior. 

Question 3: 

You  stated that your father was abusive, was this physical or verbal abuse  or both? Do you contribute some of your anxiety from previous issues  with your father? 

It  is important for the provider to understand the client’s point of view  in regards to his upbringing. He realizes it has affected in him in some  way, as he has obtained psychotherapy in the past. I would want to know  if he has ever spoken to his father about this and if his father has  ever apologized for his actions. 

Questions for family

I  would want to talk with his mother to ask her how he did as a child in  school and at home in regards to schoolwork, chores and would want to  know if he had friends. Although  social problems are not part of the diagnostic criteria for ADHD, the  peer relationship difficulties faced by youth with this disorder are  profound (Hoza, 2007)

Diagnostics & Exams

A  full psychiatric evaluation which would include the Adult Self-Report  Scale (ASRS). ASRS was been developed by the World Health Organization  to determine if an individual (adult) may have ADHD. The scale is made  up of 6 questions, and if a client has at least 4 of 6 symptoms, there  may need to be a diagnosis of ADHD made by a professional (ADDA, 2018). Seay  et al. (2009) suggests the PMHNP should utilize intelligence test,  broad-spectrum scales, tests of specific abilities, and brain scans to  confirm the diagnosis and to rule out other disabilities, autism,  auditory processing disorders or mood disorders. In addition, a full medical work-up by a PCP in order to rule out other medical conditions that could present similarly to ADHD. 

Differential DX

General Anxiety Disorder: The  patient exhibits symptoms of generalized anxiety disorder, DSM-5 300.02  (F14.1). He has had the symptoms for greater than six months with the  symptoms being severe enough to interfere with the patient’s daily  functioning. The patient complains of feels of worry that is difficult  to control, irritability, restlessness, difficulty concentrating and  feeling on edge. The patient symptoms have not been linked to a physical  condition or to substance use (Reynolds & Kamphaus,2013).

ADHD:  client consistently complains of feeling tense, irritable, and anxious  (Stahl Online, 2019).  Questions arise once the general anxiety symptoms  are resolved and the client is left feeling hyperactive, inattentive,  and the inability to focus (Stahl Online).

Post-Traumatic  Stress Disorder: The client’s diagnosis of anxiety may have been  related to underlying issues related to a traumatic event that he  experienced as a child. The client’s father was verbally abusive to him  and was an alcoholic. It is a possibility that the client’s issues could  have some relations to previous exposure as a child. Post-Traumatic  Stress Disorder is a serious condition that can occur in clients who  have experienced various incidents including abuse (PTSD, 2018).

Medications

The  case states by year six the client has failed to achieve remission on  an SSRI, a 5-HT1A receptor partial agonist, an antihistamine anxiolytic  and an SGRI (Stahl Online, 2019).

Based on the pharmacological agents, I would select either  Cymbalta 60mg or Effexor XR 150mg.  Cymbalta did illicit a response,  but side effects prevented the escalation of the dosage.  Augmenting  with guanfacine an alpha-adrenergic agonist proved to be the therapy  that elicited remission for this client.

Lessons Learned

I  learned to always consider additional differential diagnosis and  evaluate and re-evaluate every situation separately to be sure of the  correct diagnosis.  Patient’s  often have comorbid diagnosis and treating both is vital to a  successful outcome for the patient. Symptoms of mental illness change  overtime making continued care necessary for the patient. The provider  must always be approachable and helpful for the client to feel  comfortable in his/her presence. 

 

                                                References

Attention Deficit Disorder Association. (2018). Adult ADHD Test. Retrieved from https://add.org/adhd-test/

Generalized Anxiety Disorder. (2018). Anxiety and Depression Association of America. Retrieved from https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad

Posttraumatic Stress Disorder. (2018). Anxiety and Depression Association of America. Retrieved from https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd

Seay, B., McCarthy, L. F., and Williams, P. (2009). Your complete ADHD/ADD diagnosis guide.

            Retrieved from https://www.additudemag.com/adhd-testing-diagnosis-guide/

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical

            Applications (4th ed.). New York, NY: Cambridge University Press.

Stralen, J. W. (2016). Emotional dysregulation in children with attention-deficit/hyperactive disorder.

            Attention Deficit Hyperactivity Disorder. 8(4). p. 175-187. Retrieved from

            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5110580/

Hoza  B, Mrug S, Gerdes AC, Bukowski WM, Kraemer HC, Wigal T, et al. What  aspects of peer relationships are impaired in children with  attention-deficit/hyperactivity disorder? Journal of Consulting and Clinical Psychology. 2005b;73:411–423. 

Reynolds, C. & Kampaus, R. (2013). Generalized Anxiety Disorder. Pearson. Retrieved from:

www.images.pearsonclinical.com/images/assets/basc-3/basc3resources/DMS-5_

            Diagnostic-Criteria_GeneralizedAnxietyDisorder.pdf.

 

    Discuss ways to prevent health-related injuries and disorders caused from technology use.

• Read and answer the discussion questions, using complete sentences, correct spelling, correct punctuation and correct grammar.
• Your answer should be a minimum of 250 words with a minimum of one cited reference to support the discussion.

 Books Required Discovering Computers & Microsoft Office 2013: A Fundamental Combined Approach, 1st Enhanced Edition Author: Misty E. Vermaat 

Purpose 

The purpose of this assignment is to provide the student with an opportunity to explore the nurse practitioner (NP) practice requirements in his/her state of practice, NP competencies and leadership skills to develop a plan to support professional development. 

Activity Learning Outcomes 

Through this assignment, the student will demonstrate the ability to: 

1. Examine roles and competencies of advanced practice nurses essential to performing as leaders and advocates of holistic, safe, and quality care. (CO1)  
2. Analyze essential skills needed to lead within the context of complex systems. (CO3) 
3. Explore the process of scholarship engagement to improve health and healthcare outcomes in various settings. (CO4) 

 Requirements: 

1. The APN Professional Development Plan paper is worth 200 points and will be graded on the quality of the content, use of citations, use of Standard English grammar, sentence structure, and overall organization based on the required components as summarized in the directions and grading criteria/rubric. 
2. Submit the paper as a Microsoft Word Document, which is the required format at Chamberlain University. You are encouraged to use the APA Academic Writer and Grammarly tools when creating your assignment. 
3. Follow the directions below and the grading criteria located in the rubric closely. Any questions about this paper may be posted under the Q & A Forum or emailed to your faculty. 
4. The length of the paper should be 5-8 pages, excluding title page and reference page(s). 
5. Support ideas with a minimum of 3 scholarly resources. Scholarly resources do not include your textbook. You may need to use more than 3 scholarly resources to fully support your ideas. 
6. You may use first person voice when discussing information specific to your personal practice or skills.  
7. Current edition APA format is required with both a title page and reference page(s). Use the following as Level 1 headings to denote the sections of your paper (Level 1 headings use upper- and lower-case letters and are bold and centered): 
   • APN Professional Development Plan (This is the paper introduction. In APA format, a restatement of the paper title, centered and not bold serves as the heading of the introduction section) 
   • APN Scope of Practice 
   • Nurse Practitioner (NONPF) Core Competencies  
   • Leadership Skills 
   • Conclusion 

Directions: 

1. Introduction: Provide an overview of what will be covered in the paper. Introduction should include general statements on scope of practice, competencies, and leadership, and identification of the purpose of the paper. 
2. APN Scope of Practice: Research the Nurse Practice Act and APN scope of practice guidelines for the state in which you intend to practice after graduation. Describe the educational, licensure, and regulatory requirements for that state in your own words. Identify whether your state allows full, limited, or restricted NP practice. Discuss NP prescriptive authority in your state. Provide support from at least one scholarly source. Source may be the regulatory body that governs nursing practice in your state. 
3. Nurse Practitioner (NONPF) Core Competencies: Review the NONPF Core Competencies. Describe two competency areas you believe to be personal strengths and two competency areas in which you have opportunities for growth. Discuss two scholarly activities you could do during the master’s program to help yourself achieve NP competencies. Provide support from at least one scholarly source. Source may be NONPF Core Competencies document provided via the link in the week 2 readings. 
4. Leadership Skills: Analyze three leadership skills required to lead as an NP within complex systems. Describe two strategies you could use to help you develop NP leadership skills. Provide support from at least one scholarly source. Textbooks are not considered scholarly sources. 
5. Conclusion: Provide a conclusion, including a brief summary of what you discussed in the paper. 

 APA Formatting   

Formatting follows current edition APA Manual guidelines for  

1. title page 
2. running head 
3. body of paper (including citations and headings) 
4. reference page 

 Writing Mechanics  

Writing mechanics follow the rules of grammar, spelling, word usage, punctuation, and other aspects of formal written work as found in the current edition of the APA manual. The length of the paper is at least 5 pages but no more than 8 pages.  

During your tour of the city, describe 1 observation related to the 3 selected determinants of health. (a total of 3 observations must be described). Note indicators of high or low employment. Consider education levels, number of female head of households, and median household incomes for example.  Finally, describe a total of 3 strategies or evidence based recommendations to help reduce or eliminate the selected observations noted during your Sentinel City® tour.  The 3 selected determinants are: 1) social economic environment 2) physical environment 3) Individual lifestyle.

All submissions must have a minimum of two scholarly references to support your work 

 

search the article, “All of Us: Embracing Diversity in Healthcare.”

Based on your research, summarize your thoughts and provide answers or comments to the following questions:

• Discuss diversity in healthcare with examples and support from your research.
• Summarize any cited special characteristics and problems in the workplace regarding diversity.

Read The Cultural Integration and Workforce Diversity Scenario and answer the following questions:

• As you begin to develop your plan of action, what important  considerations will you address to improve the communication and  collaborative effort among the group?
• What perceived or real barriers do you anticipate based on the wide  diversity of the staff and patients? For example, do seasoned and newly  graduated staff members develop team cohesiveness immediately? How can  language barriers between the team impede proper communication across  department lines?
• What potential conflicts can arise when you do not understand or accept cultural, gender, ethnic, or age diversity?
• Develop four important steps for how you will implement your plan to  improve communication and acceptance of various cultures and diverse  workers for each of the perceived or real barriers for staff and  patients.

Cultural Integration and Workforce Diversity