2025 Practicum Journal Entry Analyzing an Ethical Decision In your role as a Psychiatric and Mental Health Nurse Practitioner PMHNP

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Assgn 1 – WK4 (C) 2025

Practicum Journal Entry: Analyzing an Ethical Decision In your role as a Psychiatric and Mental Health Nurse Practitioner (PMHNP) , you will encounter several situations that will require your ability to make sound judgments and practice decisions for the safety and well-being of individuals, families, and communities. There may not be a clear-cut answer of how to address the issue, but your ethical decision making must be based on evidenced-based practice and what is good, right, and beneficial for patients. You will encounter patients who do not hold your values, but you must remain professional and unbiased in the care you provide to all patients regardless of their socio-demographic and ethnic/racial background. You must be prepared to critically analyze ethical situations and develop an appropriate plan of action. For this Assignment, you review the literature and discover the various ethical dilemmas PMHNPs encounter and how these issues are typically addressed in your state. Assignment To prepare: · Review literature for moral/ethical issues encountered by a Psychiatric and Mental Health Nurse Practitioner (PMHNP) . · Select one of the articles you found that was published within the last 5 years to use as a focus for this assignment. Write a 2-page paper in which you do the following: · Summarize the moral/ethical issue in the article (no more than 1 paragraph). · Describe the moral and ethical dilemmas surrounding the issue. · Analyze the ethical issue and compare them to the state health laws and regulations in your state. · Outline the process of ethical decision making you would use to address this ethical dilemma. Note: Be sure to use the Practicum Journal Template attached in this assignment. Also, the Sample Practicum Journal attached is just a sample. · Include references immediately following the content. · Use APA style for your journal entry and references. Learning Resources Required Readings Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer. Chapter 5, “Examination and Diagnosis of the Psychiatric Patient” (pp. 192–289) Chapter 31, “Child Psychiatry” (pp. 1082–1107) American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. “Introduction” “Use of the Manual” “Cultural Formulation” Kaplan, C. (2017). Ethical dilemmas. Advanced Healthcare Network. Retrieved from http://nurse-practitioners-and-physician-assistants.advanceweb.com/Article/Ethical-Dilemmas-2.aspx Pumariega, A. J., Rothe, E., Mian, A., Carlisle, L., Toppelberg, C., Harris, T., . . . Smith, J. (2013). Practice parameter for cultural competence in child and adolescent psychiatric practice. Journal of the American Academy of Child & Adolescent Psychiatry , 52 (10), 1101–1115. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00479-6/pdf American Academy of Child & Adolescent Psychiatry (AACAP). (2012a). Practice parameter for psychodynamic psychotherapy with children. Journal of the American Academy of Child & Adolescent Psychiatry , 51 (5), 541–557. Retrieved from http://www.jaacap.com/article/S0890-8567(12)00141-4/pdf American Psychological Association. (2017). Code of Ethics . Retrieved from http://www.apa.org/ethics/code/ Optional Resources Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer. Chapter 1, “Neural Sciences” (pp. 1–92) Chapter 31.2, “Assessment, Examination, and Psychological testing” (pp. 1107–1118) Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell.

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2025 Question 1 The health care team is having difficulty communicating with a patient from a non English speaking culture

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NUR3045 Module 1 Quiz Chapter 2 2017 2025

Question 1 The health care team is having difficulty communicating with a patient from a non-English-speaking culture . An interpreter has not yet been located . Which behaviors might the patient demonstrate because of this communication issue? Select all that apply . 1. Withdrawing 2. Hostility 3. Belligerence 4. Uncooperativeness 5. Apathy Question 2 A group of nurses talking are overheard using jargon that is consistent with the nursing profession . Which behavior are the nurses demonstrating? 1. Socialization 2. Ethnicity 3. Acculturation 4. Heritage consistency Question 3 The nurse determines that a patient is in the process of acculturation . What did the nurse assess in this patient? 1. Americanization of the patient’s name 2. Engaging in activities with members of the family’s preferred social group 3. Speaking the family’s native language 4. Living away from the family of origin Question 4 Why does the nurse stop and think before implementing touch when providing care to a patient from a different culture? 1. Influences the patient’s personal space 2. Influences environmental control 3. Impacts time orientation 4. Alters social organization Question 5 A patient from a non-English-speaking culture explains how he has to behave differently at work than he does at home . What does the nurse realize this patient is describing? Select all that apply . 1. Withdrawing 2. Hostility 3. Belligerence 4. Uncooperativeness 5. Apathy Question 6 Prior to caring for a Native American patient, the nurse reviews the diseases that are more prevalent in this culture . What is the nurse taking into consideration when caring for this patient? 1. Biological variation 2. Environmental control 3. Social organization pattern 4. Component of heritage consistency Question 7 While conducting a health history, a patient demonstrates characteristics of ethnocentrism . What behaviors did the nurse observe in the patient? Select all that apply . 1. Superiority with ethnic group 2. Concern with race 3. Fear of strangers 4. Morbid fear of strangers 5. Ethnic pride Question 8 While collecting demographics, the nurse learns that an American patient is married to an immigrant from another country . What does this patient’s marriage exemplify? 1. Assimilation 2. Socialization 3. Acculturation 4. Ethnicity Question 9 A patient living in the United States for 10 years is distressed about not “fitting in” with American society . What aspects of acculturation will the nurse discuss with this patient? Select all that apply . 1. Socialization 2. Acculturation 3. Assimilation 4. Ethnicity 5. Heritage consistency Question 10 A patient born in a European country speaks excellent American English . The nurse realizes that this patient has achieved which type of assimilation? 1. Cultural 2. Marital 3. Primary structural 4. Secondary structural Question 11 A patient tells the nurse that it is important for him or her to be discharged soon because it is expected that the family’s needs be met . Which aspect of heritage consistency is this patient demonstrating? 1. Culture 2. Ethnicity 3. Religion 4. Acculturation Question 12 What aspects of a patient’s culture will the health care provider keep in mind when providing care? Select all that apply . 1. Parts of a person’s culture are under conscious control. 2. It is an extension of biological capabilities. 3. It is the medium of social relationships. 4. It identifies food preferences. 5. It explains folklore and music. Question 13 The nurse is planning care for an older patient . What will the nurse take into consideration to reduce generational conflict? Select all that apply . 1. Events that occurred when the patient was 10 years of age 2. Ethnocultural status of the nurse 3. Age of the nurse 4. Life trajectory 5. Religion Question 14 The nurse identifies that a patient from a different culture will not make eye contact during the assessment process . What does the lack of eye contact indicate to the nurse? 1. Respect 2. Friendliness 3. Hiding something 4. Fear Question 15 A patient tells the nurse that a health problem is common among people of the patient’s ethnic background . What other characteristics would the nurse assess as contributing to this patient’s ethnicity? Select all that apply . 1. Food preferences 2. Employment patterns 3. Special interest in the homeland 4. Divine intervention Question 16 The nurse is not happy to learn that a newly admitted patient is from the same culture as a previous patient who had created much turmoil on the care area . What behavior is this nurse prone to demonstrate? 1. Prejudice 2. Discrimination 3. Ethnocentrism 4. Racism Question 17 A seminal event in the boomer generation that can still elicit comments today is the question: 1. “Where were you when John F. Kennedy was shot?” 2. “Do you remember Pearl Harbor?” 3. “What were you doing on September 11, 2001?” 4. “How did the Challenger tragedy affect you?” Question 18 The staff development instructor is planning a seminar that focuses on the variables leading to generational conflict . What will the instructor include in this content? Select all that apply . 1. Decade of birth 2. Generation in the United States 3. Class 4. Language 5. Socialization Question 19 A patient tells the health care provider that a foot injury occurred while participating in Oktoberfest as a dancer . The patient is explaining which aspect of heritage consistency? 1. Ethnicity 2. Culture 3. Religion 4. Assimilation Question 20 A health care provider comments that a patient is “too old to take care of herself” and needs to “let a man make decisions for her . ” The nurse recognizes that this health care provider is demonstrating which misanthropic feelings? Select all that apply . 1. Ageism 2. Sexism 3. Racism 4. Heterosexism 5. Ethnocentrism

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2025 Question 1 Jonathan has been diagnosed with strep throat and needs a

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NSG6005 Week 9 Assignment 3 Quiz 2025

Question 1 . Jonathan has been diagnosed with strep throat and needs a prescription for an antibiotic . He says the last time he had penicillin he developed a red, blotchy rash . The appropriate antibiotic to prescribe would be: Penicillin VK, since his rash does not sound like a serious rash Amoxicillin Cefadroxil (Duricef) Erythromycin Question 2 . Tetracyclines are contraindicated in children younger than 8 years because of: Risk of developing cartilage problems Development of significant diarrhea Risk of kernicterus Adverse effects on bone growth Question 3 . Lisa is a healthy non-pregnant adult woman who recently had a UTI . She is asking about drinking cranberry juice to prevent a recurrence of the UTI . The answer to give her would be: “Sixteen ounces per day of cranberry juice cocktail will prevent UTIs . ” “100% cranberry juice or cranberry juice extract may decrease UTIs in some patients . ” “There is no evidence that cranberry juice helps prevent UTIs . ” “Cranberry juice only works to prevent UTIs in children . ” Question 4 . Rose is a 3 year old with an upper respiratory infection (URI) . Treatment for her URI would include: Amoxicillin Diphenhydramine Pseudoephedrine Nasal saline spray Question 5 . Patient education for a patient who is prescribed antibiotics for sinusitis includes: Use of nasal saline washes Use of inhaled corticosteroids Avoiding the use of ibuprofen while ill Use of laxatives to treat constipation Question 6 . Patients who should be cautious about using decongestants for an upper respiratory infection include: School-age children Patients with asthma Patients with cardiac disease Patients with allergies Question 7 . Janet was recently treated with clindamycin for an infection . She calls the advice nurse because she is having frequent diarrhea that she thinks may have blood in it . What would be the appropriate care for her? Encourage increased fluids and fiber Assess for pseudomembranous colitis Advise her to eat yogurt daily to help restore her gut bacteria Start her on an antidiarrheal medication Question 8 . To prevent further development of antibacterial resistance it is recommended fluoroquinolones be reserved for treatment of: Urinary tract infections in young women Upper respiratory infections in adults Skin and soft tissue infections in adults Community-acquired pneumonia in patients with comorbidities Question 9 . Nicole is a 4-year-old female with a febrile urinary tract infection . She is generally healthy and has no drug allergies . Appropriate initial therapy for her UTI would be: Azithromycin Trimethoprim/sulfamethoxazole Ceftriaxone Ciprofloxacin Question 10 . Sally is a 16-year-old female with a urinary tract infection . She is healthy, afebrile, with no use of antibiotics in the previous 6 months and no drug allergies . An appropriate first-line antibiotic choice for her would be: Azithromycin Trimethoprim/sulfamethoxazole Ceftriaxone Levofloxacin

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2025 BE SURE TO FOLLOW ALL INSTRUCTION SPELL CHECK AND MAKE SURE APA CITATIONS ARE DONE ACCORDINGLY Details Attend a committee

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Collaborative Decision Making Through Shared Governance 2025

BE SURE TO FOLLOW ALL INSTRUCTION, SPELL CHECK AND MAKE SURE APA CITATIONS ARE DONE ACCORDINGLY. Details: Attend a committee meeting in your health care organization. If you are not currently employed in a health care setting, you may elect to attend a committee meeting at another company, a community center, a local school, local chamber of commerce or other professional organization. Observe the interactions between committee members and the process used by the committee to arrive at decisions. In 500-750 words , (DO O EXCEED WORD COUNT ) describe the function of the committee and the roles of those in attendance. Describe your observations of the interactions between members of the committee and determine whether the process used to arrive at decisions is a form of shared governance. A minimum of THREE academic references from credible sources are required for this assignment. Submit the completed “Collaborative Committee Meeting Verification Form” with the assignment. – THIS PORTION OF THE ASSIGNMENT WILL BE DONE BY ME. Prepare this assignment according to the APA guidelines. This assignment uses a grading rubric. SEE RUBRIC ATTACHMENT. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment. You are required to submit this assignment to Turnitin. SIMILARITY INDEX SHOULD NOT EXCEED 15%.

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2025 Critically analyse and justify your professional role in identifying and responding to children affected by one category of child

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Safeguarding Children 2025

Critically analyse and justify your professional role in identifying and responding to children affected by one category of child abuse with reference to research, policy, practice and legal issues. In addition to this suggest and critically analyse how partnership working can inhibit and facilitate your professional role with regard to your chosen category.

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2025 To prepare Review the Peer Evaluation Form for important information on how this assignment is graded Identify a group

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NURS 6053 Week 7 Assignment 2025

To prepare: Review the Peer Evaluation Form for important information on how this assignment is graded. Identify a group facilitator. Within your group, select a topic relevant to interprofessional leadership and the health care field on which to focus your group paper. The following are some potential topics for your group to consider: “Just” culture When your group has selected a topic, the group facilitator will submit the topic to the Instructor for approval on the Discussion Board in the Week 5 Group Project Topic Forum. Conduct research on your topic using the Walden Library and other credible sources. To complete: By Day 7 of Week 7 As a group, write a 3- to 5 (page count does not include title and reference page) page paper that includes the following: Section 1: Introduction Section 2: Significance of the topic (based on literature that speaks to the relevancy of the concept selected in terms of interprofessional leadership) Section 3: Review of the literature related to the concept that the group selects (current best practices, positive or negative impact on leadership or health care organizations, etc.) Section 4: Application to nursing (e.g., implications or consequences for nursing leaders) Section 5: Conclusion

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2025 Write a 4 6 page analysis of a current problem or issue in health care including a proposed solution and possible

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Analyze a Current Health Care Problem or Issue ( I choose to talk about Limited Access to Health Care). 2025

Write a 4-6 page analysis of a current problem or issue in health care, including a proposed solution and possible ethical implications. For this assessment, you will analyze a current health care problem or issue. This assessment provides an opportunity to apply critical thinking and problem-solving skills to a current health care problem or issue. By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria: Competency 1 : Apply information literacy and library research skills to obtain scholarly information in the field of health care. Use scholarly information to describe and explain a health care problem or issue and identify possible causes for it. Competency 2 : Apply scholarly information through critical thinking to solve problems in the field of health care. Analyze a health care problem or issue by describing the context, explaining why it is important, and identifying populations affected by it. Discuss potential solutions for a health care problem or issue and describe what would be required to implement a solution. Competency 3 : Apply ethical principles and academic standards to the study of health care. Analyze the ethical implications if a potential solution to a health care problem or issue was implemented. Competency 4 : Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others, and that is consistent with expectations for health care professionals. Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics. Write following APA style for in-text citations, quotes, and references. Note : The requirements outlined below correspond to the grading criteria in the scoring guide. At a minimum, be sure to address each point. In addition, you are encouraged to review the performance level descriptions for each criterion to see how your work will be assessed. Describe the health care problem or issue you selected for use in Assessment 2 and provide details about it. Identify possible causes for the problem or issue. Use scholarly information to explain the health care problem or issue. Identify at least three scholarly or academic peer-reviewed journal articles about the topic. You may use articles you found while working on Assessment 2 or you may search the Capella Library for other articles. You may find the applicable Undergraduate Library Research Guide helpful in your search. Assess the credibility of the information sources. Assess the relevance of the information sources. Analyze the problem or issue. Describe the setting or context for the problems or issues. Describe why the problem or issue is important to you. Identify groups of people affected by the problem or issue. Discuss potential solutions for the problem or issue. Compare your opinion with other opinions you find in sources from the Capella Library. Provide the pros and cons for one of the solutions you are proposing. Analyze the ethical implications if the potential solution (the one for which you provide pros and cons) were to be implemented. Discuss the pros and cons of implementing the proposed solution from an ethical principle point of view. Provide examples from the literature to support the points you are making. Describe what would be necessary to implement the proposed solution.. Additional Requirements Length : At least 4–6 typed, double-spaced pages, not including the title page and reference page. Font and font size : Times New Roman, 12 point. APA Template : Use the APA Style Paper Template as the paper format and the APA Style Paper Tutorial for guidance. See the Resources for these documents. Written communication : Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics. Using outside sources : Integrate information from outside sources into academic writing by appropriately quoting, paraphrasing, and summarizing, following APA style. References : Integrate information from outside sources to include at least three scholarly or academic peer-reviewed journal articles and three in-text citations within the paper. APA format : Follow current APA guidelines for in-text citations of outside sources in the body of your paper and also on the reference page. Turnitin : Submit your assessment to Turnitin prior to grading. Then, only submit your final assessment to faculty for grading. Organize your paper using the following structure and headings: Title page . A separate page. Introduction . A brief one-paragraph statement about the purpose of the paper. Elements of the problem/issue . Identify the elements of the problem or issue, or question. Analysis . Analyze, define, and frame the problem or issue. Considering options . Consider solutions, responses, or answers. Solution . Choose a solution, response, or answer. Implementation . Implementation of the potential solution. Conclusion . One paragraph.

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2025 Discussion Validity in Quantitative Research Designs Validity in research refers to the extent

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NURS 5052/NURS 6052: ESSENTIALS OF EVIDENCE-BASED PRACTICE – Discussion 6 (Grading Rubic and Media Attached) 2025

Discussion: Validity in Quantitative Research Designs Validity in research refers to the extent researchers can be confident that the cause and effect they identify in their research are in fact causal relationships. If there is low validity in a study, it usually means that the research design is flawed and the results will be of little or no value. Four different aspects of validity should be considered when reviewing a research design: statistical conclusion validity, internal validity, construct validity, and external validity. In this Discussion, you consider the importance of each of these aspects in judging the validity of quantitative research. To prepare: Review the information in Chapter 10 of the course text on rigor and validity. Read the method section of one of the following quasi-experimental studies (also located in this week’s Learning Resources). Identify at least one potential concern that could be raised about the study’s internal validity. Metheny, N. A., Davis-Jackson, J., & Stewart, B. J. (2010). Effectiveness of an aspiration risk-reduction protocol. Nursing Research, 59(1), 18–25. Padula, C. A., Hughes, C., & Baumhover, L. (2009). Impact of a nurse-driven mobility protocol on functional decline in hospitalized older adults. Journal of Nursing Care Quality, 24(4), 325–331. Yuan, S., Chou, M., Hwu, L., Chang, Y., Hsu, W., & Kuo, H. (2009). An intervention program to promote health-related physical fitness in nurses. Journal of Clinical Nursing, 18(10), 1,404–1,411. Consider strategies that could be used to strengthen the study’s internal validity and how this would impact the three other types of validity. Think about the consequences of an advanced practice nurse neglecting to consider the validity of a research study when reviewing the research for potential use in developing an evidence-based practice. Post the title of the study that you selected and your analysis of the potential concerns that could be raised about the study’s internal validity. Propose recommendations to strengthen the internal validity and assess the effect your changes could have with regard to the other three types of validity. Discuss the dangers of failing to consider the validity of a research study. Read a selection of your colleagues’ responses. Respond to at least two of your colleagues in one or more of the following ways: Ask a probing question, substantiated with additional background information, and evidence. Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives. Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library. Validate an idea with your own experience and additional sources. Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings. Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence. Please use the below link for template formatting: http://academicguides.waldenu.edu/writingcenter/templates Required Readings Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer. Chapter 10, “Rigor and Validity in Quantitative Research” This chapter introduces the concept of validity in research and describes the different types of validity that must be addressed. Key threats to validity are also explored. Chapter 11, “Specific Types of Quantitative Research” This chapter focuses on the specific types of quantitative research that can be selected. The focus is on the purpose of the research rather than the research design. These include such approaches as clinical trials, evaluation research, health services and outcomes research, needs assessments, or replication studies. Cantrell, M. A. (2011). Demystifying the research process: Understanding a descriptive comparative research design. Pediatric Nursing, 37(4), 188–189. Retrieved from the Walden Library databases. The author of this article discusses the primary aspects of a prominent quantitative research design. The article examines the advantages and disadvantages of the design. Schultz, L. E., Rivers, K. O., & Ratusnik, D. L. (2008). The role of external validity in evidence-based practice for rehabilitation. Rehabilitation Psychology, 53(3), 294–302. Retrieved from the Walden Library databases. This article details the results of a study that sought to balance concern for rigor with concern for relevance. The authors of the article derive and determine a rating format for relevance and apply it to cognitive rehabilitation. Note: For the Discussion this week, you will need to read the method section of one of the following quasi-experimental studies. Refer to the details provided in the Week 6 Discussion area. Metheny, N. A., Davis-Jackson, J., & Stewart, B. J. (2010). Effectiveness of an aspiration risk-reduction protocol. Nursing Research, 59(1), 18–25. Retrieved from the Walden Library databases. Padula, C. A., Hughes, C., & Baumhover, L. (2009). Impact of a nurse-driven mobility protocol on functional decline in hospitalized older adults. Journal of Nursing Care Quality, 24(4), 325–331. Retrieved from the Walden Library databases. Yuan, S.-C., Chou, M.-C., Hwu, L.-J., Chang, Y.-O., Hsu, W.-H., & Kuo, H.-W. (2009). An intervention program to promote health-related physical fitness in nurses. Journal of Clinical Nursing, 18(10), 1,404–1,411. Retrieved from the Walden Library databases. Walden University. (n.d.a.). Paper templates. Retrieved July 23, 2012, from http://writingcenter.waldenu.edu/57.htm This resource provides you access to the School of Nursing Sample Paper, which will serve as a template for formatting your papers. Document: Critique Template for a Qualitative Study (Word document) Note: You will use this document to complete this week’s Assignment. Document: Critique Template for a Quantitative Study (Word document) Note: You will use this document to complete this week’s Assignment. Document: Critique Template for a Mixed-Methods Study (Word document) Note: You will use this document to complete this week’s Assignment.

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2025 TO REPLY 1 COMMENT TO EACH POST WITH CITATION AND TWO REFERENCE EACH COMMENT APA ABOVE

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Discussion: The Impact of Ethnicity on Antidepressant Therapy 2025

TO REPLY 1 COMMENT TO EACH POST WITH CITATION AND TWO REFERENCE EACH COMMENT APA ABOVE 2013. POST 1 Three Questions for the Patient After reviewing the material presented in this case study, there are some concerning questions regarding this patient’s psychiatric history. Additional questions would include: After each discontinuation of medication after an episode of depression, was this decision the choice of a physician or self -initiated? This question would provide knowledge of the patient’s medication compliance. For example, does the patient stop taking prescribed medication on symptoms are alleviated? What were the circumstances prior to each depressive episode? his question would enlighten the practitioner on triggers and factors that personally affect the patient before a depressive episode occurs. There appears to be history of alcohol abuse and depression in your family, has anyone in your family received treatment? This question would provide a view into the patient’s understanding of psychiatric treatment. Since the patient does not believe in psychotherapy due to religious reason, the patient may not know what treatments were, are or will be available to him. Feedback from People in Patient’s Life The patient has been married for 33 years. Assuming his spouse is around before, during and after an episode, she may provide information the patient failed to share or may not have been honest about. The first person to be questioned would be the patient’s wife. Some of the questions for the patient’s wife would include onset of symptoms. What occurs before each episode of depression? Is there conflict between you and your spouse? Are there any stressors, such as financial plaguing your spouse and you? The patient also has three children. All three of his children suffer from some form of depression. Questioning the patient’s children may provide a historical history of the patient. For example, the children may have noticed symptoms leading to the patient’s depression years ago. Questions for the children may include did your parent’s argue often while you were growing up? Did your father ever lose interest in your childhood years? Did you feel love or rejection while growing up from your father? What were your father’s behaviors? Did you ever notice any alcohol or drug abuse while growing up? Physical and Diagnostic Exams for Patient Unfortunately, there is not a certain test for depression. The primary goal of physical exam and diagnostic testing would to rule out other conditions causing similar symptoms. A physical exam should be preformed assessing respiratory and cardiovascular system. Vital signs should be taken as well. Certain labs should be assessed in the patient. The practitioner should check the patient’s thyroid levels. Thyroid hormones have been linked to depression (Stahl, 2008). Depression can be caused by an underactive or overactive thyroid. Another lab test to consider would be dexamethasone suppression test. This test assesses the negative affect of dexamethasone. Once given dexamethasone, in a small dose, cortisol levels are decreased in healthy adults, but may remain elevated in depressed patients (Smith, et al., 2013). Depressive disorders have been linked to certain inflammatory biomarkers. This blood test assesses nine biomarkers, alpha-1 antitrypsin, apolipoprotein CIII, BDNF, cortisol, epidermal growth factor, myeloperoxidase, prolactin, resin, and soluble tumor necrosis factor α type II. These biomarkers represent the inflammatory and metabolic pathways associated with depression (Serra et al., 2015). Three Differential Diagnosis Based on the symptoms listed by the patient, there a multiple diagnosis this patient could be suffering from. Recurrent Major Depressive Disorder with melancholic features. This diagnosis is due to the patient’s major depressive symptoms, such as depressed mood most of the day, increased anxiety, and suicidal thoughts (Zaninotto et al., 2016). The specifier of melancholic features is based on the patient’s symptoms being worse in the morning, inability to function and lack of pleasure (Zaninotto et al., 2016). Other diagnoses for the is patient could be a thyroid imbalance or panic disorder Two pharmacologic agents Since this patient has become resistant to first line and second line drug therapy for depression, Phenelzine, an MAOI should be started for this patient. Phenelzine 45mg daily, divided into three doses throughout the day. Another suggestion for this patient would be Isocarboxazid. The dosage would start at 10mg BID, if tolerated the dosage could increase to another 10mg every 2-4 days until the dosage of 40 mg was achieved with tolerance. If therapeutic response is achieved, this medication should be slowly decreased without affecting therapeutic response (Arcangelo et al., 2013). Due to the pharmacokinetics and pharmacodynamics of Isocarboxazid, Phenelzine, should be prescribed to this patient. Since there is an increased to patients who have cardiac issues such as atrial fibrillation. The pharmacodynamics of Isocarboxazid are not clearly understood, but this may be due to the inhibition of MAO to the heart (Drugs, 2018). MAOIs and Ethnicities With many MAOIs, hypertensive crisis is a major concern for nay race. Since minorities are diagnosed with hypertension at higher rates, this causes a greater concern. This is the reason for a tyramine restricted diet. Foods such as aged chees, yeast and tap beer should be avoided () Changes in Therapy After review of further data with this patient, changes would not be made to the suggested treatment. Lessons Learned Throughout this case study many lessons were present. The lesson of medication compliance was the first lesson learned. Another lesson learned was the lesson of proper medication selection in a patient, especially after a recurrent episode of depression. Assessment and presentation of psychiatric treatment for patients was another lesson learned from this case study. Conclusion In conclusion, this case study involved a 63-year-old male with recurrent depression. The patient has had success and failures with medication and treatment. These failures may be due to medication compliance or improper cessation of medications from a physician. After two years, the patient is finally on the right track. Hopefully, this will continue. References Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins. Drugs.com. (2018). Isocarboxazid. Retrieved from http:/ ttps://www.drugs.com/pro/marplan.html Serra, F., Spoto, A., Ghisi, M., & Vidotto, G. (2015). Formal Psychological Assessment in Evaluating Depression: A New Methodology to Build Exhaustive and Irredundant Adaptive Questionnaires. PLoS ONE , 10 (4), e0122131. http://doi.org/10.1371/journal.pone.0122131 Smith, K. M., Renshaw, P. F., & Bilello, J. (2013). The diagnosis of depression: current and emerging methods. Comprehensive Psychiatry , 54 (1), 1–6. http://doi.org/10.1016/j.comppsych.2012.06.006 Stahl, S. M. (2008). Essential Psychopharmacology Online. Retrieved September 11, 2018 from https://stahlonline-cambridge-org.ezp.waldenulibrary.org/prescribers_drug.jsf? Zaninotto, L., Solmi, M., Veronese, N., Guglielmo, R., Ioime, L., Camardese, G., & Serretti, A. (2016). A meta-analysis of cognitive performance in melancholic versus non-melancholic unipolar depression. Journal of affective disorders , 201 , 15-24. POST 2 Three questions that I might ask our patient are: Tell me when you take your medication? [The reason for this question is to establish his adherence to his medication. Tachyphylaxis aka poop out, may occur due to medication nonadherence. It is therefore important to assess if the client is experiencing tachyphylaxis related to medication nonadherence] (Targum, 2014). Do you feel a lack of motivation about life? [The Rothschild Scale for Antidepressant Tachyphylaxis suggests a conceptualization of antidepressant tachyphylaxis that is characterized by symptoms of apathy.] (Targum, 2014). Are you experiencing patterns of sleep disturbance? [This is also a symptom of poop out. It is important to assess these symptoms in order to proceed with his plan of care. Another important question is to assess the client for is substance abuse which was already addressed within the case study.) According to our case study, our client is a 69-year-old retired male who is married with children and grandchildren. In my opinion, it would be most important to speak to those that are the closest to him (his wife) who can observe him for any signs of activation of bipolar disorder such as: lack of impulse control, irritable and agitated mood lasting longer than a week (Bail, Dains, Flynn, Solomon, & Stewart, 2015). Activation of bipolar disorder would require his antidepressant to be discontinued and switched to a mood stabilizer (Stahl, 2013). Physical exams and diagnostic tests relevant to our client’s care would be testing his blood pressure before/during initiating treatment and testing for plasma levels of O-desmethylvenlafaxine (ODV) which is an active metabolite of venlafaxine formed as a result of CYP450 2D6 (Stahl, 2013). Plasma levels of ODV will determine if the provider may safely increase his dose based on results. It is imperative to assess our client’s blood pressure related to the effects of the norepinephrine in the SNRI. Based on the check points for his first follow up, I would have changed his phone follow up to a face to face follow up to assess our client better and would have ordered his plasma ODV sooner to properly assess the effectiveness of his medication therapy. According to the American Psychiatric Association (2013), three differential diagnoses that I am giving our client are: 1. mood disorder due to another medical condition 2. Sadness 3. Adjustment disorder with depressed mood. The one that I think is more likely is sadness. My thought is sadness because our client’s history from the case study reveals a long, waxing and waning major depressive episode where he feels like he is out of options (Stahl, 2013). Two pharmacologic agents that would be appropriate for our client’s therapy would be Mirtazapine 15 mg PO nightly or Bupropion 75 mg PO BID. Bupropion is an NDRI which is a good augmenting combination with Venlafaxine. It is a powerful enhancer of noradrenergic action. Mirtazapine is a dual serotonin and norepinephrine combination which also works well with Venlafaxine but it may further increase his high cholesterol; for this reason, I would choose the Bupropion. Lessons that I learned from this case study are certain drugs may not be as effective due to noncompliance, pharmacokinetic failures or even genetic variants. I have also learned the seriousness of how severe depression can be and the importance of knowing not necessarily all of the drugs out on the market for depression but more so the pharmacokinetics and pharmacodynamics of how they work. Leonie Reference Targum, S. D. (2014). Identification and treatment of antidepressant tachyphylaxis. Innovations in Clinical Neuroscience, 11 (24), 3-4. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008298/ Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby. Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Retrieved from Walden Library databases.

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2025 READ TOPIC AND INSTRUCTIONS FOR ESSAY APA FORMAT TIMES ROMAN FT 12 ABSOLUTELY NO PLAGIARISM

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READ TOPIC AND INSTRUCTIONS FOR ESSAY, APA FORMAT, TIMES ROMAN FT 12, ABSOLUTELY NO PLAGIARISM, ESSAY SHOUL BE APPROXIMATELY ONE PAGE IN LENGTH( NOT INCLUDING THE COVER AND REFERENCE SHEET) CITED AND REFERENCED.DUE ON DATE AND TIME REQUESTED. BOOK HAS TO BE ONE OF THE REFERENCE Moini, J. (2013). Focus on pharmacology. Essential for health professionals (2 nd ed). Upper Saddle River, NJ: Prentice Hall.

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