2025 An agency has focused its system development and critical infrastructure data collection efforts on separate engineering management systems for

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identify what type of critical infrastructure data collection is needed for pavement and storm water management facilities. 2025

An agency has focused its system development and critical infrastructure data collection efforts on separate engineering management systems for different types of assets and is working on the integration of these systems. In this case, the agency focused on the data collection for two types of assets: water treatment and natural gas delivery management facilities. Please identify what type of critical infrastructure data collection is needed for pavement and storm water management facilities. Chapter 6 discusses the concept of correlation. Assume that An agency has focused its system development and critical infrastructure data collection efforts on separate engineering management systems for different types of assets and is working on the integration of these systems. In this case, the agency focused on the data collection for two types of assets: water treatment and natural gas delivery management facilities. Please identify what type of critical infrastructure data collection is needed for pavement and storm water management facilities. As indicated above, identify what type of critical infrastructure data collection is needed for pavement and storm water management facilities.

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2025 For Final Project I Malpractice Case you will analyze a provided on the Final Project 1 Guidelines and Rubric First

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1-2 Worksheet – Describe the Case 2025

For Final Project I: Malpractice Case, you will analyze a provided on the Final Project 1 Guidelines and Rubric. First, you will complete the Describe the Case Worksheet to start the analysis of your case. One common method of case analysis is called the Issue, Rule, Application, and Conclusion (IRAC) method. For this task, you will only be completing the “Issue” portion of the IRAC method. To complete this assignment, review the Describe the Case Worksheet Rubric document. Attached below is the link to the case thats needed to answer the worksheet and the rubric and guidelines for all

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2025 It s a 2 page task I need it in 3 hours Use the attached file https drive google com file d 1YEAW6OGygLgIw8GypPYurUkzbsnbu2On view usp drivesdk Project Title Subject Review

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Review the sectioned headed, Two Ethical Exemplars 2025

It’s a 2 page task I need it in 3 hours. Use the attached file https://drive.google.com/file/d/1YEAW6OGygLgIw8GypPYurUkzbsnbu2On/view?usp=drivesdk Project Title/Subject Review the sectioned headed, Two Ethical Exemplars Describe Your task Review the sectioned headed, Two Ethical Exemplars in Chapter 22 Type of Service Essay Urgency 2 hours No. of Pages/Wordcount 1 page(s)/275 Words Citation Style APA Style Detailed Description/Explanation Review the sectioned headed, Two Ethical Exemplars in Chapter 22 of the textbook (Melnyk and Fineout-Overholt, 2015, pages 518-519). Discuss three main ethical controversies related to implementing Evidence-Based Quality Improvement (EBQI) Initiatives. Describe how these controversies relate to the four core ethical principles. Files app.captainform.com/upload_dld.php?fileid=4d9f87a87d6501007d41c72ba0fbe45a

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2025 To prepare for this assignment view the following brief video from the American Medical Association titled Health Literacy and Patient

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Environmental Factors and Health Promotion Pamphlet: Accident Prevention and Safety Promotion for Parents and Caregivers of Infant 2025

To prepare for this assignment view the following brief video from the American Medical Association titled, “Health Literacy and Patient Safety: Help Patients Understand.” The video can be accessed through the following link: https://youtu.be/cGtTZ_vxjyA Part I: Pamphlet Develop a pamphlet to inform parents and caregivers about environmental factors that can affect the health of infants. Use the “Pamphlet Template” document to help you create your pamphlet. Include the following: Select an environmental factor that poses a threat to the health or safety of infants. Explain how the environmental factor you selected can potentially affect the health or safety of infants. Offer recommendations on accident prevention and safety promotion as they relate to the selected environmental factor and the health or safety of infants. Offer examples, interventions, and suggestions from evidence-based research. A minimum of three scholarly resources are required. Provide readers with two community resources, a national resource, and a Web-based resource. Include a brief description and contact information for each resource. In developing your pamphlet, take into consideration the healthcare literacy level of your target audience. Part II: Pamphlet Sharing Experience Share the pamphlet you have developed with a parent of an infant child. The parent may be a person from your neighborhood, a parent of an infant from a child-care center in your community, or a parent from another organization, such as a church group with which you have an affiliation. Provide a written summary of the teaching / learning interaction. Include in your summary: Demographical information of the parent and child (age, gender, ethnicity, educational level). Description of parent response to teaching. Assessment of parent understanding. Your impressions of the experience; what went well, what can be improved. Submit Part I and Part II of the Accident Prevention and Safety Promotion for Parents and Caregivers of Infants assignment by the end of Topic 1. While APA format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center. NRS-434VN-R-Pamphlet-Template-Student.docx

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2025 Throughout the course you have developed aspects of your Academic and Professional Development Plan You have

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Wk 11 (03) 2025

Throughout the course you have developed aspects of your Academic and Professional Development Plan. You have thought a great deal about your vision and goals, your academic and professional network of support, research strategies and other tools you will need, the integrity of your work, and the value of consulting the work of others. With your portfolio in place, it is now time to finalize your blueprint for success. Much as builders remain cognizant of the building standards as they plan and begin construction, nurses must remain mindful of the formal standards of practice that govern their specialties. A good understanding of these standards can help ensure that your success plan includes any steps necessary to excel within your chosen specialty. In this Assignment you will continue developing your Academic Success and Professional Development Plan by developing the final component–a review of your specialty standards of practice. You will also submit your final version of the document, including Parts 1–5. To Prepare: Review the scope and standards of practice or competencies related to your chosen specialty in the resources for this module. Review the MSN specializations offered at Walden by viewing the module resource, Walden University. (n.d.). Master of Science in Nursing (MSN). Examine professional organizations related to the specialization you have chosen and identify at least one to focus on for this Assignment. Reflect on the thoughts you shared in the Discussion forum regarding your choice of a specialty, any challenges you have encountered in making this choice, and any feedback you have received from colleagues in the Discussion. The Assignment: Complete the following items and incorporate them into the final version of your Academic Success and Professional Development Plan. With the resources specific to the MSN specialization and the, Walden University. (n.d.). Master of Science in Nursing (MSN) , shared in this module, write a paragraph or make a Nursing Specialty Comparison table, comparing at least two nursing specialties that include your selected specialization and second-preferred specialization. Write a 2- to 3-paragraph justification statement identifying your reasons for choosing your MSN specialization. Incorporate feedback you received from colleagues in this Module’s Discussion forum. Identify the professional organization related to your chosen specialization for this Assignment, and explain how you can become an active member of this organization.

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2025 Perform a direct assessment of a community of interest using the Functional Health Patterns

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Perform a direct assessment of a community of interest using the “Functional Health Patterns Community Assessment Guide.” -The community of interest is Scottsdale, Arizona USA. Address every bulleted statement in the 2 following sections with data or rat 2025

Perform a direct assessment of a community of interest using the “Functional Health Patterns Community Assessment Guide.” -The community of interest is Scottsdale, Arizona USA. Address every bulleted statement in the 2 following sections with data or rationale for deferral. 1.) Value/Belief Pattern • Predominant ethnic and cultural groups along with beliefs related to health. • Predominant spiritual beliefs in the community that may influence health. • Availability of spiritual resources within or near the community (churches/chapels, synagogues, chaplains, Bible studies, sacraments, self-help groups, support groups, etc.). • Do the community members value health promotion measures? What is the evidence that they do or do not (e.g., involvement in education, fundraising events, etc.)? • What does the community value? How is this evident? • On what do the community members spend their money? Are funds adequate? 2.) Health Perception/Management • Predominant health problems: Compare at least one health problem to a credible statistic (CDC, county, or state). • Immunization rates (age appropriate). • Appropriate death rates and causes, if applicable. • Prevention programs (dental, fire, fitness, safety, etc.): Does the community think these are sufficient? • Available health professionals, health resources within the community, and usage. • Common referrals to outside agencies.

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2025 The collection of evidence is an activity that occurs with an endgame in

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Assignment: Evidence-Based Project, Part 5: Recommending an Evidence-Based Practice Change 2025

The collection of evidence is an activity that occurs with an endgame in mind. For example, law enforcement professionals collect evidence to support a decision to charge those accused of criminal activity. Similarly, evidence-based healthcare practitioners collect evidence to support decisions in pursuit of specific healthcare outcomes. In this Assignment, you will identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach. To Prepare: Reflect on the four peer-reviewed articles you critically appraised in Module 4. Reflect on your current healthcare organization and think about potential opportunities for evidence-based change. The Assignment: (Evidence-Based Project) Part 5: Recommending an Evidence-Based Practice Change Create an 8- to 9-slide PowerPoint presentation in which you do the following: Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)Chicago Lakeshore Hospital Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general. Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered. Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation. Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change. Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking. Add a lessons learned section that includes the following: A summary of the critical appraisal of the peer-reviewed articles you previously submitted An explanation about what you learned from completing the evaluation table (1 slide) An explanation about what you learned from completing the levels of evidence table (1 slide) An explanation about what you learned from completing the outcomes synthesis table (1 slide) Rurbic: Part 5: Recommending an Evidence-Based Practice Change Create an 8- to 9-slide PowerPoint presentation in which you do the following: · Briefly describe your healthcare organization, including its culture and readiness for change. · Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.–Levels of Achievement:Excellent 18 (18%) – 20 (20%) The presentation clearly and accurately describes in detail a healthcare organization, including a detailed explanation of its culture and readiness for change. The presentation clearly and accurately describes in detail a current problem or opportunity for change. An accurate, specific, and detailed description of the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general is provided. Good 16 (16%) – 17 (17%) The presentation accurately describes a healthcare organization, including an accurate explanation of its culture and readiness for change. The presentation accurately describes a current problem or opportunity for change. An accurate description of the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with the change implementation in general is provided. Fair 14 (14%) – 15 (15%) The presentation inaccurately or vaguely describes a healthcare organization, including an inaccurate or vague explanation of its culture and readiness for change. The presentation inaccurately or vaguely describes a current problem or opportunity for change. An inaccurate or vague description of the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with the change implementation in general is provided. Poor 0 (0%) – 13 (13%) The presentation inaccurately and vaguely describes a healthcare organization, including an inaccurate and vague explanation of its culture and readiness for change, or is missing. The presentation inaccurately and vaguely describes a current problem or opportunity for change or is missing. An inaccurate and vague description of the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with the change implementation in general is provided or is missing.Feedback: · Propose an evidence-based idea for a change in practice using an evidence-based practice approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered. · Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation. · Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change. · Be sure to provide APA citations of the supporting evidence-based peer-reviewed articles you selected to support your thinking.–Levels of Achievement:Excellent 32 (32%) – 35 (35%) The presentation clearly and accurately proposes in detail an evidence-based idea for a change in practice that is fully aligned to an evidence-based practice approach for decision making. The presentation clearly and accurately describes in detail a plan for knowledge transfer of this change, including a detailed plan for knowledge creation, dissemination, and organizational adoption and implementation that is specific. The presentation clearly and accurately describes in detail the measurable outcomes desired for the implementation of the evidence-based change. The presentation includes accurate, complete, and full APA citations of the supporting evidence-based peer-reviewed articles selected. Good 28 (28%) – 31 (31%) The presentation accurately proposes an evidence-based idea for a change in practice that is adequately aligned to an evidence-based practice approach for decision making. The presentation accurately describes a plan for knowledge transfer of this change, including a plan for knowledge creation, dissemination, and organizational adoption and implementation that is adequate. The presentation accurately describes the measurable outcomes desired for the implementation of the evidence-based changes. The presentation includes accurate APA citations of the supporting evidence-based peer-reviewed articles selected. Fair 25 (25%) – 27 (27%) The presentation inaccurately or vaguely proposes an evidence-based idea for a change in practice that may be aligned to an evidence-based practice approach for decision making. The presentation inaccurately or vaguely describes a plan for knowledge transfer of this change, including a plan for knowledge creation, dissemination, and organizational adoption and implementation that may be relevant. The presentation inaccurately or vaguely describes the measurable outcomes desired for the implementation of the evidence-based change. Inaccurate and incomplete APA citations of the supporting evidence-based peer-reviewed articles selected are provided. Poor 0 (0%) – 24 (24%) The presentation inaccurately and vaguely proposes an evidence-based idea for a change in practice that is not aligned to an evidence-based practice approach for decision making or is missing. The presentation inaccurately and vaguely describes a plan for knowledge transfer of this change, including a plan for knowledge creation, dissemination, and organizational adoption that implementation that is incomplete, or is missing. The presentation inaccurately and vaguely describes the measurable outcomes desired for the implementation of the evidence-based change or is missing. Inaccurate and incomplete APA citations of the supporting evidence-based peer-reviewed articles selected are provided or are missing.Feedback: Add a lessons learned section that includes: · A summary of the critical appraisal of the peer-reviewed articles you previously submitted. · What did you learn from completing the evaluation table? · What did you learn from completing the levels of evidence table? · What did you learn from completing the outcomes synthesis table?–Levels of Achievement:Excellent 27 (27%) – 30 (30%) The presentation clearly and accurately summarizes in detail the critical appraisal process of the peer-reviewed articles previously submitted. The presentation thoroughly describes in detail at least one lesson learned from completing the evaluation table that is specific. The presentation thoroughly describes in detail at least one lesson learned from completing the levels of evidence table that is specific. The presentation thoroughly describes in detail at least one lesson learned from completing the outcomes synthesis table that is specific. The presentation provides a complete, detailed, and specific synthesis of two outside resources reviewed on the lessons learned explained. The presentation fully integrates at least two outside resources and two or three course-specific resources that fully support the presentation. Good 24 (24%) – 26 (26%) The presentation accurately summarizes the critical appraisal process of the peer-reviewed articles previously submitted. The presentation accurately describes at least one lesson learned from completing the evaluation table that may include some specificity. The presentation accurately describes at least one lesson learned from completing the levels of evidence table that may include some specificity. The presentation accurately describes at least one lesson learned from completing the outcomes synthesis table that may include some specificity. The presentation provides an accurate synthesis of at least one outside resource reviewed related to the lessons learned explained. The presentation integrates at least one outside resource and two or three course-specific resources that may support the presentation. Fair 21 (21%) – 23 (23%) The presentation inaccurately or vaguely summarizes the critical appraisal process of the peer-reviewed articles previously submitted. The presentation inaccurately or vaguely describes at least one lesson learned from completing the evaluation table and may lack some specificity. The presentation inaccurately or vaguely describes at least one lesson learned from completing the levels of evidence table and may lack some specificity. The presentation inaccurately or vaguely describes at least one lesson learned from completing the outcomes synthesis table and may lack some specificity. The presentation provides a vague or inaccurate synthesis of outside resources reviewed related to the lessons learned explained. The response minimally integrates resources that may support the presentation. Poor 0 (0%) – 20 (20%) The presentation inaccurately and vaguely summarizes the critical appraisal process of the peer-reviewed articles previously submitted or is missing. The presentation inaccurately and vaguely describes at least one lesson learned from completing the evaluation table and lacks specificity or is missing. The presentation inaccurately and vaguely describes at least one lesson learned from completing the levels of evidence table that lacks specificity or is missing. The presentation inaccurately and vaguely describes at least one lesson learned from completing the outcomes synthesis table that lacks specificity or is missing. The presentation provides a vague and inaccurate synthesis of no outside resources related to the lessons learned explained or is missing. The presentation fails to incorporate any resources to support the responses provided.Feedback: Written Expression and Formatting—Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.–Levels of Achievement:Excellent 5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria. Good 4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment is stated yet is brief and not descriptive. Fair 3.5 (3.5%) – 3.5 (3.5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic. Poor 0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. No purpose statement, introduction, or conclusion was provided.Feedback: Written Expression and Formatting—English Writing Standards: Correct grammar, mechanics, and proper punctuation.–Levels of Achievement:Excellent 5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors. Good 4 (4%) – 4 (4%) Contains a few (one or two) grammar, spelling, and punctuation errors. Fair 3.5 (3.5%) – 3.5 (3.5%) Contains several (three or four) grammar, spelling, and punctuation errors. Poor 0 (0%) – 3 (3%) Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.Feedback: Written Expression and Formatting—The paper follows correct format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.–Levels of Achievement:Excellent 5 (5%) – 5 (5%) Uses correct paper formatting with no errors. Good 4 (4%) – 4 (4%) Contains a few (one or two) paper formatting errors. Fair 3.5 (3.5%) – 3.5 (3.5%) Contains several (three or four) paper formatting errors. Poor 0 (0%) – 3 (3%)

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2025 5 DQ 2 Over the ten years I have been a Registered Nurse I have daily interactions

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Intervention and Ethical Decision-Making 2025

5 DQ 2 Over the ten years I have been a Registered Nurse, I have daily interactions with patients that both share and have a different worldview than I do. I find myself extremely lucky to work in a multicultural environment with co-workers, staff and patients that have many different religious cultural and overall worldviews. This environment has allowed me to understand other cultures a lot better, while being able to provide high quality care. An individual’s worldview of spirituality and faith affects, shapes impact their perspective (Grand Canyon University, 2018). I feel that my strengths in facilitating spiritual care for patients with different worldviews than mine include being open minded, understanding and being compassionate. It is important to educate patients and families on the importance of certain medications, treatments or plans, however ultimately the patient always has the right to refuse. It is our job to provide the best education and information that we possibly can however, the patient and family has the right to choose, and it is our ultimate duty to respect their decision. My weakness in facilitating spiritual care for patients include not knowing every different spiritual view. Every day, I feel I learn something new about what others believe in or value. I find asking culturally appropriate questions are truly helpful. For the most part, people are very willing to share and open up about their beliefs and why and what they value in their lives. It is also important to assess the patient and family for spiritual needs which can include dietary or medical restrictions. At my hospital, this assessment is done upon admission and can be a very helpful tool. For me personally, the person who would have the final say in terms of ethical decision-making and interventions in the event of a difficult situation would be my next of kin. At the moment, this role would go to my husband. I have found that regardless of cultures or religion, every family or individual is unique and has specific needs that are distinctive only to that person. It is essential that the nurse knows the needs of the individual patient in order to provide the best care possible. When it comes to facilitating spiritual care for patients with worldviews different from your own, what are your strengths and weaknesses? If you were the patient, who would have the final say in terms of ethical decision-making and intervention in the event of a difficult situation? Using 200-300 words APA format with at least two references. Sources must be published within the last 5 years.

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2025 In 2008 Donald Berwick and colleagues provided a framework for the delivery of high

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Evidence-Based Practice & The Quadruple Aim 2025

In 2008, Donald Berwick and colleagues provided a framework for the delivery of high value care in the USA, the Triple Aim , that is centered around three overarching goals: improving the individual experience of care; improving the health of populations; and reducing the per capita cost of healthcare. 1 The intent is that the Triple Aim will guide the redesign of healthcare systems and the transition to population health. FULL ARTICLE ATTACHED FOR ASSISTANCE Reflect on how Evidenced Based Practice might impact (or not impact) the Quadruple Aim in healthcare. Consider the impact that Evidenced Based Practice may have on factors impacting these quadruple aim elements, such as preventable medical errors or healthcare delivery . To Complete: Write a brief analysis of the connection between Evidenced Based Practice and the Quadruple Aim. Your analysis should address how Evidenced Based Practice might (or might not) help reach the Quadruple Aim, including each of the four measures of : 1. Patient experience 2. Population health 3. Costs 4. Work life of healthcare providers (2 pages only no longer than 2 pages) APA FORMAT WITH REFERENCES & IN-TEXT CITATIONS

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2025 PLEASE FOLLOW THE INSTRUCTIONS AS INDICATED BELOW 1 ZERO 0 PLAGIARISM 2 ATLEAST 5 REFERENCES NO MORE

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Assignment: Off-Label Drug Use in Pediatrics 2025

PLEASE FOLLOW THE INSTRUCTIONS AS INDICATED BELOW 1). ZERO (0) PLAGIARISM 2). ATLEAST 5 REFERENCES, NO MORE THAN 5 YEARS (WITHIN 5YRS, OR LESS THAN 5YRS) 3). PLEASE SEE THE ATTACHMENT FOR RUBRIC DETAILS AND RECOMMENDED WRITING TEMPLATE AND APA 7 STYLE. 4). Please review and follow the grading rubric details, and include each component in the assignment as required. Also, follow the APA writing rules and style, Title page, summary, Conclusion, References. 5) Please, Include the Title page, Introduction, purpose statement, Literature Review, conclusion, and reference page. Thank you very much. The unapproved use of approved drugs, also called off-label use, with children is quite common. This is because pediatric dosage guidelines are typically unavailable, since very few drugs have been specifically researched and tested with children. When treating children, prescribers often adjust dosages approved for adults to accommodate a child’s weight. However, children are not just “smaller” adults. Adults and children process and respond to drugs differently in their absorption, distribution, metabolism, and excretion. Children even respond differently during stages from infancy to adolescence. This poses potential safety concerns when prescribing drugs to pediatric patients. As an advanced practice nurse, you have to be aware of the safety implications of the off-label use of drugs with this patient group. To Prepare Review the interactive media piece in this week’s Resources and reflect on the types of drugs used to treat pediatric patients with mood disorders. Reflect on situations in which children should be prescribed drugs for off-label use. Think about strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Consider specific off-label drugs that you think require extra care and attention when used in pediatrics. Write a 1-page narrative in APA format that addresses the following: Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples. Describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics. Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From Depression BACKGROUND INFORMATION The client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression. Client complained of feeling “sad” Mother reports that teacher said child is withdrawn from peers in class Mother notes decreased appetite and occasional periods of irritation Client reached all developmental landmarks at appropriate ages Physical exam unremarkable Laboratory studies WNL Child referred to psychiatry for evaluation MENTAL STATUS EXAM Alert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation, but does admit that he often thinks about himself being dead and what it would be like to be dead. You administer the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression) RESOURCES § Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services. PLEASE NOTE BELOW: I have provided all the decision points about the drugs. Decisions point one is to pick one medication to begin, either Zoloft, Paxil, or Wellbutrin. I provided all decision points under each drug to follow if any changes are to be made. For Zoloft: Decision Point One Begin Zoloft 25 mg orally daily RESULTS OF DECISION POINT ONE Client returns to clinic in four weeks No change in depressive symptoms at all Decision Point Two Increase dose to Zoloft 50 mg orally daily RESULTS OF DECISION POINT TWO Client returns to clinic in four weeks Depressive symptoms decrease by 50%. Client tolerating well Decision Point Three Maintain current dose Guidance to Student At this point, sufficient symptom reduction has been achieved. This is considered a “response” to therapy. Can continue with current dose for additional 4 week to see if any further reductions in depressive symptoms are noted. An increase in dose may be warranted since this is not “full” remission- Discuss pros/cons of increasing drug dose with client at this time and empower the client to be part of the decision. There is no indication that the drug therapy should be changed to an SNRI at this point as the client is clearly responding to this therapy. For Paxil: Decision Point One Begin Paxil 10 mg orally daily RESULTS OF DECISION POINT ONE Client returns to clinic in four weeks Reduction in The Children’s Depression Rating Scale by 5 points overall, but with complaints of nausea, vomiting, and diarrhea Decision Point Two Change to Prozac 10 mg orally daily RESULTS OF DECISION POINT TWO Client returns to clinic in four weeks There is a 25% reduction in symptoms, client’s side effects of nausea, vomiting, and diarrhea have resolved. Client reports that he is feeling a “little bit better” Decision Point Three Continue current dose Guidance to Student You have two equally compelling choices at this point. The client has only been taking the current drug at its current dose for 4 weeks. It would be appropriate to continue at current dose. Additionally, you could also increase the dose to 20 mg orally daily. A discussion of risk/benefits should be had with the childs guardian regarding this and collaborative decision making should occur. There is no indication at this point that augmentation agents are required as the child is showing a partial response to therapy. For Wellbutrin: Decision Point One Begin Wellbutrin 75 mg orally BID RESULTS OF DECISION POINT ONE Client returns to clinic in four weeks Child is unable to fall asleep at night Decision Point Two Change to Lexapro 10 mg orally daily RESULTS OF DECISION POINT TWO Client returns to clinic in four weeks Child is tolerating Lexapro, and is sleeping at night. There is a 40% reduction in symptoms Decision Point Three Continue current dose Guidance to Student At this point, there is no indicating that you should change back to Wellbutrin as the child is tolerating the current medication without mention of side effects. Also, the child is experiencing a reduction in symptoms. You could also increase the dose to 15 mg orally daily, but the child has only been taking the drug for 4 weeks at this point. It may be more prudent to give the current therapy an additional 4 weeks before making any decisions to change current dose.

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