nursing assessment 2025

Lat…. Week 3 discussion An anxious patient is having rapid and shallow breathing. After a few moments, he complains of a tingling sensation. What could be the causes of this tingling sensation? What are the various patterns of respiration and their significance? Ethnicity and culture influence risk factors for heart disease. Do you agree? Why or why not? What is the technique of percussion and palpation of the chest wall for tenderness, symmetry, bulges, fremitus, and thoracic expansion? Explain. Would you anticipate hearing hyper-resonance on a patient with a history of tobacco use? Why or why not? What are the mechanics of breathing with reference to lung borders and the anatomical structure of the lungs and diaphragm? The patient is having rapid and shallow breathing because of a decrease in Co2 in the blood to the extremities. The patient is experiencing hyperventilation. This could be a result of a panic attack or cardiac related. Norml respirations between 12-20 breaths/min. The chest expands and falls with a normal and even rate and rhythm Tachypnea: Respiratory rate that is above 20 breath/min. Some things that can cause this change is fever, pain, anxiety, respiratory issues. Bradypnea: Respiratory rate below 12 breaths per/min. Some causes of this could be certain medications such as narcotics or sedatives. Cheyene Stokes: Deep shallow breathing with periods of apnea. This could be in relation to renal faluire or drug overdose. African Americans are at a higher risk for devoloping heart disease due to genetics. Yes, I do agree because African Americans consume alot of sodium in their diet, and are geneticly sensitive to salt consumption which causes an increase in blood volume and raises blood pressure. Palpitation: Stand behind the patient and place your thumbs at the 10 th rib. Your hands will be out with thumbs touching. You can ask your patient to take a deep breath and you would watch for symmetry movement on your thumbs. During this point in the examination you will ask the patient to say ninety-nine as you bring your hands down along the sides of chest. You should have the same type of vibration throughout as you make your way down. To feel for bulges you would assess both posteriorly and anteriorly. You would use the tips of your fingers and gently palpate the area below the breast tissue. Percussion: You can perform the anterior assessment this way with your patient lying down. Then, strike the finger placed on the patient’s skin with the end of the middle finger of your dominant hand. You are listening and feeling for differences. For someone that has a history of tobacco use, I would anticipate hyper resonance because tobacco use can cause emphysema or COPD. The action of breathing in and out is due to changes of pressure within the thorax, in comparison with the outside. This action is also known as external respiration . When we inhale the intercostal muscles (between the ribs) and diaphragm contract to expand the chest cavity. The diaphragm flattens and moves downwards and the intercostal muscles move the rib cage upwards and out. This increase in size decreases the internal air pressure and air from the outside (at a now higher pressure that inside the thorax) rushes into the lungs to equalise the pressures. When we exhale the diaphragm and intercostal muscles relax and return to their resting positions. This reduces the size of the thoracic cavity, thereby increasing the pressure and forcing air out of the lungs

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Describe two external stressors that are unique to adolescents 2025

opic 3 DQ 2 Adolescence is a period of growth and development that occurs between childhood and adulthood. As they continue to form an identity, they face many difficulties in integrating themselves into society; they do not belong to either the childhood or adult groups. Any transition that upsets the balance of our lives and forces us to adapt is referred to as a stressor. Stress may be described as physical or mental tension experienced as a result of life events. They don’t stress factors affecting adolescents are here or social stressor and self-esteem and sexual stressor. Rejections when they begin to form intimate relationships, teasing or being teased, as this is the moment that teenage bodies are undergoing physical changes such as weight gain, awkwardness, acne growth, and so on, are all possible peer or social stressors. Other sources of tension during this time include education and the need to excel, dealing with a family crisis, and online social lives. Self-esteem and sexual stressors are normal in puberty as their bodies shift, they continue to develop sexual identities, and self-esteem may be low. An adolescent’s life revolves around fitting in, and identifying sexually outside of what is considered normal (i.e., bisexual, homosexual, transgender/gender neutral) can be stressful. Society does not often tolerate these kinds of sexual identities, and their bullying, teasing, gossip, and family rejection of their decisions contribute to a poor sense of self-esteem. As a result, when puberty is confronted by stressors like these, they feel depressed and resort to action to cope. Social avoidance, behaving violently against others, or self-abuse, as well as consuming alcohol or using drugs, are examples of those behaviors. When these fails to properly relive the stress experienced by the teenager, they may consider or attempt suicide. Any of the reinforcement or coping mechanisms that may be used are mentioned below. Since nurses’ assessments are critical for understanding stressor signs and symptoms, this would help nurses to understand how the teenager is feeling and speak about it when their adult is not present. As a result, they would feel more at ease debating those topics. We will teach them to talk about their feelings by giving them things to talk about that they are comfortable with. When it comes to suicidal thoughts or acts, ask them simple questions. To ease tension, encourage healthy coping skills such as sports or exercise, listening to music, or praying. If they don’t feel comfortable talking about their emotions, they can write them down in a diary as a stress reliever. Giving them information about support groups where they can go on their own and get assistance is another informative opportunity. Some of the support groups- self-esteem: Teens Health.org, gender identity question or stress associated with the subject: gay, lesbian and straight education Network (www.gisen.org), Bullying: www.bullying.org or kidshealth.org. Depression and suicide are complex issues and get torn on the flesh for adolescents. It is important for nurses to use communication and sensitivity in education for this group. Respond using 200-300 words APA format with references supporting the discussion. Describe two external stressors that are unique to adolescents. Discuss what risk-taking behaviors may result from the external stressors and what support or coping mechanism can be introduced.

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Medical Coding 2025

1) Assign CPT code(s) and appropriate modifiers to each statement. The physician performed a complex repair during resection of the diaphragm and closed the residual defect with synthetic graft material. 2) Mediastinotomy to remove foreign body using transthoracic approach, including median sternotomy. 3) Patient underwent repair, laceration of diaphragm. 4) Physician inserted a mediastinoscope through an incision in the sternal notch and performed a mediastinal lymph node biopsy. 5) Physician repaired an acute traumatic diaphragmatic hernia. Patient underwent alveoloplasty to remove sharp areas or undercuts of alveolar bone, one quadrant. Surgeon used a scalpel to slice off a cancerous portion of the vermillion border of the patient’s lip: mucosal advancement was performed after excision. Surgeon made an incision through submucosal tissue and removed a lesion in the vestibule of the mouth. Wound repair was not required. Patient underwent simple incision of the lingual frenum to free the tongue. Patient underwent incision in the parotid gland to remove calcified stone. Surgeon repaired a tear at the pharyngeal esophageal junction. Physician drained and abscess near the tonsil. Surgeon removed an 8 year old patient’s tonsils and adenoids. Physician controlled secondary oropharyngeal hemorrhaging, status post tonsillectomy, by using cellulose sponges that expanded when placed in the tonsillar cavity. Physician performed a tonsillectomy on a 12 year old male patient. Physician inserted a flexible esophagoscope into the esophagus and destroyed a lesion, using snare technique. Surgeon made an incision in the left posterior chest wall into the esophagus to remove a foreign body from the esophagus. Physician inserted a balloon endoscopically for tamponade of bleeding esophageal varices. Dr. Smith performed a partial cervical esophagectomy while Dr. Jones performed a jejunum transfer with microvascular anastomosis. The physyician passed an endoscope through the patient’s mouth and visualized the entire esophagus, stomach, duodenum, and jejunum. One lesion was removed using biopsy forceps. Another was remove using snare. Patient underwent incision of the pyloric muscle. The physician performed an open revision of a previously performed gastric restrictive procedure and reversed the previously partitioned stomach to restore normal gastrointestinal continuity. Using fluoroscopic guidance, the physician repositioned a gastric feeding tube through the duodenum. The physician performed a laparoscopic surgical gastric restrictive procedure with gastric bypass and roux-en-Y gastroenterostomy. The physician percutaneously place a gastrostomy tube into the stomach under fluoroscopic guidance including contrast injection(s), image documentation.

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Examine Case Study: Pakistani Woman with Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmaco 2025

Week 6: Antipsychotic Therapy According to the National Alliance on Mental Illness, approximately 100,000 people experience psychosis in the United States each year (NAMI, 2016). In practice, clients may present with delusions, hallucinations, disorganized thinking, disorganized or abnormal motor behavior, as well as other negative symptoms that can be disabling for these individuals. Not only are these symptoms one of the most challenging symptom clusters you will encounter, many are associated with other disorders such as depression, bipolar disorder, and disorders on the schizophrenia spectrum. As a psychiatric mental health nurse practitioner, you must understand the underlying neurobiology of these symptoms to select appropriate therapies and improve outcomes for clients. This week, as you examine antipsychotic therapies, you explore the assessment and treatment of clients with psychosis and schizophrenia. You also consider ethical and legal implications of these therapies. Photo Credit: Ingram Publishing/Getty Images Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia Psychosis and schizophrenia greatly impact the brain’s normal processes, which interferes with the ability to think clearly. When symptoms of these disorders are uncontrolled, clients may struggle to function in daily life. However, clients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with psychosis and schizophrenia. Learning Objectives Students will: · Assess client factors and history to develop personalized plans of antipsychotic therapy for clients · Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring antipsychotic therapy · Evaluate efficacy of treatment plans · Analyze ethical and legal implications related to prescribing antipsychotic therapy to clients across the lifespan Learning Resources Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus. Required Readings Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear. Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press. To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter. · Chapter 4, “Psychosis and Schizophrenia” · Chapter 5, “Antipsychotic Agents” Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press. To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication. Review the following medications: amisulpride aripiprazole asenapine chlorpromazine clozapine flupenthixol fluphenazine haloperidol iloperidone loxapine lurasidone olanzapine paliperidone perphenazine quetiapine risperidone sulpiride thioridazine thiothixene trifluoperazine ziprasidone Naber, D., & Lambert, M. (2009). The CATIE and CUtLASS studies in schizophrenia: Results and implications for clinicians. CNS Drugs, 23 (8), 649-659. doi:10.2165/00023210-200923080-00002 Note: Retrieved from Walden Library databases. Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261-276. Note: Retrieved from Walden Library databases. Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine. Retrieved from https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf Walden University. (2016). ASC success strategies: Studying for and taking a test. Retrieved from http://academicguides.waldenu.edu/ASCsuccess/ASCtesting Required Media Laureate Education. (2016j). Case study: Pakistani woman with delusional thought processes [Interactive media file]. Baltimore, MD: Author Note: This case study will serve as the foundation for this week’s Assignment. Optional Resources Chakos, M., Patel, J. K., Rosenheck, R., Glick, I. D., Hammer, M. B., Tapp, A., & … Miller, D. (2011). Concomitant psychotropic medication use during treatment of schizophrenia patients: Longitudinal results from the CATIE study. Clinical Schizophrenia & Related Psychoses, 5 (3), 124-134. doi:10.3371/CSRP.5.3.2 Fangfang, S., Stock, E. M., Copeland, L. A., Zeber, J. E., Ahmedani, B. K., & Morissette, S. B. (2014). Polypharmacy with antipsychotic drugs in patients with schizophrenia: Trends in multiple health care systems. American Journal of Health-System Pharmacy, 71 (9), 728-738. doi:10.2146/ajhp130471 Lin, L. A., Rosenheck, R., Sugar, C., & Zbrozek, A. (2015). Comparing antipsychotic treatments for schizophrenia: A health state approach. The Psychiatric Quarterly, 86 (1), 107-121. doi:10.1007/s11126-014-9326-2 To prepare for this Assignment: · Review this week’s Learning Resources. Consider how to assess and treat clients requiring anxiolytic therapy. The Assignment Examine Case Study: Pakistani Woman with Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. At each decision point stop to complete the following: · Decision #1 o Which decision did you select? o Why did you select this decision? Support your response with evidence and references to the Learning Resources. o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. o Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different? · Decision #2 o Why did you select this decision? Support your response with evidence and references to the Learning Resources. o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. o Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different? · Decision #3 o Why did you select this decision? Support your response with evidence and references to the Learning Resources. o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. o Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different? Also include how ethical considerations might impact your treatment plan and communication with clients. Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

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The Lifestyle and Health Practices Profile is to be submitted at the end of Week 2. 2025

Purpose This assignment is to help you gain insight regarding the influence of an individual’s lifestyle and health-related practices, on their opportunities for health promotion. You are to obtain a lifestyle and health practices profile using yourself as the client, and then practice analyzing the data to formulate a health promotion nursing diagnosis. Course Outcomes This assignment enables the student to meet the following Course Outcomes. CO1: Utilize prior knowledge of theories and principles of nursing and related disciplines to explain expected client behaviors, while differentiating between normal findings, variations, and abnormalities. (PO #1) CO5: Explore the professional responsibilities involved in conducting a comprehensive health assessment and provide appropriate documentation. (PO #6) Note: This assignment must be answered on the form in the attached. The description and format is on the form uploaded. Not less 500 words. Please see the grading criteria and rubrics on the attachment. This assignment is worth a total of 200 points.

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