Assignment:

Respond to at least two of your colleagues by providing an additional scholarly resource that supports or challenges their position along with a brief explanation of the resource.

Each response must have at least 2 references no more than five years old

Colleagues Response # 1

Psychotherapy and biological basis

         I believe that psychotherapy has a biological basis and there continues to be emerging evidence supporting this. Psychotherapy has ability to touch many aspects of the clients lives to include self-esteem. Family, work, and relationships (Laureate Education, 2016). Psychotherapy can work alone or in conjunction with psychopharmacology and it is often the first line of treatment (Laureate Eductaion, 2016).

         There have been studies on brain changes after psychotherapy for depression, anxiety disorders, and borderline personality disorder that have been published (Karlsson, 2011). Studies have focused on comparing behavior therapy against psychopharmacologic agents such as antidepressants and the changes in the brain with both modalities. “In the recent study by Karlsson and colleagues, clear differences emerged between short-term psychodynamic psychotherapy and fluoxetine among patients with MDD” (Karlsson, 2011).

           Many psychotherapies attempt to enhance patients’ problem-solving capacities, self-representation, and regulation of affective states. The brain areas that play a role in these functions include the dorsolateral prefrontal cortex, ventral anterior cingulate cortex, dorsal anterior cingulate cortex, ventral and dorsal subregions of the medial prefrontal cortex, posterior cingulate cortex, precuneus, insular cortex, amygdala, and ventrolateral prefrontal cortex. For example, the mechanism behind the effectiveness of cognitive therapy for patients with MDD could be through an increase in prefrontal function, which is involved in cognitive control, while antidepressant medications operate more directly on the amygdala, which is involved in the generation of negative emotion (Karlsson, 2011).

Culture, religion, and socioeconomic influences on the perception of psychotherapy treatment

It is important for the advanced nurse practitioner to always treat each client in a holistic manner because each client differ, based on their cultural, religion beliefs, and socioeconomic background. Culture and beliefs affect many aspects of psychosocial intervention, and cultural assessment will be imperative during the initial treatment phase. This assessment will facilitate the groundwork for treatment outcomes and interventions, indicated to tailor the treatment plan to the individual treating. Cultural evaluations completed by the healthcare professional will promote the trust that is imperative in a professional therapeutic relationship (Wheeler, 2014).

Some patient’s may have strong spiritual beliefs which provides stabilization in the treatment hierarchy framework for practice (Wheeler, 2014). And individuals’ spiritual beliefs are often a significant strength and/or protective factor that the health professional can utilize to assist with recovery or coping and in addition, incorporating the spiritual aspect of life into therapy ensures that existential needs are not swept under the carpet with psychological/psychiatric terms (such as depression) (Brown, Elkonin,  & Naicker, 2013).

Socioeconomic factors may determine if the client would have access to care, if the client would be adherent to the treatment and if the outcome would be successful or not. According to Hawley, Leibert, & Lane, (2014), socioeconomic Status affects therapeutic outcomes and significance of therapeutic intervention because client’s educational level and benefits of health insurance have shown greater compliance with the treatment regimen, therefore, improving client outcome and follow-up.

For Nurse Practitioners to successfully diagnose and treat mental illness ethnicity, religion, race, social, economic Status, and culture are imperative to address, and with the competence gained during the initial goal setting and assessment all the factors above must be thoroughly assessed and discussed (Wheeler, 2014). Preparing for successful intervention will encompass the whole patient to include support, socioeconomic means to healthy living and personal spiritual beliefs will identify what drives the client internally for holistic health.

Colleagues Response # 2

Explanation of Whether Psychotherapy Has a Biological Basis

           Psychotherapy is an interaction between a trained professional and a patient to explore thoughts, feelings, and behaviors with the goal of problem-solving or achieving higher levels of functioning (American Psychiatric Association, 2016). Psychotherapy can be helpful with problems like issues in coping with daily life; traumatic life event, medical illness or loss of a loved one; and specific mental disorders, like depression or anxiety (American Psychiatric Association, 2016).  For example, to show that psychotherapy has a biological basis on the brain and the body, In a study with a client suffering from PTSD who participate in psychotherapy show marked improved dysfunctional cognitive coping strategies and blood pressure  compare with those with no therapy (Schubert et al., 2019). Just like learning to perceive and incorporate new informations, views, and internal processing, psychotherapy produces lasting, detectable physical changes in the brain (Kandel, 2014).

Cultural influences on Psychotherapy Treatments

For an APPN to treat and diagnose mental illness effectively, the APPN must consider the patient culture, religion and socioeconomics influences to recommend the appropriate psychotherapy treatments (Wheeler, 2014). Although it is not possible to have a vast knowledge base regarding all cultures, practitioners should have a working knowledge of the client’s background and research their culture (Wheeler, 2014). Using generalized knowledge of culture will not be appropriate to work with diverse population.  If the practitioner has conflicting information of the client’s culture, asking question will help build a rapport with the client. For example, a Spanish woman hearing voices of her death husband does not mean she is psychotic. As a practitioner, with the knowledge of different culture, he will not prescribed treatment since what the patient is experiencing is cultural related (Wheeler, 2014).

Religious influences on Psychotherapy Treatment

           It is important to consider religion in psychotherapy sessions.  Some therapeutic tools such as meditation, prayer, spiritual journaling, forgiveness protocols, using biblical texts to reinforce healthy mental and emotional habits can lead clients to let go of unhealthy anger and move past an abusive situation without justifying the abuse (Kersting, 2015). Clients with religious or spiritual background will be sensitive and willing to interact religiously. Thereby helping them to trust the therapist and hence brings some positive aspect of the human experience in the therapy room. Some people describe the beauty of spiritually guided therapy as experiencing a third presence in the room a spiritual presence or a God presence. There’s a mystery being revealed to the patient in that presence; it is a sort of an epiphany that can be extremely useful in therapy (Kersting, 2015). As being religious can shape culture, being empathetic to patient’s beliefs and incorporating them into therapeutic plan enhances professional dialogue in a therapeutic meaning (Dilip, Barton & Elyn, 2017).When  the client have a relationship of confidence and empathy with their psychotherapist, there is an efficacy of the treatment

Socioeconomics Influences on psychotherapy Treatment

Socioeconomic factors can hinder clients from getting psychotherapy. Most client who don’t have insurance are unable to pay for services, they are more likely to be discouraged from seeking treatment.  Hawley, Leibert, and  Lane, (2014), noted that social, economic status has a significant influence on therapy. In a research study, results show that  with higher education and access to health insurance even at a free counseling clinic may improve counseling outcome and retention.  The study also pointed out individuals with lower social, economic status levels as having greater dysfunction and greater goal disagreement about treatment has less successful counseling outcomes. These patients are less motivated and lack social support (Hawley, Leibert & Lane, 2014). There are community based services that are also offer for free or low cost based on income. It is also important to know that those with low income have life problems and mental illness as well as client with higher income. ( Jeste, Palmer, Rettew & Boardman, 2015).

Conclusively, for an PMHNP to diagnose and treat mental illness effectively,  they must considered the ethnicity, religion, race, social, economic status, and culture of the client Even though, it is not possible to culturally be competent in all cultures, a working knowledge of the backgrounds of those who most seek treatment is essential (Wheeler, 2014).

 

The class will be placed by the instructor into groups. Each team member will personally interview one leader of his/her choice. Examples of leaders can include, but are not limited to, former or current managers or supervisors, educational leaders, civic/business leaders, and religious leaders. This interview can take place via phone, via e-mail, or in person.

To ensure that the interviews yield comparable results, the team must prepare a list of questions to ask the chosen leaders (interviewees). As a team, choose four questions from the list below:

1. What are the most important qualities an effective leader should have?
2. What is the importance of trust in leadership?
3. What are the qualities you want most in an employee? Why?
4. Who has had the most influence on how you lead? Why?
5. In what areas would you like to improve your leadership?
6. How do your employees react to your leadership?
7. Have you engaged in 360-degree feedback? If so, what has been the result?
8. What is the role of effective communication in leadership?
9. How would you rate yourself at being able to communicate with all your important stakeholders?

In addition to the four interview questions your team will use from the above list, as a group, generate two more questions, for a total of six interview questions. Please note: Each team member is required to ask his/her chosen leaders the same interview questions so you must decide as a team which questions you will ask.

After conducting the interview, each team member will individually create a leadership profile of his/her chosen leader within a PowerPoint presentation (5-6 slides). Be sure to include the following in your individual leadership profile:

1. A slide that introduces your chosen leader
2. A summary of the answers to the interview questions
3. A description of the leadership model with which the leader seems most closely aligned

Write a Senior Project Summary paper on the selected topic from Week One. In your paper include the following:(2-3 PAGES ONLY)

1. Title Page 
   1. Anticipated title (this may change for the completed project)
   2. Your name
   3. Course name and number
   4. Instructor’s name
   5. Date submitted
2. Introduction: Provide a description of your selected topic (i.e., health care trend) and a thesis statement. Identify the organization that you have chosen to address, including why the issue of your selected topic is important to the health care administrators in your organization, and to the health care industry in general. This should be about one-third of a page.
3. Scope of the Senior Project: This section should summarize the content topics and sub-topics related to the health care trend that will be addressed in the Senior Project.
4. Discussion: This section should be a constructive and analytical overview of what was found in the scholarly and professional literature. Make sure to discuss the pros/cons or strengths/weaknesses of the stakeholder group impacted (e.g., patient, provider, third-party payer, administrator, legislator, etc.) as applicable. In developing this section, it is important to demonstrate your understanding of the topic and the interventions and influences. This should be about one page.
5. Conclusion:  Provide a summary of the main effects of the contemporary health care trend on costs, quality, and access to services as it impacts various stakeholder groups.
6. Reference Page
7. The Senior Project Summary should be two- to- three pages (excluding title and reference pages) in APA format as outlined in the Ashford Writing Center

 

Chief complaint: “I’m here for a medication refill because I ran out of my medicines”.

HPI:  Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.

She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.

PMH: Primary Hypertension, Previous history of MI 1 year ago

Surgeries:

1 year ago-Left Anterior Descending (LAD) cardiac stent placement

Allergies: Penicillin

Vaccination History:  Up-to-date

Social history:

High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.

Family history:

Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.

ROS:

Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.

Psychiatric: Non-contributory.

Physical examination:

Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111,  R 22 and non-labored

HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: + Heberden’s nodes at the DIP joints, hands. + Crepitus, bilateral knees. Slow gait but steady. No Kyphosis. PSYCH: Normal affect. Cooperative. SKIN: No rashes. Positive for dry skin.

Labs: Hgb 13.2, Hct 38%, K+ 4.0, Na+137, Cholesterol 228, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.

A:

Primary Diagnosis: Congestive Heart Failure (CHF)

Secondary Diagnoses: Primary Hypertension, Obesity, Osteoarthritis (OA)

Differential Diagnosis: Peripheral Vascular Disease (PVD)

Plan:

Medications: Tylenol 650 mg PO Q4 hours as needed for arthritis pain

Labs: UA; Brain natriuretic peptide (BNP); LFTs and TSH; 12-lead EKG, Chest X-ray; Initial 2D echo with Doppler; Ankle-brachial index.

Additional lab results: Echo results 1 week ago: Left ventricular EJ Fraction decreased to 35 %

BNP – not available.

As a future FNP, you need to determine the medications for CHF/ASCVD. (Arteriosclerotic Cardiovascular Disease).

Questions:

1.     According to the ACC/AHA guidelines, what medications should this patient be prescribed?

2.     Does he need medication(s) given his history of MI?

the test is for my Health Science terminology class it is on chapters 1-8. will be available under Content on Monday, July 9, 2018 from 6 AM-7PM. You have one attempt. There will be 50 questions. You will have 90 minutes. i will give you my log in and password. There is only one attempt.

Chapter 1. The Anatomy of Medical Terms

Chapter 2. The Body as a Whole

Chapter 3. The Integumentary System

Chapter 4. The Skeletal System

Chapter 5. Muscles and Tendons

Chapter 6. The Cardiovascular and Circulatory Systems 

Chapter 7. The Blood, Lymphatic, and Immune Systems

Chapter 8. The Respiratory System