CHAPTER 3, Conceptual Frameworks and Theories:

In completing the case study, students will be addressing the following learning objective:

Give examples of behavioral and cognitive-behavioral interventions.

The student nurse has been assigned a 37-year-old woman admitted to the psychiatric hospital with an anxiety disorder.  This morning, the student notices that the client has a tense facial expression and is walking constantly around the group room.   The student walked over to the client and used reflective communication by stating, “I see that you have a tense expression and are walking around almost all of the time.  Is there something that we could discuss?”  The client replied that she has talked on the telephone to her mother who was keeping her children while she was in the hospital.  The client said that her mother had told her that she was not a good mother, and then said, “I guess I am a bad mother, but I could never measure up to my mother’s expectations.”  The student has learned that negative self-talk can greatly aggravate anxiety and lead to depression.  The student decided to use a behavioral intervention with the client and asked the client who is a good artist and why the client liked the artist’s works. The student and the client then made a list of activities that the client liked. The student taught the client to engage in one of these activities when an unpleasant experience evoked negative thoughts.  The following day, the student decided that the client needed some cognitive restructuring for her relationship with her mother.  The student taught the client that during discussions with her mother, feelings of incompetence might be experienced when the mother made negative comments.  The client was instructed that if her mother made negative comments about parenting, she was to immediately tell her mother that she was a good parent to her children and terminate the conversation at the first opportunity.

(Learning Objective: 3)

a. Will the client be able to learn cognitive restructuring in her relationship with her mother?

  b.    How will engaging in activities help the client with her anxiety?

Question

1. In Parkinson disease (PD), the basal ganglia influences the hypothalamic function to produce which grouping of clinical manifestations?

Inappropriate diaphoresis, orthostatic hypotension, constipation, and urinary retention

Asymmetric, regular, rhythmic tremors with slow alternating flexion and extension contractions

Involuntary contractions of skeletal muscles that impair active and passive movement

Bradykinesia of chewing, swallowing, and articulation

Question 2. Which is a characteristic of brainstem death?

Vegetative state

Comatose

Apnea

Locked-in syndrome

Question 3. With receptive dysphasia (fluent), the individual is able to

respond in writing, but not in speech.

speak back, but not comprehend speech.

comprehend speech, but not respond verbally.

respond verbally, but not comprehend speech.

Question 4. The body compensates to a rise in intracranial pressure by first displacing

cerebrospinal fluid (CSF).

arterial blood.

venous blood.

cerebral cells.

Question 5. Dementia is characterized by

deficits in attention and coherence of thought.

easy distractibility and poor concentration.

loss of recent and remote memory.

irritability, agitation, and restlessness.

Question 6. Which dyskinesia involves involuntary movements of the face, trunk, and extremities?

Paroxysmal

Tardive

Hyperkinesia

Cardive

Question 7. Vomiting is associated with CNS injuries that compress which anatomic location(s)?

Vestibular nuclei in the lower pons and medulla oblongata

Floor of the third ventricle

Vestibular nuclei in the midbrain

Diencephalon

Question 8. Cognitive operations cannot occur without the _____ functioning.

pons

medulla oblongata

reticular activating system

cingulate gyrus

Question 9. What are the initial clinical manifestations noted immediately after a spinal cord injury?

Headache, bradycardia, and elevated blood pressure

Confusion, irritability, and retrograde amnesia

Loss of deep tendon reflexes and flaccid paralysis

Hypertension, neurogenic shock, and tachycardia

Question 10. Which clinical manifestation is characteristic of cluster headaches?

Aura before the headache with photophobia and nausea and vomiting

Severe unilateral tearing, burning, or temporal pain

Gradual onset of bilateral pain with sensation of a tight band around the head

Throbbing headache with intermittent burning sensation

Question 11. A man who sustained a cervical spinal cord injury 2 days ago suddenly develops severe hypertension and bradycardia. He reports severe head pain and blurred vision. The most likely explanation for these clinical manifestations is that he is

experiencing acute anxiety.

developing spinal shock.

developing autonomic hyperreflexia.

experiencing parasympathetic areflexia.

Question 12. The most severe diffuse brain injury caused by rotational acceleration is most likely to be located in the

diencephalon to the brainstem.

medial portion of the brainstem.

entire brainstem.

diencephalon.

Question 13. Which neurotransmitter is reduced in people with schizophrenia?

Dopamine

Gamma-aminobutyric acid (GABA)

Acetylcholine

Serotonin

Question 14. Which is a positive symptom of schizophrenia?

Blunted affect

Auditory hallucinations

Poverty of speech

Lack of social interaction

Question 15. Hypothalamic-pituitary-adrenal (HPA) system abnormalities exist in a large percentage of individuals with

schizophrenia.

major depression.

mania.

panic disorder.

Question 16. The life-threatening problems associated with myelomeningocele include

upward displacement of the cerebellum into the diencephalon.

motor and sensory lesions below the level of the myelomeningocele.

downward displacement of the cerebellum, brainstem, and fourth ventricle.

encephalitis causing generalized cerebral edema and hydrocephalus.

Question 17. The neural groove closes dorsally during the _____ week of gestational life.

second

fourth

eighth

twelfth

Question 18. Anterior midline defects of neural tube closure cause developmental defects in the

brain and skull.

spinal cord.

vertebrae.

peripheral nerves.

Question 19. Which statement is false regarding the pathophysiology of acute pancreatitis?

Pancreatic acinar cells metabolize ethanol, which generates toxic metabolites.

Injury to the pancreatic acinar cells permits leakage of pancreatic enzymes that digest pancreatic tissue.

Acute pancreatitis is an autoimmune disease in which IgG coats the pancreatic acinar cells so they are destroyed by the pancreatic enzymes.

When gallstones are present, bile flows into the pancreas, contributing to attacks.

Question 20. The desire to eat is stimulated by

agouti-related protein (AgRP).

alpha-melanocyte–stimulating hormone (?-MSH).

cocaine- and amphetamine-regulated transcript (CART).

peptide YY (PYY).

Question 21. The most common manifestation of portal hypertension induced splenomegaly is

leukopenia.

thrombocytopenia.

erythrocytopenia.

pancytopenia.

Question 22. Incomplete fusion of the nasomedial or intermaxillary process during the fourth week of embryonic development causes

cleft palate.

sinus dysfunction.

cleft lip.

esophageal malformation.

Question 23. At 2 or 3 weeks of age, an infant who has been fed well and gained weight begins to vomit for no apparent reason. The vomiting has gradually become more forceful. These symptoms may be indicative of which disorder?

Esophageal atresia

Congenital aganglionic megacolon

Pyloric stenosis

Galactosemia

Question 24. Hepatitis _____ in children is primarily associated with blood transfusions.

A

B

C

D

Question 25. Meconium _____ is an intestinal obstruction caused by meconium formed in utero that is abnormally sticky and adheres firmly to the mucosa of the small intestine.

cecum

ileus

obstruction

vivax

 

 

 

NRS 410V Module 3 Case Study 2..6.5

Case Study 2

Mr. P is a 76-year-old male with cardiomyopathy and congestive heart failure who has been hospitalized frequently to treat CHF symptoms. He has difficulty maintaining diet restrictions and managing his polypharmacy. He has 4+ pitting edema, moist crackles throughout lung fields, and labored breathing. He has no family other than his wife, who verbalizes sadness over his declining health and over her inability to get out of the house. She is overwhelmed with the stack of medical bills, as Mr. P always took care of the financial issues. Mr. P is despondent and asks why God has not taken him.

Question:

Considering Mr. Ps condition and circumstance, write an essay of 500-750 words that includes the following:

Describe your approach to care.

Recommend a treatment plan.

Describe a method for providing both the patient and family with education and explain your rationale.

Provide a teaching plan (avoid using terminology that the patient and family may not understand).

View the scenario called “Critical Decision Making for Providers” found in the Allied Health Community media (http://lc.gcumedia.com/hlt307v/allied-health-community/allied-health-community-v1.1.html)

In a 750-1,200 word paper, describe the scenario involving Mike, the lab technician, and answer the following questions:

1.   What were the consequences of a failure to report?

2.   What impact did his decision have on patient safety, on the risk for litigation, on the organization’s quality metrics, and on the workload of other hospital departments?

3.   As Mike’s manager, what will you do to address the issue with him and ensure other staff members do not repeat the same mistakes?

A minimum of three academic references from credible sources are required for this assignment.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a grading rubric. 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. Refer to the directions in the Student Success Center. Only Word documents can be submitted to Turnitin.

 

Rubric:

1.     Thesis and/or main claim are comprehensive; contained within the thesis is the essence of the paper. Thesis statement makes the purpose of the paper clear.

2.     There is a sophisticated construction of paragraphs and transitions. Ideas progress and relate to each other. Paragraph and transition construction guide the reader. Paragraph structure is seamless.

3.     Writer is clearly in command of standard, written, academic English.

4.     All format elements are correct.

5.     In-text citations and a reference page are complete. The documentation of cited sources is free of error.

 

DON’T WASTE MY TIME IF YOU DO NOT HAVE THE TIME TO DO QUALITY WORK PLEASE !!!

 

Select one of the following topics for your project.

 

1. You have been appointed to chair a hospital-wide committee to develop and implement a plan to improve patient satisfaction in your facility. Your Chief Nursing Officer has provided you a summary report indicating a steady decline in patient satisfaction over the previous six months. You will need to identify the various resources available for tracking patient satisfaction, establish a clear bench mark and design a specific plan of action for reversing this trend. It is essential to note in your development that research has shown nurse communication and hourly rounding to be key drivers in patient satisfaction metric improvements. These points should be a focus of your change initiative.

 

2. The prevention of Hospital Acquired Infections (HAIs) is a key focus for healthcare organizations of late. Infections acquired during admission not only affect patient care outcomes, but are of high impact to the financial operations of the organization as reimbursement is directly affected. Identify a particular HAI as the focus of your change management and develop a plan to reduce and/or eliminate HAIs in a particular patient population in the facility.

 

3. Meaningful Use is a hot topic relative to initiatives from the Centers for Medicare and Medicaid Services (CMS). As we move to a virtual, interactive medical record that transcends physical walls of organizations and primary care providers, it is essential that nurses embrace the Electronic Medical Record (EMR) and its documentation capabilities. Devise a plan for improvement of at least two Meaningful Use metrics for your facility; ensure you include education and monitoring as key relative to the established benchmarks from CMS.

 

 

 

 

 

Each student will produce a plan for implementing a change project in nursingdepartments throughout theorganization.You will beginby selecting oneoftheoptionsprovided in module oneandproposeachange to solve the problem. If you do not select one of the provided options you will not receive credit for this assignment. Then you will select one of the change theories you have studiedthat modelshowyouwant toimplementtheproposedchange. Youwillconducta SWOTanalysisanddevelop a comprehensive action plan. You will create a PowerPoint presentation of your planwith a“script”intheNotessection below each slide, asifyouarepresentingthistoanaudience. These will be your speaker notes as if you are presenting your PowerPoint to an audience. You MUST have a notes section for your slides. There will be a 50 point deduction if notes are not present. (The Notes section can be found below each slide within the PowerPoint presentation).

 

Duringandafteryourwork,youwillexaminethetypesofcommunications,decision-making processes,andprocessesyouuse,andcommentuponthoseinthelastpartofthe“script.”

 

 

 

 

PLEASE SEE RUBIC ATTACHMENT FOR REQUIREMENTS AND REFERENCES NEEDED FOR THE POWER POINT AS WELL AS THE NOTES THAT ALSO HAVE TO BE REQUIRED. IF YOU DONT HAVE THE TIME TO DO THIS WELL PLEASE DO NOT WASTE MY TIME AND MONEY