Assgn 2 – WK10 (C)

Practicum: Decision Tree

Childhood psychosis is extremely rare; however, children that present with psychosis must be carefully assessed and evaluated with appropriate interviewing of parent, child, and use of assessment tools.

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 early onset schizophrenia.

The Assignment:

Examine Case 3. You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment. 

(N: B. A CASE STUDY WITH ANSWER SAMPLE IS ATTACHED WITH THIS ASSIGNMENT)

At each Decision Point, stop to complete the following:

                                          · Decision #1: Differential Diagnosis

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: Treatment Plan for Psychotherapy

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: Treatment Plan for Psychopharmacology

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 and their families.

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.

                                                                      Case #3
A young girl with strange behaviors

BACKGROUND

            Carrie is a 13-year-old Hispanic female who is brought to your office today by her mother and father. They report that they were referred to you by their primary care provider after seeking her advice because Carrie’s behavior has been difficult to manage, and they don’t know what to do.

SUBJECTIVE

            Carrie’s parents report that they have concerns about her behavior, which they describe as sometimes “not normal for a 13-year-old.” They notice that she talks to people who aren’t real. Her behavior is calm and “passive.” Her parents noted that when she was younger, she was irritable at times, but have noticed that this has given way to passivity. Her parents state that they understand that it’s normal for younger children to have “imaginary friends,” but they feel that at    

           Carrie’s age, she should have grown out of these behaviors. Carrie’s parents report that she has friends that are half-cat and half-human, and “spirits” who speak with her “in her head.” She also reports that the people on television know when she is home and that they have certain shows “just for her.”

           Carrie’s parents report that they have taken her to her pediatrician who has given her a “clean bill of health.” Carrie’s parents note that they had some early concerns as she was lagging in meeting developmental milestones. Initially, when she first started school, Carrie managed to keep up with her peers in terms of academic performance, but she was noticed by her teachers to be isolative. It was also noted by her teachers and guidance counselor that Carrie’s social skills do not seem to match what they see in other children her age. Initially the school counselor suspected that Carrie may have been suffering from attention deficit hyperactivity disorder (primarily inattentive type), but now is not certain and has recommended a psychiatric evaluation. Her grades were “ok” in school up until last year when she left junior high school, and entered high school, where the academic demands began to increase. Carrie’s teachers had wanted to hold her back a grade, but her parents acknowledge that they were “insistent” that this did not happen. Now they are describing some regrets over this as Carrie seems “more lost than ever” in her schoolwork. Carrie’s mother produced a copy of a paper that Carrie had to submit as a homework assignment. You attempt to read the assignment, but there does not appear to be any clarity to the work, and it can best be described as a hodge-podge of thoughts and ideas.

           Carrie’s parents want you to know that although they are concerned about Carrie, they are opposed to giving her medications that would turn her “into a zombie.” Carrie’s mother also confides that her husband’s grandfather spent “a few years in the nut house.” When you probe further, she began crying and said, “He was schizophrenic … what if Carrie is schizophrenic?”

            During your interview with Carrie, she seems pleasant, but somewhat distant. When you ask her about her friends at school, she shrugs her shoulders and says, “I don’t really have any. I don’t like those people.” You inquire if she is sad or upset that she doesn’t like them, to which she states “no, why should I be? I guess they would be friends with me if I asked, but I’m not interested. I could make them be my friends if I wanted, but I don’t … but if I wanted them to, all that I have to do is make up my mind that they will be my friend and they would have to.” When you ask Carrie if she believes that she can control the thoughts of others with her mind, she puts her index finger up to her mouth and looks toward the door. “My mom gets upset when I talk about these things. I try not to think about them either because if she is close enough, she could read my thoughts and they upset her. She may think that I’m into witchcraft or something.”

When you ask Carrie about the homework assignment that you read, she explains that her teacher “is just miserable. She doesn’t understand how I think—I think high, she just can’t get it.”

OBJECTIVE

            The client is a 13-year-old Hispanic female client who appears appropriately developed for her age. She is dressed appropriately for the current weather and ambulates with a steady upright gait. She does not appear to be demonstrating any noteworthy mannerisms, gestures, or tics. No psychomotor agitation/retardation apparent.

MENTAL STATUS EXAM

            Carries is alert and oriented × 4 spheres. Her speech is clear, coherent, goal directed, and spontaneous. Carrie self-reports her mood as “good.” However, her affect does appear somewhat constricted. Her eye contact is minimal throughout the clinical interview and at times, Carrie seems preoccupied. Carrie is oriented to person, place, and time. She endorses hearing and seeing strange “things that I talk to. They don’t scare me; they come to see me from another world.” No overt paranoia is appreciated. She does report delusions of reference (she believes that the people on TV play programs “just for her” and at times, television commercials were designed to tell her what to do), as well as other delusional thoughts (as described above). Carrie denies any suicidal or homicidal ideation.

At this point, please discuss any additional diagnostic tests you would perform on Carrie.

                                                     Decision Point One

BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PSYCHIATRIC/MENTAL HEALTH NURSE PRACTITIONER (PMHNP) GIVE TO CARRIE?

In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.

 

Early Onset Schizophrenia

Schizoaffective Disorder

Schizotypal Personality Disorder

                                            

                                                        Answer Chosen:  

Early Onset Schizophrenia

                                                   Decision Point Two

BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS:

 

Refer for psychological testing

Begin Clozaril 100 mg orally daily

Begin psychotherapy using a psychodynamic approach

                                               Answer Chosen:

Refer for psychological testing

RESULTS OF DECISION POINT TWO

·  Client returns to clinic in four weeks

·  Although there are no specific psychometric tests available for schizophrenia, the consulting psychologist administered a comprehensive psychological battery of tests in order to assess personality and cognitive functioning as well as to identify any underlying intellectual disabilities that could account for the difficulty Carrie is having in school. Tests administered included the Minnesota Multiphasic Personality Inventory; Kaufman Adolescent and Adult Intelligence Test; Rorschach test; Whitaker Index of Schizophrenic Thinking (WIST) test; Wide Range Achievement Test – 4th Edition (WRAT-4); and the Millon Adolescent Clinical Inventory (MACI). The consulting psychologist opined that early-onset schizophrenia was strongly suspected in this client.

                                                           Decision Point Three

BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.

 

Begin Clozapine 100 mg orally daily

Begin family interventions

Begin Lurasidone 40 mg orally daily

                                               Answer Chosen

Begin Lurasidone 40 mg orally daily

Guidance to Student 

           It is not always necessary to procure a consult with a psychologist. However, psychologists by virtue of their advanced training and licensure are able to conduct comprehensive psychological testing on clients more advanced than those tests that could be conducted by the psychiatric/mental health nurse practitioner. In this case, we would like to know if the poor academic performance was the result of an intellectual disability, versus poor premorbid intellectual functioning that is often seen in schizophrenia.

            In terms of treatment decisions, Clozapine is FDA-approved for treatment-resistant schizophrenia. Since the child has not yet been treated with any agent, we have no way of knowing if her schizophrenia is treatment resistant. Additionally, if we were to use Clozapine, the starting dose is approximately 25 mg in adults (perhaps 12.5 mg in a child, depending on body weight). Clozapine 100 mg would most likely cause significant side effects that both the child and parents would find objectionable, thus making compliance an issue.

Although not FDA-approved for use in children, Lurasidone is used as an off-label drug in this population. There are no legal prohibitions against any prescriber using drugs “off-label”; however, attention must be given to the concept of informed consent. When working with children/adolescents, the PMHNP must explain pros/cons, discuss therapeutic endpoints/goals of treatment, etc. The parent/guardian must have all of the information needed to make an informed consent. Therefore, Lurasidone would be the best choice. Additionally, Lurasidone may be the preferred antipsychotic, as it appears to have the least impact on body weight and lipid profile.

           Recall that with any antipsychotic medication, you should determine fasting plasma glucose levels, monitor weight and BMI during treatment, as well as blood pressure and fasting triglycerides.

            Family interventions are important as well, as they do have a positive benefit on symptom relapse and admission/readmission to the hospital. Family interventions should include teaching about the disease, medications, and anticipatory guidance.

                                                                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      31, “Child Psychiatry” (pp. 1268–1283)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

• “Schizophrenia Spectrum and Other Psychotic Disorders”

McClellan, J., & Stock, S. (2013). Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. Journal of the American Academy of Child & Adolescent Psychiatry, 52(9), 976–990. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00112-3/pdf

Giles, L. L., & Martini, D. R. (2016). Challenges and promises of pediatric psychopharmacology. Academic Pediatrics, 16(6), 508–518. doi:10.1016/j.acap.2016.03.011

Hargrave, T. M., & Arthur, M. E. (2015). Teaching child psychiatric assessment skills: Using pediatric mental health screening tools. International Journal of Psychiatry in Medicine, 50(1), 60–72. Retrieved from http://search.proquest.com.ezp.waldenulibrary.org/docview/1702699596?accountid=14872

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press. 

Required Media

Laureate Education (Producer). (2017b). A young girl with strange behaviors [Multimedia file]. Baltimore, MD: Author. (THE ATTACHED CASE STUDY IS THE MEDIA)

PLEASE PART OF THE CONTRACT IS TO HAVE IT DONE IN 12 HOURS. THANKS

 

Please read chapter 6 and 7 of the class textbook and review the attached Power Point presentations.  Once done answer the following questions;

1.  Give an overview of the African American and the Amish culture and mention any difference with your own culture.

2. What are the healthcare culture beliefs of the African American and the Amish cultures and mention if there is any similarity in their beliefs.

3. How these two cultures healthcare beliefs affect the delivery of evidence based nursing care.  Please give an example.

As stated in the syllabus present your assignment in an APA format word document, Arial 12 font attached to the forum in the discussion tab of the blackboard title “week 3 discussion questions”.  A minimum of 2 evidence based references no older than 5 years  old are required,and a minimum of 500 words.

  

Information Systems and Changing Organizational Culture
 

The Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine (2011) notes that “the nursing profession is the largest segment of the nation’s health care workforce.” Nursing’s three million–plus members are known for their ability to react quickly and efficiently on the front lines of patient care. This agility is lost, however, when the nursing profession fails to evolve with the field of information technology. Have you witnessed any unintentional barriers that have excluded nurses from quickly adopting and accepting informatics systems?
 

Those nurses who apply strategies developed by change management experts can help expedite the adoption process by positively addressing staff concerns and implementation challenges. In this Discussion, you explore change leadership strategies through a role-playing activity.
 

Reference:
Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. (2011). The future of nursing: Leading change, advancing health [Consensus report]. Retrieved from the Institute of Medicine of the National Academies website: http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx
 

To prepare:

• Review      the Learning Resources, focusing on the findings of the TIGER Leadership      Collaborative.
• Consider      the TIGER Nursing Informatics Competencies model from a leadership      standpoint.
• Engage      in the following role play: Your practice setting has appointed you to      lead the implementation of a new information technology initiative. As you      plan for this undertaking, you consider the various challenges that this      implementation may bring to your practice.

 

• Select       an information technology initiative that your practice could benefit       from (i.e., a new information system, point-of-care service, robotics       machinery, mobile devices, glucometers, smart pumps etc.).
• What       change management strategies might you utilize to facilitate a quick and       successful implementation?
• What       potential barriers might the initiative bring to the practice? What       leadership strategies could shift the culture toward a smooth transition?

By tomorrow Tuesday October 31, 2017, write a minimum of 550 words essay in APA format with at least 3 references. Include the level one headings as numbered below:

post a cohesive response that addresses the following:

1) Briefly identify your practice setting (hospital setting) and the information technology initiative you selected. Provide a rationale for your selection. (i.e., a new information system, point-of-care service, robotics machinery, mobile devices, glucometers, smart pumps etc.).

2) Evaluate the potential barriers to implementing your hypothetical initiative.

3) Identify the change management strategies that you would use to facilitate a successful implementation. Identify key resources that you would need to promptly overcome potential barriers.

4) Appraise the leadership strategies that you would employ to establish a culture that supports the new information technology initiative. Reference the TIGER Informatics Competencies where appropriate.

Required Readings

Course Text: Ball, M. J., Douglas, J. V., Hinton Walker, P., DuLong, D., Gugerty, B., Hannah, K. J., . . . Troseth, M. R. (Eds.) (2011). Nursing informatics: Where technology and caring meet (4th ed.). London, England: Springer-Verlag.

Chapter 2, “Strategies for Culture Change”

Chapter 9, “Leadership Collaborative”

Chapter 10, “Challenging Leadership Status Quo”

Chapters 2 and 10 discuss the theories, models, and trends of technology. Chapter 9 details TIGER’s strides in the realms of education and basic competency requirements to better prepare nurses in informatics principles.

Caballero Muñoz, E., & Hullin Lucay Cossio, C. M. (2010). Engaging clinicians in health informatics projects. Studies in Health Technology and Informatics, 151,195-206.

The authors of this article break down the implementation, planning, and design phases of informatics projects into specific management categories. Each category consists of factors that can help to integrate clinician’s work flow needs.

Liaw, S. T., & Gray, K. (2010). Clinical health informatics education for a 21st century world. Studies in Health Technology and Informatics, 151, 479-491.

This article examines the educational and competency requirements put into place by the American Medical Informatics Association.

T.I.G.E.R. Technology Informatics Guiding Education Reform. (2011). Informatics competencies collaborative team. Retrieved from https://web.archive.org/web/20150910131244/http://www.thetigerinitiative.org/docs/tigerreport_informaticscompetencies.pdf 

Use this website to acquire the informatics competencies as outlined by the TIGER collaborative. Useful links, resources, and learning objectives can be easily located, as they are categorized into the competencies of basic computer, information literacy, and information management.

Required Media

Laureate Education, Inc. (Executive Producer). (2011). Transforming nursing and healthcare through technology: Information systems and changing culture. Baltimore, MD: Author.

Note: The approximate length of this media piece is 7 minutes.

This week’s media presentation provides real-world examples of doctors, nurses, and general staff changing their standard methods and procedures to reap the benefits of new technology systems. 

Optional Resources

Simpson, R. L. (2009). Innovations in transforming organizations. Nursing Administration Quarterly, 33(3), 268-272.

Stanton, M. P., & Barnett Lammon, C. A. (2008). The “wins” of change: Evaluating the impact of predicted changes on case management practice. Professional Case Management, 13(3), 161-168.

Szydlowski, S., & Smith, C. (2009). Perspectives from nurse leaders and chief information officers on health information technology implementation. Hospital Topics, 87(1), 3-9.Bottom of Form

In nursing practice, accurate identification and application of   research is essential to achieving successful outcomes. Being able to   articulate the information and successfully summarize relevant   peer-reviewed articles in a scholarly fashion helps to support the   student’s ability and confidence to further develop and synthesize the   progressively more complex assignments that constitute the components   of the course change proposal capstone project.

For this assignment, the student will provide a synopsis of eight   peer-reviewed articles from nursing journals using an evaluation table   that determines the level and strength of evidence for each of the   eight articles. The articles should be current within the last 5 years   and closely relate to the PICOT statement developed earlier in this   course. The articles may include quantitative research, descriptive   analyses, longitudinal studies, or meta-analysis articles. A   systematic review may be used to provide background information for   the purpose or problem identified in the proposed capstone project.   Use the “Literature Evaluation Table” resource to complete   this assignment.

While APA style 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.