Professional Platform for Ethics and Leadership 

The role of the health care professional includes being a moral agent or a person whose actions affect themselves and others at a moral level. It is important to have a personal ethic or moral framework in which you ground your practice and professional relationships. The purpose of this assignment is to explore and create a foundation for leadership and ethics in your professional practice.

Write a reflection on the nature, sources, and implications of your values, beliefs, and ethical perspectives that guide your personal life and nursing practice. Please note, grading is based on the clarity and depth of your writing and the apparent effort given the assignment, not on the rightness or wrongness of your position. You are encouraged to be honest in your self-assessments and conclusions.

Each of the following points must be addressed in your essay:

• Primary influences (childhood and adult)
• Ethical principles that influence you personally and professionally
• Ethical practice of professional nursing
• Ethical leadership and professional development plan. Include both positive and negative aspects of your character that emerge when you are in a position of authority

Assignment Expectations:

Length: 1500 to 2000 words total.

Structure: Include a title page and reference page in APA format. These do not count towards the minimum word count for this assignment. Your essay must include an introduction and a conclusion.

 You are about to be sent to a remote area by WHO where you will be working with infectious diseases caused by a variety of microorganisms. You will be using what you know about the chemistry underlying biological processes in microbes and infections to solve the case on Rabbit Island. What will you need to know? What resources would you use to find more information 

 one paragraph with intext citation and reference follow up discussion for the above discussion.Further the dialogue by providing more information and clarification. Provide feedback on whether you agree or disagree with their criticism. Explain why. Build on their posts by providing additional insight of your own  

 

1. Discuss what the nurse should have done to effectively control this situation and limit the risks of wrongful delegation? Give a detailed response and reference 2 evidenced based resources.

 According to American Nurses Association (2017), the RN is accountable for confirming that the delegated task to the CNA meets all 5 rights of delegation. After watching the video, It has come to my realization that nurses must be careful when delegating. Rules must be followed in other not to get into trouble. Even thought some organizations train UAPs to do higher level abilities, the nurse must make sure that the UAP is certified and qualified to accomplish any skills preceding to delegation. Instead of permitting the CNA to insert GI tube the RN should have given directions the UAP to take the patient to the ER and not to reinsert the tube on her own.  The delegated task must be within the delegator’s scope. Again, the UAP must receive task based on their proficiency level.  Patients protection is very vital and should have been the RN priority which she did not. The nurse should have also evaluated the right to delegation prior to delegation (Nurse Services Organization, 2019). 

2 )Identify 3 to 4 risk control recommendations that were learned from the required video that could have been utilized in this case.

a) Nurses must refer to their state’s nurse practice acts, which has the rules on what to do not what not to do when it comes to delegation or any task the RN wants to delegate to any one to help him or her with. If this is done it will help reduce errors in the medical field and increase patients safety.

b) If the nurse chooses to assign any task to the UAP, she should confirm that the UAP have being appropriately qualified and competent for such task. Once allowing the UAP do the task, the RN should supervise to safeguard the task was appropriately and correctly done and can not lead to injury of the patient

c) Evaluating the CNA’s capabilities and skills when it comes to delegation help the nurse to improve care given to patient and also reduced death and law suit from patients family to nurses (Marquis & Huston, 2020)

References

American Nurse Association, & National Council of State Board of Nursing. (2017). Joint statement on delegation.

Nurse Services Organization. (2019). Defending your license: Strategies for nursing professionals.

Marquis, B. L., & Huston, C. (2020). Leadership Roles and Management Functions in Nursing: Theory and Application (10th ed.). Wolters Kluwer.

Case Study 

Delusional Disorders

Pakistani Female With Delusional Thought Processes

Hispanic male

BACKGROUND

The client is a 34-year-old Pakistani female who moved to the United States in her late teens/early 20s. She is currently in an “arranged” marriage (her husband was selected for her when she was 9 years old). She presents following a 21-day hospitalization for what was diagnosed as “brief psychotic disorder.” She was given this diagnosis as her symptoms have persisted for less than 1 month.

Prior to admission, she was reporting visions of Allah, and over the course of a week, she believed that she was the prophet Mohammad. She believed that she would deliver the world from sin. Her husband became concerned about her behavior to the point that he was afraid of leaving their 4 children with her. One evening, she was “out of control,” which resulted in his calling the police and her subsequent admission to an inpatient psych unit.

During today’s assessment, she appears quite calm and insists that the entire incident was “blown out of proportion.” She denies that she believed herself to be the prophet Mohammad and states that her husband was just out to get her because he never loved her and wanted an “American wife” instead of her. She says she knows this because the television is telling her so.

She currently weighs 140 lbs., and she is 5’ 5.

SUBJECTIVE

Client reports that her mood is “good.” She denies auditory/visual hallucinations but believes that the television talks to her. She believes that Allah sends her messages through the TV. At times throughout the clinical interview, she becomes hostile towards you but then calms down.

A review of her hospital records shows that she received a medical workup from physician, who reported her to be in overall good health. Lab studies were all within normal limits.

Client admits that she stopped taking her Risperdal about a week after she got out of the hospital because she thinks her husband is going to poison her so that he can marry an American woman.

MENTAL STATUS EXAM

The client is alert and oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Her speech is slow and, at times, interrupted by periods of silence. Self-reported mood is euthymic. Affect is constricted. Although the client denies visual or auditory hallucinations, she appears to be “listening” to something. Delusional and paranoid thought processes as described above. Insight and judgment are impaired. She is currently denying suicidal or homicidal ideation

You administer the PANSS which reveals the following scores:

-40 for the positive symptoms scale

-20 for the negative symptom scale

-60 for general psychopathology scalDiagnosis: Schizophrenia, paranoid type

RESOURCES

PANSS Scale. Available at: http://egret.psychol.cam.ac.uk/medicine/scales/PANSS

§ Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261–276. doi:10.1093/schbul/13.2.261

https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf

§ Clozapine REMS Program. (n.d.). Clozapine REMS: A guide for healthcare providers. Retrieved September 7, 2016, from https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf

http://www.ima.org.il/FilesUpload/IMAJ/0/40/20149.pdf

§ Paz, Z., Nalls, M., and Ziv, E. (2011). The genetics of benign neutropenia. Israel Medical Association Journal, 13(10), 625–629. Retrieved from http://www.ima.org.il/FilesUpload/IMAJ/0/40/20149.pdf

Decision Point One

Select what you should do:

Start Zyprexa (olanzapine) 10 mg orally at BEDTIME

Start Invega Sustenna 234 mg IM X1 followed by 156 mg IM on day 4 and monthly thereafter

Start Abilify (aripiprazole) 10 mg orally at BEDTIME

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?

Start Invega Sustenna 234 mg IM X1 followed by 156 mg IM on day 4 and monthly thereafter

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

Decision Point Two

Select what the PMHNP should do next:

Continue same made but instruct administering nurse to begin injections into the deltoid at this visit and moving forward

DC Invega Sustenna and start Haldol Decanoate (haloperidol decanoate ) 50 mg IM q2weeks with oral Haldol 5 mg BID for the next 3 months

Continue Invega Sustenna. Begin injections into the deltoid and add on Abilify Maintena 300 mg IM qmonthly with oral Abilify 10 mg in the MORNING for 2 weeks

Which decision did you select?

Continue same made but instruct administering nurse to begin injections into the deltoid at this visit and moving forward

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

Decision Point Three

Select what you should do next:

Decision Point Three

Select what you should do next:

Continue with the Invega Sustenna. Counsel client on the fact that weight gain from Invega Sustenna is not as much as what other drugs with similar efficacy can cause. Make appointment with a dietician and an exercise physiologist. Follow up in one month

DC Invega Sustenna and start Abilify Maintena (aripiprazole ) 400 mg IM monthly (after a few test doses of Abilify oral have been tried and tolerated) with overlapping oral Abilify 10 mg in the MORNING

Continue Invega Sustenna and add on Qsymia (phentermine and topiramate) for weight lossDC Invega Sustenna and start Abilify Maintena (aripiprazole ) 400 mg IM monthly (after a few test doses of Abilify oral have been tried and tolerated) with overlapping oral Abilify 10 mg in the MORNING

Continue Invega Sustenna and add on Qsymia (phentermine and topiramate) for weight loss

Which decision did you select?

Continue with the Invega Sustenna. Counsel client on the fact that weight gain from Invega Sustenna is not as much as what other drugs with similar efficacy can cause. Make appointment with a dietician and an exercise physiologist. Follow up in one month

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

  

Assignment:

Respond to at least two of your colleagues by comparing the differential diagnostic features of the disorder you were assigned to the diagnostic features of the disorder your colleagues were assigned.

Support your responses with evidence-based literature with at least two references in each colleague’s response with proper citation in APA Format. 

Colleagues Respond # 1

Criteria for Alzheimer’s Disease

Alzheimer’s disease is a slowly progressing disorder where the individual may be asymptomatic for many years in preclinical phase, followed by a period called mild cognitive impairment without functional deficit, and finally leading to dementia or neurocognitive syndrome with cognitive deficits, functional decline with neuropsychiatric symptoms (Gabbard 2014). 

According to American psychiatric association (2013), neurocognitive disorders can be either major or mild neurocognitive disorder. To diagnose Alzheimer’s disease, the DSM-5 has given criteria as follows.  

Major neurocognitive disorder due to Alzheimer’s disease are diagnosed either as probable and possible Alzheimer’s disease (American psychiatric association 2013). Probable Alzheimer’s disease is diagnosed if either of the following are present otherwise, possible Alzheimer’s disease is diagnosed.

1.Evidence of a causative Alzheimer’s disease genetic mutation from family history or genetic testing

2. All three of the following such as a) Clear evidence of decline in memory and learning and at least one other cognitive domain based on detailed history or serial neuropsychological testing, b) Steadily progressive, gradual decline in cognition, without extended plateaus, c) No evidence of mixed etiology such as absence of other neurodegenerative or cerebrovascular disease, or another neurological, mental, or systemic disease or condition likely contributing to cognitive decline 

Mild neuro cognitive disorder due to Alzheimer’s disease can be either Probable or possible Alzheimer’s disease (American Psychiatric association 2013).

Probable Alzheimer’s disease is diagnosed if there is evidence of a causative Alzheimer’s disease genetic mutation from either genetic testing or family history. Possible Alzheimer’s disease is diagnosed if there is no evidence of a causative Alzheimer’s disease genetic mutation from either genetic testing or family history, and all three of the following are present such as a) clear evidence of decline in memory and learning, b) steadily progressive, gradual decline in cognition, without extended plateaus, no evidence of mixed etiology such as absence of other condition likely contributing to cognitive decline. c) The disturbance is not better explained by cerebrovascular disease, another neurodegenerative disease, the effects of a substance, or another mental, neurological, or systemic disorder.

Psychopharmacological Treatment

It is important to minimize or eliminate medications that impair cognition such as anticholinergics, opioid analgesics and benzodiazepines before starting pharmacological treatment for Alzheimer’s disease (AD) (Gabbard 2014). The general treatment for AD are anticholinesterase inhibitors (AChEI) and Memantine (Gabbard 2014). Acetylcholinesterase inhibitors reversibly inhibit the activity of acetylcholinesterase, the enzyme responsible for synaptic metabolism of acetylcholine; their administration thereby increases levels of synaptic acetylcholine (Gabbard 2014).  The usual AChEI are Donepezil, Galantamine, and Rivastigmine. Donepezil is an oral dissolving tablet and once daily dosing (Gabbard 2014). It is used in mild, moderate and severe AD and it may take up to 6 weeks to have baseline memory improvement (Stahl 2014). The initial dose is 5 mg /day and can reach a target dose of 10 mg /day (Gabbard 2014). Galantamine is a AChEI and allosteric nicotinic receptor modulator and is used in mild to moderate AD (Stahl 2014). The initial dose is 4 mg /Bid for immediate release and 8 mg/day for the extended release with a target dose of 8-12 mg Bid for immediate release and 16-24 mg/day for extended release (Gabbard 2014). It may take up to 6 weeks for improvement in any baseline memory (Stahl 2014). It has reported side effects of bradycardia. Rivastigmine is a AChEI and butyryl cholinesterase (BuChEI) with an initial dose of 1.5 mg Bid (Oral) or 4.6 mg/day transdermal to reach a target dose of 3-6 mg bid oral or 9.6 mg /day transdermal (Gabbard 2014). It is used in mild to moderate AD and may take up to 6 weeks for improvement in mild to moderate memory (Stahl 2014). The transdermal administration decreases GI side effects (Gabbard 2014).

Another medication used to treat AD is Memantine which is a NMDA receptor antagonist. It interferes with postulated persistent activation of NMDA receptors by excessive glutamate release in AD (Stahl 2014). The dosage is 5mg /day (initial) and 10 mg Bid (Gabbard 2014). Memory improvement is not expected with the treatment and takes many months in for stabilization of degenerative course (Stahl 2014). Decreased creatinine clearance is a side effect and dose adjustment is required if it occurs (Gabbard 2014).   

Psychotherapy

A research study by Forstmeier et al. (2015) has concluded that cognitive behavior therapy has shown benefit to both the individual with Alzheimer’s disease having neuropsychiatric symptoms and to the care giver where it helps reduce the use of medication and delayed nursing home placement. insight oriented therapy and less verbal therapies such as music therapy and art therapy can be helpful in alleviating negative emotions and minimizing problematic behaviors (Betty 1994)

Supportive treatment such as education, counseling about diagnosis and prognosis, comfort, and emotional support including instructions on safe and effective caregiving, problem solving, and crisis intervention are important for patients and caregivers (Gabbard 2014). It is also important to consider safety concerns, including driving (and its eventual restriction), living independently, medication administration, and fall risks (Gabbard 2014). They can be helped with a safe predictable place to live with support for activities of daily living, assistance with managing medical comorbidities, and assistance with advanced planning and end-of-life decisions (Gabbard 2014)

Benefits and Risks of Neurocognitive Therapies

The treatments for Alzheimer’s disease are anticholinesterase inhibiters and memantine. These medications are not expected to cure the disease but the beneficial part of the treatment is that it helps delay the progression of neurocognitive and physical decline. There are some side effects for Donepezil (which is a acetylcholinesterase inhibitor ) such as atrioventricular block, decreased appetite, diarrhea, dizziness, headache, hypertension, nausea, syncope, torsades de pointes, vomiting, weight loss are the major side effects (Boice, Dunay, Epperly 2017). Galantamine has additional side effects such as nausea, vomiting and weight loss and Rivastigmine side effects are Abdominal pain, atrial fibrillation, atrioventricular block, decreased appetite, diarrhea, dizziness, headache, myocardial infarction, nausea, vomiting (Boice, Dunay, Epperly 2017). The side effects of Memantine are confusion, constipation, diarrhea, dizziness, vomiting; rarely, cerebrovascular event or acute kidney injury (Boice, Dunay, Epperly 2017

Differential Diagnostic Features of Alzheimer’s Disease

Almost 80% of dementia in older people are related to Alzheimer’s disease, however the diagnosis can be difficult where the patients may exhibit similar pathologies and symptoms (Alzheimer’s association n. d). Based on the major clinical differences between major dementias, a correct diagnosis can be made. The common dementias with similar symptoms are Frontotemporal dementia, Levy body disease, vascular dementia, Creutzfeldt-Jakob Disease and Alzheimer’s disease (Alzheimer’s association n. d). Vascular dementia is related to cerebral vascular disease and are seen in patients with preexisting hypertension or other cardiovascular risk factors (Ruiz, Sadock & Sadock 2014). Frontotemporal dementia is characterized by preponderance of atrophy in the frontotemporal regions (Ruiz et al., 2014). In Levy body disease the patients often have cap grass syndrome in addition to hallucination and parkinsonian features (Ruiz et al., 2014).

Colleagues Respond # 2

Diagnosis of Dementia

Dementia is a general term used for loss of problem-solving, language, memory, and other thinking capabilities, which are severe and have the intensity to affect an individual’s daily life. The most common cause of dementia is Alzheimer’s (Mosk et al., 2017). It can be challenging diagnosing dementia. Individuals with this condition have a cognitive impairment, and they have lost the ability to attend to their daily duties such as driving safely, paying bills, and their medications. During the diagnosis, the doctor must recognize the oaters for the loss of functions and skills and determine what the person can do at that moment. Recently there has been a more accurate diagnosis from the biomarkers of Alzheimer’s disease. The doctors do cognitive and neuropsychological tests to evaluate the patient’s thinking. Several tests involve measuring thinking skills, language skills, judgments, reasoning, orientation, and attention. Neurological evaluation is where the doctor will evaluate attention, visual perception, memory, language, senses, and movements, balance, problem-solving, and reflexes, among other areas. Brain scans include CT or MRI, which checks the evidence of bleeding, tumor or stroke, or hydrocephalus. PET scans checks on the patterns of the brain. Laboratory tests include blood samples to determine the physical problems that can affect the brain functioning, such as deficiency of vitamin B-12 or thyroid gland underactive.

Treatment of Dementia

Psychopharmacologic treatment includes the use of the following: cholinesterase inhibitors, which include galantamine (Razadyne), donepezil (Aricept), and rivastigmine (Exelon) which works by boosting the levels of chemical messenger which are involved in judgment and memory.  They are used to treat Alzheimer’s disease in the primary case. Doctors might be prescribed these drugs to other dementias, including Lewy body dementia, Parkinson’s disease dementia, and vascular dementia. There are side effects of these drugs that include diarrhea, vomiting, and nausea.  Memantine (Namenda) regulates the activity of glutamate, which is a chemical messenger involved in brain functions such as memory and learning. This can also be prescribed with a cholinesterase inhibitor and had dizziness as one of the most common side effects. Psychotherapy includes occupational therapy, which teaches one coping behaviors and ensures that one is home safer. This prevents accidents and manages behaviors as well as preparing one for the dementia progression. Modifying the environment is another psychotherapy that reduces noise and clutter, making it easier for dementia to function and focus (Carrion et al., 2018). This involves hiding objects that threaten the safety and monitoring system, alerting when a person with dementia wanders. Simplifying tasks will break tasks into smaller portions and hence make one focus on success and not a failure. Routine and structure also help to reduce confusion among people with dementia.

Research has identified several risks involved in the treatment of patients with dementia. Many of the patients have been prescribed some medications which act on the nervous system and the brain, but they are not meant to treat dementia. These kinds of interventions have special risks for older people (Gnjidic et al., 2018). These drugs have been linked with worse cognitive symptoms in older adults. Depressants do not treat dementia, but most doctors prescribe these drugs nearly triple to the older adults. These have negative impacts and mild side effects on the patients.