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
  • Which decision did you select?
  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support  your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with  Decision #1 and the results of the decision. Why were they different?
• Decision #2
  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support  your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with  Decision #2 and the results of the decision. Why were they different?
• Decision #3
  • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this decision? Support  your response with evidence and references to the Learning Resources.
  • 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.

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 since she was 9 years old).  She presents to your office today 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 tells you that she knows this  because the television is telling her so.  

She currently weighs 140 lbs, and is 5’ 5”

SUBJECTIVE

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

You reviewed her hospital records and find that she has been  medically worked up by a 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, 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 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.

The PMHNP administers the PANSS which reveals the following scores:

-40 for the positive symptoms scale

-20 for the negative symptom scale

-60 for general psychopathology scale

Diagnosis: Schizophrenia, paranoid type

 Decision Point One

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

RESULTS OF DECISION POINT ONE

• Client returns to clinic in four weeks
• A decrease in PANSS score of 25% is noted at this visit  
• Client seems to be tolerating medication
• Client’s husband has made sure she makes her appointments for injections (one thus far) 
• Client has noted a 2 pound weight gain but it does not seem to be an important point for her
• Client complains of injection site pain telling the PMHNP that she  has trouble siting for a few hours after the injections and doesn’t like  having to walk around for such a long period of time 

Decision Point Two

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

RESULTS OF DECISION POINT TWO

• Client returns to clinic in four weeks
• Client’s PANNS has reduced by a total of 50% from the initiation of Invega sustenna
• When questioned about injection site pain, client states it is much better in the arm 
• Client’s weight has increased by an  additional 2.5 pounds (total of 4.5 pounds in a 2 month period). She is  somewhat bothered by the weight gain and is afraid that her husband does  not like it. He is not present at this visit as she brought herself 
• Client likes how she feels on the  Invega Sustenna but is wondering if there is another drug like it that  would not cause the weight gain 

Decision Point Three

 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     

Guidance to Student
 Weight gain can occur with Invega  Sustenna. It is modest in nature and can be controlled with proper  nutrition and exercise. It is always a good idea to try and control a  client’s weight through consultation with a dietician and exercise  physiologist (life coach) before switching to another agent when a  product is showing efficacy for at least 6 months.  
Abilify Maintena is a good option for someone who has good  response to abilify oral. Remember that Abilify does not bind to the D2  receptor for a great period of time (such as Invega) and can be less  affective in certain individuals. Also, remember that akathisia  can be a  possible side effect. Once an IM long acting medication is given, the  effects of the drug (both efficacious and untoward effects) can be  maintained for a long duration (up to a month or longer). Tolerability  and efficacy should be established with oral medication first before  administering the first injection. Also a disadvantage to Abilify  Maintena is a 2-week overlap of oral therapy is required due to  effective blood levels lagging behind the induction dose.  
Qsymia is a weight loss medication that is a combination of  Phenteramine and Topiramate. It is only indicated to treat obesity. This  client’s BMI (28.9 kg/M2) does not fit the definition of obesity (BMI  >30 Kg/M2- Following from CDC website: Class 1: BMI of 30 to < 35,  Class 2: BMI of 35 to < 40, Class 3: BMI of 40 or higher. Class 3  obesity is sometimes categorized as “extreme” or “severe” obesity).   There are two things wrong with this therapy option. First, there are  only a few occasions where add-on therapy to treat a side effect is  acceptable and weight gain is not one of those scenarios. Secondly,  Phenteramine has a lot of cardiovascular toxicities (such as elevated  BP, HR, increased workload on the heart).
 

You are a nurse at an outpatient clinic and are presented with a 68-year-old female client.  She is experiencing the following symptoms: decreased appetite, disturbed sleep pattern, fatigue, difficulty concentrating, disordered thought process, anhedonia, guilt, and low self-esteem. The doctor diagnoses the client with major depressive disorder.  Answer the following questions:

• What medication do you think is likely to be prescribed for this client and why? 
• What are some important teachings you would give this client when administering the first dose? 
• When following up with the client 2 months later.  What are some changes you may expect to see with the client? If the client is not displaying the expected outcomes, what are some possible alternatives for the client? 

Chapter 2 of the Direct Practice Improvement (DPI) Project Proposal is titled “Literature Review” and expands upon work you completed in DNP-820 in the Develop a Literature Review assignment. Synthesis of the literature in the Literature Review (Chapter 2) defines the key aspects of the learner’s scholarly project, such as the problem statement, population and location, clinical questions, variables or phenomena (if relevant to the project), methodology and design, purpose statement, data collection, and data analysis approaches. The literature selected must illustrate strong support for the learner’s practice change proposal.

 

TOPIC: Impact of Medication Administration Errors on 3-4-Year-old Leukemia Patients

 

General Requirements:

Use the following information to ensure successful completion of the assignment:

· Locate the “DPI Proposal Template” in the PI Workspace of the DC Network.

· Locate the Develop a Literature Review assignment you completed in DNP-820.

· Locate the “Research Article Chart” resource in the DC network Course Materials.

· Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is 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.

· You are required to submit this assignment to LopesWrite.

Directions:

Use the “DPI Proposal Template” and the “Develop a Literature Review” assignment from DNP-820 to develop a draft of a literature review (Chapter 2) for your DPI Project Proposal. The literature review (Chapter 2) is required to be a minimum of 20-25 pages including a minimum of 50 scholarly citations.  You have already completed some of this review in previous courses. No less than 85% of the articles must have been published in the past 5 years. Articles selected must provide strong, reliable support for the proposal.

Use the following DPI proposal template’s criteria to create your draft Literature Review (Chapter 2):

1. Access and review the DPI Project Template for Chapter 2 criteria

o Sections of this Chapter include:

§ Introduction to the Chapter and Background to the Problem

§ Theoretical Foundations

§ Review of Literature including Themes and Sub-themes

§ Summary

1. Using the Clinical Question/PICOT question components, identify at least two themes which will organize the literature review .

2. Identify at least three subthemes that relate to each theme (six subthemes total).

3. Identify at least three empirical or scholarly articles related to each subtheme (18 articles total). At least one article must demonstrate a quantitative methodology.

4. Use the “Research Article Chart” resource as a guide to: (a) analyze and synthesize the literature into your paper, (b) state the article title, (c) identify the author, (d) state the research question(s), (e) identify the research sample, (f) explain the research methodology, (g) identify the limitations in the study, (h) provide the research findings of the study, and (i) identify the opportunities for practice implementation. For scholarly, nonempirical articles, state the article title and author, and provide a brief contextual summary of the article.

Resources

Read:

Sole, M. L., Talbert, S., Bennett, M., Middleton, A., Deaton, L., & Penoyer, D. (2018). Collecting Nursing Research Data 24 Hours a Day: Challenges, Lessons, and Recommendations. American Journal of Critical Care, 27(4), 305–311.

URL:https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=130296171&site=ehost-live&scope=site

Read:

Hammer, M. J. (2017). Research Ethics in Big Data. Oncology Nursing Forum, 44(3), 293–295.

URL:https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=122723364&site=ehost-live&scope=site

Read:

Corwin, E., Jones, D., & Dunlop, A. (2019). Symptom science research in the era of big data: Leveraging interdisciplinary resources and partners to make it happen. Journal of Nursing Scholarship, 51(1), 4-8.

URL:https://lopes.idm.oclc.org/login?url=https://search-proquest-com.lopes.idm.oclc.org/docview/2169563196?accountid=7374

 

 Reply to this student post with less than 20 % similarity APA style 

 

1- What originates to attention when you consider about culture? For a lot of us, we instantly think of what’s correct in visible of us: distinctive idioms, diverse clothing and different food. But a humanity’s culture also influences an individual’s principles, customs and beliefs. It influences in what way you view confident concepts or behaviors, and in the event of mental health, it can influence whether or not you pursue help, what type of help you pursue and what sustenance you have nearby you. It is significant that we understand the role culture plays in mental health care so we can sustenance our loved ones and inspire treatment once it is required most. (Kapil, Rubina, 2019). There are four ways culture be able to influence mental health:

– Cultural stigma. Each culture has a diverse method of seeing at mental health. For various, there is increasing stigma round mental health, and mental health trials are measured a weakness and something to hide. This should make it firmer for those struggling to conversation flexibly and request for help.

– Understanding symptoms. Culture should impact how individuals designate and impression about their symptoms. It can affect whether somebody selects to identify and dialogue around only physical signs, only emotional signs or both.

– Community Support. Cultural influences can regulate how much sustenance somebody acquires from their family and communal when it comes to mental health. Since of prevailing stigma, sectors are occasionally left to find mental health management and provision alone.

– Resources. When watching for mental health treatment, you want to discourse to a person who appreciates your precise skills and apprehensions. It can occasionally be problematic or time-consuming to discovery possessions and treatment choices that take into explanation specific cultures influences and needs.

These are simply a few conducts culture can influence the observation of and treatment for mental health. Each culture and individual is dissimilar and appearance a single journey to recovery. You can support discourse the mental health of subgroups by considerate the role culture plays in mental health and by suitable skilled to help those round you. Mental Health First Aid gives individuals the expertise to recognize signs of mental health and element use contests and action stages to take to help them get treatment

2- Culture is an attractive piece of our lives, but it can similarly negatively impact our approaches in the direction of mental health. Mental disease is still stigmatized in many values. Persons may be disinclined to even dialog about mental health, let alone seek action. For example, African American community were “not very open to acknowledging psychological problems,” and they remained also averse to seek specialized help. In addition, Asian cultures incline to brand mental illness by respecting silence, reserve and face-saving. Physical symptoms of diverse mental illnesses incline to be clarified as appearances of spiritual or ethical weakness, and some Asian dialects don’t even have a word for “depression,” Han says. “In some cultures, they’ll say, ‘My liver is bad,’ and that is translated into, ‘I’m depressed and sad’,” she says. “The standpoint on mental illness as slightly that can be preserved is a pretty new, Western idea for numerous of our clients, so it develops a family secret and persons do not look for help until it becomes out of control or certainly, really bad.” Hispanics/Latinos apply mental health care at an amount that is about half that of non-Hispanic Whites. Stigma and ethnic and spiritual values play a important role in mental health care use differences. Trust that individuals with mental disorder were unsafe, out of control, and grief from an irrepressible illness that occasioned in refusal and ostracism. Greatest families would repudiate the reality of depression and mental disorder, except symptoms seriously inhibited with daily operative or remained life-threatening. Spiritual managing such as prayer, and faith in God, were whispered to be defensive influences. Causative acknowledgements for depression were both biomedical and spiritual, such as absence of faith, not praying, fears, and bad performances of close relative. (Caplan, Susan, 2019).

3- A number of Latinos interpretation mental illness as a signal of weakness. Others think it is a individual subject to be reserved quiet. Others anxiety existence categorized “loco,”  “crazy.” Latinos have robust family connection. Family sustenance should benefit improve the stigma of a mental disorder and reassure patients to discourse it. Distribution evidence with family supporter’s intensifications their understanding of the disease and benefits them improved sustenance the patient. Also, African Americans have faith in that a mental health disorder is a particular signal of weakness. This stigma can performance as a preventive from persons looking for mental health care when they necessity it.

4-Cultural ability has been planned as a approach to progress admittance to healthcare and the superiority of healthcare. (Pullen, Lara, 2016). There are diverse communication techniques:

– Culturally sensitive communication: Open and truthful communication among staff and the individual who is sick, and those acknowledged as significant to them, comprising careers, is critically significant to good care, comprehensible and basic linguistic necessity be used orally and in all other methods of communication.

-Culturally congruent communication: is an instruction theory respected by instructors all finished the world, is the good and correct form to transmit information to patient and family.

-Non-verbal communication: contains the use of form language and facial expressions.

-Transparent communication: it provides the material that individuals need in directive to understand what is successful on at the time that they need it. It evades surprises. It delivers follow-up for apprehensions that are elevated. It is reliable both in gratified and procedure.

References:

– Kapil, Rubina. (2019). Four Ways Culture Impacts Mental Health. Cultural Diversity, Mental Health First Aid, Minority Health, News. (July 11, 2019).

– Caplan, Susan (2019).Intersection of Cultural and Religious Beliefs about Mental Health: Latinos in the Faith-Based Setting. Hispanic Health Care International. First Published: (February 25, 2019). https://doi.org/10.1177/1540415319828265

– Pullen, Lara. (2016). Communication, Transparency Can Improve Healthcare Value. Published: (July 8, 2016).

pleasee see instructions attached, The paper is to be a five to six (5-6) pages total (double-spaced, 12 font, 1-inch margins). 

Follow APA guidelines for a cover sheet, headers, pagination, references, etc.  Chapter 21 – Katharine Kolcaba’s Comfort Theory

Chapter 22 – Joanne Duffy’s Quality-Caring Model

Reflection and Scholarly Papers:

This assignment will involve your providing a reflection based on this week’s reading assignments of Chapter 21 Kolcaba’s Comfort Theory and Chapter 22 Duffy’s Quality Caring Model. Each theory should be a minimum of three paragraphs for each chapter. The quality of your writing is much more important is more important than the quantity.