Health Care Delivery Models and Nursing Practice

Examine changes introduced to reform or restructure the U.S. health care delivery system. In a 1,000-1,250 word paper, discuss action taken for reform and restructuring and the role of the nurse within this changing environment.

Include the following:

1. Outline a current or emerging health care law or federal regulation introduced to reform or restructure some aspect of the health care delivery system. Describe the effect of this on nursing practice and the nurse’s role and responsibility.
2. Discuss how quality measures and pay for performance affect patient outcomes. Explain how these affect nursing practice and describe the expectations and responsibilities of the nursing role in these situations.
3. Discuss professional nursing leadership and management roles that have arisen and how they are important in responding to emerging trends and in the promotion of patient safety and quality care in diverse health care settings.
4. Research emerging trends. Predict two ways in which the practice of nursing and nursing roles will grow or transform within the next five years to respond to upcoming trends or predicted issues in health care.

You are required to cite to a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.  

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

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. Refer to the LopesWrite Technical Support articles for assistance. 

A 33-year-old female comes to your clinic alarmed about sudden “drooping” on the right side of the face that began this morning. She complains of excessive tearing and drooling on her right side as well.

Directions

Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources.

Provide evidence from the literature to support diagnostic tests that would be appropriate for each case.

List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.

 

Senior Health

Read chapter 19 of the class textbook and review the attached PowerPoint presentation.  Once done, answer the following questions.

1. Mention and discuss the Healthy People 2020 wellness goals and objectives for older adults.
2. Define and discuss the aging process and the demographic characteristics of the elderly population in your community.
3. Identify and discuss nursing actions that address the needs of older adults.
4. Mention and discuss health/illness concerns common to the elderly population.

INSTRUCTIONS:

As stated in the syllabus present your assignment in an APA format word document, APA required font attached to the forum in the discussion tab of the blackboard titled “Week 12 essay” and the SafeAssign exercise in the assignment tab of the blackboard which is a mandatory requirement.  A minimum of 2 evidence-based references (besides the class textbook) no older than five years must be used.  You must post two replies on different dates to any of your peers sustained with the proper references no older than five years as well and make sure the references are properly quoted in your assignment. The replies cannot be posted on the same day; I must see different dates in the replies.   A minimum of 800 words are required and not exceeding 1,000 words (excluding the first and reference page).  Please make sure to follow the instructions as given and use either spell-check or Grammarly before you post your assignment.

Please check your assignment after the week is due or after it is graded because I either made comments or ask for clarification in some replies or the assignment that required your response.

The assignment must be submitted in the requested form..  You need to number the question and answer , no essay unless it is required. 

Example;

1.  Question one

Response

1.  Question two

 Response

Due dates:  Assignment – Wednesday, July 27, 2020, at 11:59 PM in the discussion tab of the blackboard, and in the SafeAssign exercise in the assignment tab of the blackboard.

 

• Analyze nursing and counseling theories to guide practice in psychotherapy
• Develop goals and objectives for personal practicum experiences
• Create timelines for practicum activities
• Develop diagnoses for clients receiving psychotherapy
• Analyze legal and ethical implications of counseling clients with psychiatric disorders
• Develop diagnoses for clients receiving psychotherapy
• Evaluate the efficacy of cognitive behavioral therapy for clients
• Analyze legal and ethical implications of counseling clients with psychiatric disorders

The Learning Objectives are related to the Practicum Journal Assignments presented in Weeks 1, 2, and 4.

Week 4 Journal Entry
Select a client that you observed or counseled this week. Then, address the following in your Practicum Journal:

• Describe the client (without violating HIPAA regulations) and identify any pertinent history or medical information, including prescribed medications.
• Using the DSM-5, explain and justify your diagnosis for this client.
• Explain whether cognitive behavioral therapy would be effective with this client. Include expected outcomes based on this therapeutic approach. Support your approach with evidence-based literature.
• Explain any legal and/or ethical implications related to counseling this client.

 

Examine Case Study: A Young Caucasian Girl With ADHD 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.

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.

THE CASE STUDY 

 

BACKGROUND

Katie is an 8 year old Caucasian female who is brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katie’s teacher suggested that she may have ADHD. Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine whether or not she has this condition.

The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised”. This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their family primary care provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. The teacher opined that she lacks interest in school work and is easily distracted. Katie is also noted to start things but never finish them, and seldom follows through on instructions and fails to finish her school work.

Katie’s parents actively deny that Katie has ADHD. “She would be running around like a wild person if she had ADHD” reports her mother. “She is never defiant or has temper outburst” adds her father.

SUBJECTIVE

Katie reports that she doesn’t know what the “big deal” is. She states that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds her other subjects boring, and sometimes hard because she feels “lost”. She admits that her mind does wander during class to things that she thinks of as more fun. “Sometimes” Katie reports “I will just be thinking about nothing and the teacher will call my name and I don’t know what they were talking about.”

Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. Offers no other concerns at this time.

MENTAL STATUS EXAM

The client is an 8 year old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately 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. Self-reported mood is euthymic. Affect is bright. Katie denies visual or auditory hallucinations, no delusional or paranoid thought processes readily appreciated. Attention and concentration are grossly intact based on Katie’s attending to the clinical interview and her ability to count backwards from 100 by serial 2’s and 5’s. Insight and judgment appear age appropriate. Katie denies any suicidal or homicidal ideation.

Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation

 Decision Point One

Begin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING

RESULTS OF DECISION POINT ONE

• Client returns to clinic in four weeks
• Katie’s parents report that they spoke with Katie’s teacher who notices that her symptoms are much better in the morning, which has resulted in improvement in her overall academic performance. However, by the afternoon, Katie is “staring off into space” and “daydreaming” again
• Katie’s parents are very concerned, however, because Katie reported that her “heart felt funny.” You obtain a pulse rate and find that Katie’s heart is beating about 130 beats per minute

Decision Point Two

Discontinue Ritalin and begin Adderall XR 15 mg orally daily

RESULTS OF DECISION POINT TWO

• Client returns to clinic in four weeks
• Katie’s academic performance is still improved, and the XR preparation has helped sustain her attention throughout the school day, however, you also learn that Katie is having tachycardia with this medication, too

Decision Point Three

Decrease to Adderall XR 10 mg orally daily

Guidance to Student
Adderall XR should be initiated at 10 mg orally daily and increased by 5–10 mg/day at weekly intervals; maximum dose generally 30 mg/day. Tachycardia is one of the side effects of Adderall, and may be worse because it was started at a higher dose. The PMHNP should decrease the dose to 10 mg orally daily and re-evaluate at the next office visit.
Continuing the same dose will most likely not significantly improve the side effect of tachycardia, so maintaining the current dose of medication would not be prudent as Katie may refuse to take the medication if it causes unpleasant side effects.
There is no indication to move to a second line agent at this point due to a side effect which may be caused by a high starting dose of medication.