It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mr. M., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mr. M., a 70-year-old male, has been living at the assisted living facility where you work. He has no know allergies. He is a nonsmoker and does not use alcohol. Limited physical activity related to difficulty ambulating and unsteady gait. Medical history includes hypertension controlled with ACE inhibitors, hypercholesterolemia, status post appendectomy, and tibial fracture status postsurgical repair with no obvious signs of complications. Current medications include Lisinopril 20mg daily, Lipitor 40mg daily, Ambien 10mg PRN, Xanax 0.5 mg PRN, and ibuprofen 400mg PRN.

Case Scenario

Over the past 2 months, Mr. M. seems to be deteriorating quickly. He is having trouble recalling the names of his family members, remembering his room number, and even repeating what he has just read. He is becoming agitated and aggressive quickly. He appears to be afraid and fearful when he gets aggressive. He has been found wandering at night and will frequently become lost, needing help to get back to his room. Mr. M has become dependent with many ADLs, whereas a few months ago he was fully able to dress, bathe, and feed himself. The assisted living facility is concerned with his rapid decline and has decided to order testing.

Objective Data

1. Temperature: 37.1 degrees C
2. BP 123/78 HR 93 RR 22 Pox 99%
3. Denies pain
4. Height: 69.5 inches; Weight 87 kg

Laboratory Results

1. WBC: 19.2 (1,000/uL)
2. Lymphocytes 6700 (cells/uL)
3. CT Head shows no changes since previous scan
4. Urinalysis positive for moderate amount of leukocytes and cloudy
5. Protein: 7.1 g/dL; AST: 32 U/L; ALT 29 U/L

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mr. M.’s situation. Include the following:

1. Describe the clinical manifestations present in Mr. M.
2. Based on the information presented in the case scenario, discuss what primary and secondary medical diagnoses should be considered for Mr. M. Explain why these should be considered and what data is provided for support.
3. When performing your nursing assessment, discuss what abnormalities would you expect to find and why.
4. Describe the physical, psychological, and emotional effects Mr. M.’s current health status may have on him. Discuss the impact it can have on his family.
5. Discuss what interventions can be put into place to support Mr. M. and his family.
6. Given Mr. M.’s current condition, discuss at least four actual or potential problems he faces. Provide rationale for each.

You are required to cite to a minimum of two 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. 

RUBRIC

Teaching project topic :Firearm safety, 

7-year-old gunshot victim (not life threatening, lower left leg), in the trauma unit, lives at home with dad. gun shot wound was due to the child shooting himself. Gun was obtained by the child from the fathers unlocked gun safe and the Gun was loaded.

Blood pressure 104/62, Pulse 78, Respirations 18, Temperature 98.7°F, SaO2 99% room air. His mother explained what had happened, but she was not aware of any history of allergies. J.T. has younger sisters, and his  Father and mother are divorced.  Once stable, the nurse gained a more thorough history, assessment, and began discharge instructions. The mother is devastated and the father is very apologetic with felings of guilt

  The following post is from another student to wish i have to reply adding some extra information. less than 20 % similarity   

 

Question 1

Policy is a compilation of decisions, plans and approaches utilized with the purpose of signaling priorities, goals and achievements for a period of time (Health Policy, 2020).

Question 2

Public policy: It is a group of regulations and laws on a particular topic.

Private policy: It is a document stating how information is used, spread and managed.

Health policy: It is a vision or a plan for the future with specific goals.

Social policy: It is directly linked to human welfare and the conditions that influence this.

Organizational policy: Defines the views of an organization, such as behaviors, procedures and tasks.

Question 3

Florence Nightingale was a nurse during the Crimean War, known for giving personal attention and touch as well as nursing care to wounded warriors. She is known as the founder of modern nursing and pioneered the efforts for nursing to be recognized and formalized thus creating The Nightingale School of Nursing in London, 1860 (Selanders, 2020).

Question 4

Lillian Wald was an American nurse who founded The Henry Street Settlement in New York and advocated for public health nursing (Britannica, 2020).

Question 5

Margaret Sanger was an obstetrics nurse who advocated for women’s rights regarding pregnancies, sex education and developed the concept of birth control. Margaret Sanger founded the American Birth Control League, it served as a model to what is now known as Planned Parenthood (Britannica, 2020).

Question 6

ICN stands for International Council of Nurses. It is an organization of health professionals led by nurses working together to oversee policies, advancement of nursing education, and competent care in organizations (ICN, 2020).

Question 7

Nurse Licensure Compact (NLC) gives nurses the opportunity to practice in other states without obtaining additional licenses.

Question 8

This scenario represents the evaluation stage. In the evaluation stage the policy is reassessed to verify if its components are aligned with what it is intended to accomplish (NCCHPP, 2013)

References

Health policy. (2020). Retrieved from https://www.who.int/topics/health_policy/en/

Lillian D. Wald. (2020, March 6). Retrieved from https://www.britannica.com/biography/Lillian-D-Wald

Margaret Sanger. (2020, July 21). Retrieved from https://www.britannica.com/biography/Margaret-Sanger

Public Policy Models and Their Usefulness in Public Health: The Stages Model. (2013, October). Retrieved from http://www.ncchpp.ca/docs/modeleetapespolpubliques_

Selanders, L. (2020, May 8). Florence Nightingale. Retrieved from https://www.britannica.com/biography/Florence-Nightingale

Who we are. (2020). Retrieved from https://www.icn.ch/who-we-are

  Hello i need a Briefly, Good and Positive Comment for this Post.Thank you.  I need at least two references .  

   

Donlashoni Cowley

NURS 6650 WEEK 10 Discussion Clinical Supervision Child and Adolescent Group

         The patient I was focusing on was not responding to any of his treatment plan we prepared. The young man was 18-year-old white male who has a history (F31.31) bipolar with depression and (F10.1) alcohol abuse (American Psychiatric Association (APA), 2013).  He lives with his father and stepmother whom his father just married 3 months ago. He had 2 other siblings 3 months old stepsister and a brother who is 25 years old who lives in Ohio with his wife. He dropped out of high school in the 10 grade and moved in with his dad. He was brought to the medical facility due to excessive alcohol abuse and bizarre behavior. The young man refused to participate in group therapy. He would not response to general questions or any activity lessons. He was very disrespectful to the other patient in therapy. He was constantly getting into argument and instigating flights with others. During the session he was invaded other patient space and was redirected several times by medical staff.  He presents as anger, irritated by others and withdrawn. The only thing he would say to express himself is “You’re not like me and you don’t know me”. 

         Group therapy starts at 1030am and end at 1130 before lunch time.  The age group was between 17 years old to 20 years old both male and female patients present. The group was made up of 10 patients along with1 mental health tech, social worker and me. He stated privately during his intake “he was not happy with living with his stepmother”. He drinks to forget his problems. The young man was escorted out of the group therapy because he continued to be aggressive to others and he was causing the other in the group to become agitated resulting in physical altercation to erupt. The patient denied suicidal ideations or attempts. The patient denied any past medical history and psychiatric history including past hospitalization. The patient also denied any family medical history and described his father as “healthy.” The patient reports that he drinks every day starting when he wakes up. He drinks about of one to two bottle of vodka a day. We administered the PHQ-(2)-(9) assessment where he scored 13 indicating moderate depression. The doctor was notified of the behaviors during therapy and new order placed. 

           My therapeutic approach with this patient started out to be psychodynamic and group cognitive-behavioral therapy (CBT).  We use “group work to help each patient become aware of there inner feels and needs” (Wheeler, 2014 p.410). CBT was attempted by trying to help the young man view his inner feeling and emotions along with identifying the trigger that influence the behaviors (Wheeler, 2014 p.410). CBT is a short-term psychotherapy which should be seen within 6 to 11 sessions where the patient participates in the therapy. We used psychoeducation to create some structure in the group according to the book of Wheeler (2014) “psychoeducational groups can be directed by nurses, social worker and license professional counselor (LPC). 

           The reason I think that group CBT was not helpful to the patient is mainly because he would not participate in group but would open up to one on one counseling at times. My treatment plan was to increase more one on one therapy and slowly implement group therapy with the same participates within the same age group. According to the video with Microtraining Associates (2009) this patient follows the typical “conflict of interpersonal relationship, this mean we had find another approach by using group therapy in a way to get more of the patient peers involved with the discussion”. This helped the patient to relate to the others in the group which allowed the patient to feel better with the acceptance to modify his behavior and value what is being expressed from his peers. This therapeutic approach would not look like the adult in the room, is tell him anything but rather he understands it from a selected similar position of his peers.  

         We used the CBT approach to help this  patient to recognize and understand his negative thoughts and feelings in order to ultimately substitute them with positive ones but to help this young adolescent man, we must implement other approaches to help achieve a positive out for the patient.  The journey for this client can be achieved but would require a long time with individual, group therapy along with substance abuse counseling to confront the under lying issues with this patient. Since this patient doesn’t interact with the group it is hindering his progress though group sessions. We notified the doctors and followed up on this patient with referrals for more frequent visits by the psychologist and psychiatric included medication changes to help with improving behaviors.  

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). 

         Washington, DC: Author.

Microtraining Associates (Producer). (2009). Leading groups with adolescents [Video file]. Alexandria, 

         VA: Author.

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for 

         evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company

Assignment Details

Differentiate the Major Regulatory Restrictions on NP Practice 

Purpose

NPs have scopes of practice that are regulated by state laws, boards of nursing, boards of medicine and reimbursement that may differ depending on your location. There are several sources of restrictions to NP practice such as state laws and federal regulations which include who may prescribe controlled substances and which substances NPs can prescribe, as well as the various reimbursement agencies. It is essential that the NP be fully informed of what they are allowed to do by law (state and federal) or by other regulatory organizations. These regulations vary widely from state to state. Consequences of practicing outside your scope of practice may be anything from a fine, suspension or revocation of your license, civil lawsuit, or even criminal charges. 

Directions

Use the provided template to compare and contrast the three major regulatory practice models for NPs: Supervisory, Collaborative, and Independent. Please keep this assignment in the template format provided. This Assignment requires credible and up to date resources for each category. Include in each model at least one state that represents the scope of practice you are discussing. For example, Texas requires a supervisory relationship with a physician along with a practice agreement, formulary, and protocols. In order to apply and receive a DEA license to prescribe controlled substances, you must be approved by the state you are practicing in to prescribe these medications.

Assignment Template

To view the Grading Rubric for this Assignment, please visit the Grading Rubrics section under Course Resources. 

Assignment Requirements

Before finalizing your work, you should:

• be sure to read the Assignment description carefully (as displayed above)
• consult the Grading Rubric (under Course Resources) to make sure you have included everything necessary
• utilize spelling and grammar check to minimize errors 

Your writing Assignment should:

• follow the conventions of Standard English (correct grammar, punctuation, etc.)
• be well ordered, logical, and unified, as well as original and insightful
• display superior content, organization, style, and mechanics
• use APA 7th Edition format for organization, style, and crediting sources. Refer to the APA Progression Ladder.