Lupus Patient Education Activity

A 20-year old female presents with chief complaint of fatigue, anxiety, and heart palpitations. She has recently given birth to her second child, a daughter. Initial recommendation from her follow up appointment is to rest. The patient’s symptoms worsen and then gradually resolve. Over the next year she has increased fatigue and headaches. She also starts to complain of joint pain in her ankles, knees, elbows, wrists, and fingers. Rest and over-the-counter pain medication relieve her symptoms, but it is difficult for her to find time for much rest due to the responsibilities of caring for a family and working full-time. The winter brings a new intolerance to low temperatures. She states her hands and feet becoming painful and discolored when she is exposed to cold. Her extremities became painful, stiff, and altered in color when exposed to cold temperatures. She also develops a butterfly rash.

DX: systemic lupus erythematosus.

Rx: prednisone and hydroxychloroquine

You are providing the patient with education on her new diagnosis. Create a patient teaching plan that covers the following questions.

1. What is lupus?

2. What key lifestyle changes will the patient need to address to manage her condition?

3. What are the important teaching points for her medications?

4. What are the recommendations to manage her symptoms, to avoid flare-ups, and to monitor her condition?

5. What symptoms, if they occur, should she report immediately to her provider and why?

Rheumatoid Arthritis Patient Education Activity

A 48-year old female presents stiffness in both hands in the morning for last 7 months. Stiffness now lasted more than 1 hour every morning and includes hands, wrists and ankles. She also had increasing difficulty standing for long periods at work or at home due to foot and ankle pain. She began taking ibuprofen 800mg 3 times daily and found it helped her get through her day with less pain and stiffness. Three months ago, Joy noticed pain in her right and left shoulders when she would cut or blow dry her client’s hair. She also began feeling extremely tired and short tempered. She had no energy to do her usual activities. Ibuprofen was no longer very effective for her pain or stiffness. One morning, Joy could not lift her arms at all without extreme shoulder pain. She knew it was time to get help. 

Pt is married with 3 teenagers, and works part time as a hairdresser.

Dx: Rheumatoid Arthritis (RA) 

Rx: methotrexate, Physical Therapy

You are providing the patient with education on her new diagnosis. Create a patient teaching plan that covers the following questions. 

1. What is rheumatoid arthritis? 

2. What are the important teaching points for her medication? 

3. What are the recommendations to manage her joint pain during remission? During exacerbation?

For Week 10, reply to the questions below in a one paragraph (four to five sentences) response. You are not required to respond to your peers, but you may do so if you like.

Your response is due no later than Monday, 11:59 p.m. (Pacific time).

Briefly reflect on your pathophysiology experience and address the following questions:

• How will the knowledge of pathophysiology play into your career role?
• What aspect of pathophysiology do you feel will be the most important moving forward?
• Scholarly sources and citations please!!!

 Respond to  your  colleagues by suggesting an alternate therapeutic approach. Support your  feedback with evidence-based literature and/or your own experiences  with clients.  

                                                        Main Discussion

The client is a 17-year-old white girl that was accompanied by her mother to the clinic. She has two older brothers in the university and they are all studying to be doctors. Her father is a doctor and her mother is a nurse in the community hospital. She self-reported that she has been feeling very anxious of late. For a duration of about 8 months, she has been very worried about school especially now that she is almost done with her high school. Her grades don’t look so good and she is worried that she might not be able to follow the family tradition of working as a doctor, something that her father wants for her. She also dreams about the same but it is the fact there is too much that is expected from her that worries her.

The client has been finding it hard to cope with the worrying and this has further affected her performance which makes the situation worse. Her father has been putting so much pressure on her and this is not helping. She has been restless and is always on edge. She is always irritable and this affects how she relates with her parents and colleagues at school. She has challenges when it comes to concentrating at school and at the end of the day, she feels more fatigued than ever. Her sleep has not been normal. She finds it hard to fall asleep and staying asleep about 2-3 nights in a week. These disturbances cannot be attributed to any other mental or psychiatric illnesses. According to the interview and the comprehensive assessment, it was concluded that this was a case of generalized anxiety disorder due to pressure from school and her performance (APA, 2013).

The approach that was selected for this client was cognitive behavioral therapy. This is one of the most effective empirical treatment for generalized anxiety disorder and it is also a proper alternative to pharmacological interventions. The mother to the client and the client agreed that it would be better to avoid drugs after they were educated about potential side effects. Cognitive behavioral therapy is also considered as a first-line intervention to generalized anxiety disorder (Hirsch et al., 2019). The other reason for using cognitive behavioral therapy with this client is because she was entertaining negative thoughts that led to uncontrolled worrying. Using CBT allows the client to be able to change how she deals with the reason for her excessive anxiety. After a few weeks of therapy and after involving her father in a few sessions, it became clear that she could start controlling her anxiety and she found the will to cope with pressure from school. She even reported that the sleep disturbance reduced significantly.

The role of her father in her education and performance may have serious impact on the expected outcomes. This is why her father was included in a few sessions. It was very clear from the initial meeting that she was not only worried about her performance but also about not being able to meet the expectations that her father has for her and her future career. Allowing them to discuss about the issue as a family encouraged the parents to also appreciate their contribution to her anxiety. They therefore agreed to give her more support instead of pressure. Generalized anxiety disorder is one of the most common mental disorders in children and adolescents. Detecting it early is important in order to ensure that the quality of life of the affected person is not significantly affected (Bhatia & Goyal, 2018). The role of parents in exacerbating the problem should also be considered, especially when it comes to school performance. 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Bhatia, M. S., & Goyal, A. (2018). Anxiety disorders in children and adolescents: Need for early detection. Journal of postgraduate medicine, 64(2), 75

Hirsch, C. R., Beale, S., Grey, N., & Liness, S. (2019). Approaching Cognitive Behavior Therapy For Generalized Anxiety Disorder From A Cognitive Process Perspective. Frontiers in psychiatry, 10, 796

  PLEASE FOLLOW THE INSTRUCTIONS AS INDICATED BELOW

1). ZERO (0) PLAGIARISM

2). 5 REFERENCES, NO MORE THAN 5 YEARS

3). PLEASE SEE THE FOLLOWING ATTACHED RUBRIC DETAILS. 

Thank you.  

Here is the assignment below:

Boards of Nursing (BON) exist in all 50 states, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands. Similar entities may also exist for different regions. The mission of BONs is the protection of the public through the regulation of the nursing practice. BONs put into practice state/region regulations for nurses that, among other things, lay out the requirements for licensure and define the scope of nursing practice in that state/region.

It can be a valuable exercise to compare regulations among various state/regional boards of nursing. Doing so can help share insights that could be useful should there be future changes in a state/region. In addition, nurses may find the need to be licensed in multiple states or regions.

To Prepare:

• Review the Resources and reflect on the mission of state/regional boards of nursing as the protection of the public through the regulation of the nursing practice.
• Consider how key regulations may impact nursing practice.
• Review key regulations for the nursing practice of your state’s/region’s board of nursing and those of at least one other state/region and select at least two APRN regulations to focus on for this Discussion.

Post a comparison of at least two APRN board of nursing regulations in your state/region with those of at least one other state/region. Describe how they may differ. Be specific and provide examples. Then, explain how the regulations you selected may apply to Advanced Practice Registered Nurses (APRNs) who have the legal authority to practice within the full scope of their education and experience. Provide at least one example of how APRNs may adhere to the two regulations you selected.

P/S Note:  The assignment said to write a comparison of at least two APRN (Advanced Practice Registered Nurse) board of nursing regulations in your state/region with those of at least one other state/region. Describe how they may differ.  I practice in the District of Columbia (Washington, DC), and the state of Maryland (MD).  

Assignment: Decision Tree

For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting symptoms of a mental health disorder.

Learning Objectives

Students will:

· Evaluate clients for treatment of mental health disorders

· Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders

The Assignment:

Examine Case 2 ( follow media link below) 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.

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.

 Required Readings

American Academy of Child & Adolescent Psychiatry (AACAP). (2012a). Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 51(1), 98–113. Retrieved from http://www.jaacap.com/article/S0890-8567(11)00882-3/pdf 

American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.

• Standard 8 “Education” (pages 69-70)

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

McClelland, M., Crombez, M., Crombez, C., Wenz, C., Lisius, M., Mattia, A., & Marku, S. (2015). Implications for advanced practice nurses when pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is suspected: A qualitative study. Journal of Pediatric Healthcare, 29(5), 442-452. doi:10.1016/j.pedhc.2015.03.005

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. 1253–1268)

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

Required Media Resource 

Laureate Education (Producer). (2017c). Anxiety disorder, ODC, or something else? [Multimedia file]. Baltimore, MD: Author.

Optional Resources

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell. 

• Chapter 60, “Anxiety Disorders” (pp. 822–840)
• Chapter 61, “Obsessive Compulsive Disorder”      (pp. 841–857)