Group Note – 2025 Select a client family that you have observed or counseled at your practicum site Review pages 137 142 of Wheeler

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Group Note – 2025

 

  • Select a client family that you have observed or counseled at your practicum site.
  • Review pages 137–142 of Wheeler (2014) and the Hernandez Family Genogram video in this week’s Learning Resources.
  • Reflect on elements of writing a comprehensive client assessment and creating a genogram for the client you selected.

Assignment

Part 1: Comprehensive Client Family Assessment

Create a comprehensive client assessment for  your selected client family that addresses (without violating HIPAA  regulations) the following:

  • Demographic information
  • Presenting problem
  • History or present illness
  • Past psychiatric history
  • Medical history
  • Substance use history
  • Developmental history
  • Family psychiatric history
  • Psychosocial history
  • History of abuse and/or trauma
  • Review of systems
  • Physical assessment
  • Mental status exam
  • Differential diagnosis
  • Case formulation
  • Treatment plan

Part 2: Family Genogram

Develop a genogram for the client family you  selected. The genogram should extend back at least three generations  (parents, grandparents, and great grandparents).

Clinical Supervision Gr – 2025 I NEED A RESPONSE FOR THIS ASSIGNMENT 2 REFERENCES Cognitive Behavior Therapy Cognitive behavior therapy CBT

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Clinical Supervision Gr – 2025

I NEED A RESPONSE FOR THIS ASSIGNMENT

2 REFERENCES 

Cognitive Behavior Therapy

Cognitive behavior therapy (CBT) is a practical therapeutic approach to psychotherapy. According to Eidelmen et al. (2019), CBT effectively treats 50-60 % of individuals with depression and anxiety, sustainably decreasing their symptoms by targeted therapeutic approaches. CBT is a form of psychotherapy that provides clients with the insight that thoughts, feelings, and behavior are connected and teaches clients how to change negative cognition that leads to psychopathology(Tovote et al., 2017).

Contrasting CBT

Spillane-Grieco (2000) noted that in contrasting CBT with families to CBT with individuals, CBT with families focuses on cognition, beliefs, perception, behavior, and current interaction between family members, which overlap and affect how the family functions. On the other, In CBT with individuals, the therapist works with the client to set and achieve specific goals and explore how the client’s behavior, thoughts, and feelings contribute to the difficulties the client is currently facing.

An example from my practicum experience is a couple presenting for psychotherapy due to marital challenges because of the husband’s mother’s strong involvement in the marriage, which displease the wife and causes strife. This family’s treatment goal was to help the couple describe a healthy and positive relationship in their family systems and rebuild essential family relationships.

Stigma

Stigma is a challenge mental health counselor can encounter in CBT with families. According to Halder and Mahato (2019), although awareness of mental health continues to increase, some families remain in denial of the mental health illness of their family members and can blame their ward, not giving them the attention needed and not developing real insight concerning the challenges their ward faces. For instance, in this week’s video resource, some female group members talked about stigma, feeling blame, and being blamed by others even though they were dealing with very severe traumatic experiences. In conclusion, CBT is a useful tool for both families and individuals; however, healthcare providers must recognize the difference and its impact when treating families or individuals.

References

Eidelman, P., Jensen, A., & Rappaport, L. M. (2019). Social support, negative social exchange, and response to case formulation-based cognitive behavior therapy. Cognitive Behavior Therapy, 48(2), 146–161. https://doi-org.ezp.waldenulibrary.org/10.1080/16506073.2018.1490809

Halder, S., & Mahato, A. (2019). Cognitive behavior therapy for children and adolescents: Challenges and gaps in practice. Indian Journal of Psychological Medicine, 41(3), 279–283. https://doi-org.ezp.waldenulibrary.org/10.4103/IJPSYM.IJPSYM_470_18

Hauksson, P., Ingibergsdóttir, S., Gunnarsdóttir, T., & Jónsdóttir, I. H. (2017). Effectiveness of cognitive behavior therapy for treatment-resistant depression with psychiatric comorbidity: comparison of individual versus group CBT in an interdisciplinary rehabilitation setting. Nordic Journal of Psychiatry, 71(6), 465–472. https://doi-org.ezp.waldenulibrary.org/10.1080/08039488.2017.1331263

Shryane, N., Drake, R., Morrison, A., & Palmier-Claus, J. (2020). Is cognitive-behavioral therapy effective for individuals experiencing thought disorder? Psychiatry Research, 285. https://doi-org.ezp.waldenulibrary.org/10.1016/j.psychres.2020.112806

Spillane-Grieco, E. (2000). Cognitive-Behavioral Family Therapy with a Family in High-Conflict Divorce: A Case Study. Clinical Social Work Journal, 28(1), 105–119.

Tovote, K., Schroevers, M., Snippe, E., Emmelkamp, P., Links, T., Sanderman, R., & Fleer, J. (2017). What works best for whom? Cognitive Behavior Therapy and Mindfulness-Based Cognitive Therapy for depressive symptoms in patients with diabetes. PLoS ONE, 12(6), 1–16. https://doi-org.ezp.waldenulibrary.org/10.1371/journal.pone.0179941

Child Development – 2025 Assignment In teams you will create a research based handbook complete with written component and illustrations and graphics For this assignment

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Child Development – 2025

 

Assignment:

In teams, you will create a research-based handbook complete with written component and illustrations and graphics.

For this assignment, you will be placed (virtually) in a real-world scenario that occurs in schools. Please read the following description of the authentic performance task and complete the requirements as described in the scenario.

SCENARIO

“Imagine you are an expert in child development. You will design a helpful handbook for new and expecting parents that will be a helpful resource for parents in learning about how their child will develop in a variety of areas. In your handbook, define specific topics in child development, providing in-depth explanations of the characteristics of each (research-based), and develop three key activities that parents can do at home for each of the following topics to include:

  • Prenatal Development and Birth
  • Physical Development and Health
  • Motor, Sensory, and Perceptual Development
  • Cognitive Development Approaches
  • Language Development

Your handbook should be realistic, research-based, and precise, and should address all 5 required components in a research-based manner using text support and outside research to create a comprehensive informational handbook focused on development in early childhood.”

The handbook should be 2000-2500 words and should include at least four (4) citations. The sections should be clearly marked with headings so that your instructor knows which points you are addressing. Follow the guidelines for APA writing style. The title page and references page so not count towards the minimum word amount for this assignment.

Clinical Supervision – 2025 I NEED A RESPONSE TO THIS ASSIGNMEN T 2 REFERENCES Anxiety disorder is a

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Clinical Supervision – 2025

 I NEED A RESPONSE TO THIS ASSIGNMEN T

2 REFERENCES

Anxiety disorder is a common and disabling condition that mostly begins during childhood, adolescence, and early adulthood (Craske & Stein, 2016). Anxiety is persistent and impairs daily functioning. Most anxiety disorders affect almost twice as many women as men. Anxiety mostly co-occurs with major depression, alcohol, substance-use disorders, and personality disorders (Craske & Stein, 2016).

Anxiety disorders, when untreated, tend to recur chronically. The recommendation is to treat psychological treatments, particularly cognitive behavioral therapy, and pharmacological treatments, particularly selective serotonin-reuptake inhibitors and serotonin-noradrenaline-reuptake inhibitors. The combination of the two drugs works more effectively. (Beesdo, Knappe, & Pine, 2009) Childhood and adolescence is the core risk phase for the development of anxiety symptoms and syndromes, ranging from transient mild symptoms to full-blown anxiety disorders (Beesdo, Knappe, & Pine, 2009)

      I learned from the information you gave about enhancing client medication dosing using cytochrome B450 and gene testing in checking how a person metabolizes medication. This client, her Celexa, was increased to 5mg because she was fast in metabolizing her pills. 

I will be very interested to learn her outcome.

Reference,

Beesdo, K., Knappe, S., & Pine, D. S. (2009). Anxiety and anxiety disorders in children and adolescents: Developmental issues and implications for DSM-V. The Psychiatric clinics of North America32(3), 483–524. https://doi.org/10.1016/j.psc.2009.06.002

Craske, M. G., & Stein, M. B. (2016). Anxiety. Lancet (London, England)388(10063), 3048–3059. https://doi.org/10.1016/S0140-6736(16)30381-6

American Government 3 – 2025 Being the President of the United States is a very powerful and influential position This week we will discuss

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American Government 3 – 2025

Being the President of the United States is a very powerful and influential position. This week we will discuss education reform and welfare reform. Identify one (1) President of the United States and write a two (2) page paper discussing the following. Each section of your paper should have a section header. 1- Explain why you selected the President? 2- Give some historical background about the President. 3- Identify and discuss an initiative accomplished by the President which relates to welfare, health, education, and/or environmental reform. APA format and at least 2 academic resources (your textbook and one other source)

Epidemiology – 2025 Explain the two major types of bias Identify a peer reviewed epidemiology article that discusses potential issues with bias as a

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Epidemiology – 2025

  

Explain the two major types of bias. Identify a peer-reviewed epidemiology article that discusses potential issues with bias as a limitation and discuss what could have been done to minimize the bias (exclude articles that combine multiple studies such as meta-analysis and systemic review articles). What are the implications of making inferences based on data with bias? Include a link to the article in your reference. 

Great article on identifying and avoiding bias in research

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2917255/.

Wk6 Patho Knowledge Check 6501 – 2025 QUESTION 1 A 67 year old Caucasian woman was brought to the clinic by her son who stated that his mother had become slightly confused over

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Wk6 Patho Knowledge Check 6501 – 2025

QUESTION 1

  1. A 67-year-old Caucasian woman was brought to the clinic by her son who stated that his mother had become slightly confused over the past several days. She had been stumbling at home and had fallen once but was able to ambulate with some difficulty. She had no other obvious problems and had been eating and drinking. The son became concerned when she forgot her son’s name, so he thought he better bring her to the clinic.  
    PMH-Type II diabetes mellitus (DM) with peripheral neuropathy x 20 years. COPD. Depression after death of spouse several months ago 
    Social/family hx – non contributary except for 30 pack/year history tobacco use.  
    Meds: Metformin 500 mg po BID, ASA 81 mg po qam, escitalopram (Lexapro) 5 mg po q am started 2 months ago 
    Labs-CBC WNL; Chem 7- Glucose-92 mg/dl, BUN 18 mg/dl, Creatinine 1.1 mg/dl, Na+120 mmol/L, 
    K+4.2 mmol/L, CO237 m mol/L, Cl-97 mmol/L.  
    The APRN refers the patient to the ED and called endocrinology for a consult for diagnosis and management of syndrome of inappropriate antidiuretic hormone (SIADH). 

    Question:
    Define SIADH and identify any patient characteristics that may have contributed to the development of SIADH.

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1 points   

QUESTION 2

  1. A 43-year-old female presents to the clinic with a chief complaint of fever, chills, nausea and vomiting and weakness. She has been unable to keep any food, liquids or medications down. The symptoms began 3 days ago and have not responded to ibuprofen, acetaminophen, or Nyquil when she tried to take them. The temperature has reached as high as 102˚F.  

     Allergies: none known to drugs or food or environmental  

     Medications-20 mg prednisone po qd, omeprazole 10 po qam 

     PMH-significant for 20-year history of steroid dependent rheumatoid arthritis (RA). GERD. No other significant illnesses or surgeries. 

    Social-denies alcohol, illicit drugs, vaping, tobacco use 

    Physical exam 

    Thin, ill appearing woman who is sitting in exam room chair as she said she was too weak to climb on the exam table. VS Temp 101.2˚F, BP 98/64, pulse 110, Resp 16, PaO2 96% on room air.  

    ROS negative other than GI symptoms. 

    Based on the patient’s clinical presentation, the APRN diagnoses the patient as having secondary hypocortisolism due to the lack of prednisone the patient was taking for her RA secondary to vomiting.

    Question:

    Explain why the patient exhibited these symptoms? 

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1 points   

QUESTION 3

  1. A 64-year-old Caucasian female presents to the clinic with vague symptoms of non- specific abdominal pain, myalgias, constipation, polyuria, and says she feels “fuzzy headed” much of the time. She had about of kidney stones a few weeks ago and she fortunately was able to pass the small stones without requiring lithotripsy or other interventions. She was told by the urologist to follow up with her primary care provider after the kidney stones has resolved.  
    The APRN examining the patient orders a Chem 7 which revealed a serum Ca++ of 13.1 mg/dl. The APN believes the patient has primary hyperparathyroidism and refers the patient to an endocrinologist who does a complete work up and concurs with the APRN’s diagnosis. 
    Question:
    What is the role of parathyroid hormone in the development of primary hyperparathyroidism? 

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1 points   

QUESTION 4

  1. A 64-year-old Caucasian female presents to the clinic with vague symptoms of non- specific abdominal pain, myalgias, constipation, polyuria, and says she feels “fuzzy headed” much of the time. She had a fracture of her right metatarsal without trauma and currently is wearing a walking boot. She also had a bout of kidney stones a few weeks ago and she fortunately was able to pass the small stones without requiring lithotripsy or other interventions. She was told by the urologist to follow up with her primary care provider after the kidney stones has resolved.  

    The APRN examining the patient orders a Chem 12 which revealed a serum Ca++ of 13.1 mg/dl. The APRN believes the patient has primary hyperparathyroidism and refers the patient to an endocrinologist who does a complete work up and concurs with the APRN’s diagnosis. 

    Question 1 of 2:

    Explain the processes involved in the formation of renal stones in patients with hyperparathyroidism. 

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0.5 points   

QUESTION 5

  1. A 64-year-old Caucasian female presents to the clinic with vague symptoms of non- specific abdominal pain, myalgias, constipation, polyuria, and says she feels “fuzzy headed” much of the time. She had a fracture of her right metatarsal without trauma and currently is wearing a walking boot. She also had a bout of kidney stones a few weeks ago and she fortunately was able to pass the small stones without requiring lithotripsy or other interventions. She was told by the urologist to follow up with her primary care provider after the kidney stones has resolved.  
    The APRN examining the patient orders a Chem 12 which revealed a serum Ca++ of 13.1 mg/dl. The APRN believes the patient has primary hyperparathyroidism and refers the patient to an endocrinologist who does a complete work up and concurs with the APRN’s diagnosis. 
    Question 2 of 2:
    Explain how a patient with hyperparathyroidism is at risk for bone fractures.  

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0.5 points   

QUESTION 6

  1. A 64-year-old Caucasian female who is 4 weeks status post total parathyroidectomy with forearm gland insertion presents to the general surgeon for her post-operative checkup. She states that her mouth feels numb and she feels “tingly all over. The surgeon suspects the patient has hypoparathyroidism secondary to the parathyroidectomy with delayed vascularization of the implanted gland. She orders a Chem 20 to determine what electrolyte abnormalities may be present. The labs reveal a serum Ca++ of 7.1 mg/dl (normal 8.5 mg/dl-10.5 mg/dl) and phosphorous level of 5.6 mg/dl (normal 2.4-4.1 mg/dl).  

    Question:

    What serious consequences of hypoparathyroidism occur and why? — Font family —- Font size —- Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)Path: pWords:0

1 points   

QUESTION 7

  1. A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.  

    PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child  

    Allergies-none know  

    Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process 

    Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends. 

    Labs in office: random glucose 220 mg/dl.  

    Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.  

    Question 1 of 6:

    The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “polydipsia.”

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1 points   

QUESTION 8

  1. A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.  

    PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child  

    Allergies-none know  

    Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process 

    Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends. 

    Labs in office: random glucose 220 mg/dl.  

    Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.  
    Question 2 of 6:

    The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “polyuria.”

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1 points   

QUESTION 9

  1. A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.  
    PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child  
    Allergies-none know  
    Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process 
    Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends. 
    Labs in office: random glucose 220 mg/dl.  
    Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.  
    Question 3 of 6:
    The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “polyphagia.”

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1 points   

QUESTION 10

  1. A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.  

    PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child  

    Allergies-none know  

    Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process 

    Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends. 

    Labs in office: random glucose 220 mg/dl.  

    Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.  
    Question 4 of 6:
    The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “weight loss.”

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0.5 points   

QUESTION 11

  1. A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.  
    PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child  
    Allergies-none know  
    Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process 
    Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends. 
    Labs in office: random glucose 220 mg/dl.  
    Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.  
    Question 5 of 6:
    The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “fatigue.”

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0.5 points   

QUESTION 12

  1. A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.  
    PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child  
    Allergies-none know  
    Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process 
    Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends. 
    Labs in office: random glucose 220 mg/dl.  
    Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.  
    Question 6 of 6:
    How do genetics and environmental factors contribute to the development of Type 1 diabetes?

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1 points   

QUESTION 13

  1. A 17-year-old boy recently diagnosed with Type I diabetes is brought to the pediatrician’s office by his parents with a chief complaint of “having the flu”. His symptoms began 2 days ago, and he has vomited several times and has not eaten very much. He can’t remember if he took his prescribed insulin for several days because he felt so sick. Random glucose in the office reveals glucose 560 mg/dl and the pediatrician made arrangements for the patient to be admitted to the hospitalist service with an endocrinology consult.  

    BP 124/80mmHg; HR 122bpm; Respirations 32 breaths/min; Temp 97.2˚F; PaO297% on RA 

    Admission labs: Hgb 14.6 g/dl; Hct 58% 

    CMP- Na+ 122mmol/L; K+ 5.3mmol/L; Glucose 560mg/dl; BUN 52mg/dl; Creatinine 4.9mg/dl;  

    Cl- 95mmol/L; Ca++ 8.8mmol/L; AST (SGOT) 248U/L; ALT 198U/L; CK 34/35 IU/L; Cholesterol 198mg/dl;  

    Phosphorus 6.8mg/dl; Acetone Moderate; LDH38U/L; Alkaline Phosphatase 132U/L. 

    Arterial blood gas values were as follows: pH 7.09; Paco220mm Hg; Po2100mm Hg; Sao2 98% (room air) 

    HCO3-7.5mmol/L; anion gap 19.4 

    A diagnosis of diabetic ketoacidosis was made, and the patient was transferred to the Intensive Care Unit (ICU) for close monitoring.  

    Question:

    The hormones involved in intermediary metabolism, exclusive of insulin, that can participate in the development of diabetic ketoacidosis (DKA) are epinephrine, glucagon, cortisol, growth hormone. Describe how they participate in the development of DKA.

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1 points   

QUESTION 14

  1. A 67-year-old African American male presents to the clinic with a chief complaint that he has to “go to the bathroom all the time and I feel really weak.” He states that this has been going on for about 3 days but couldn’t come to the clinic sooner as he went to the Wound Care clinic for a dressing change to his right great toe that has been chronically infected, and he now has osteomyelitis. Patient with known Type II diabetes with poor control. His last HgA1C was 10.2 %. He says he can’t afford the insulin he was prescribed and only takes half of the oral agent he was prescribed. Random glucose in the office revealed glucose of 890 mg/dl. He was immediately referred to the ED by the APRN for evaluation of suspected hyperosmolar hyperglycemic non ketotic syndrome (HHNKS). Also called hyperglycemic hyperosmolar state (HHS).  

    Question:

    Explain the underlying processes that lead to HHNKS or HHS.

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1 points   

QUESTION 15

  1. A 32-year-old woman presented to the clinic complaining of weight gain, swelling in her legs and ankles and a puffy face. She also recently developed hypertension and diabetes type 2. She noted poor short-term memory, irritability, excess hair growth (women), red-ruddy face, extra fat around her neck, fatigue, poor concentration, and menstrual irregularity in addition to muscle weakness. Given her physical appearance and history, a tentative diagnosis of hypercortical function was made. Diagnostics included serum and urinary cortisol and serum adrenocorticotropic hormone (ACTH). MRI revealed a pituitary adenoma.  

    Question:

    How would you differentiate Cushing’s disease from Cushing’s syndrome? 

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1 points   

QUESTION 16

  1. A 47-year-old female is referred to the endocrinologist for evaluation of her chronically elevated blood pressure, hypokalemia, and hypervolemia. The patient’s hypertension has been refractory to the usual medications such as beta blockers, diuretics, and angiotensin-converting enzyme (ACE) inhibitors. After a full work up including serum and urinary electrolyte levels, aldosterone suppression test, plasma aldosterone to renin ratio, and MRI which revealed an autonomous adenoma, the endocrinologist diagnoses the patient with primary hyper-aldosteronism.  

    Question:

    What is the pathogenesis of primary hyper-aldosteronism? 

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1 points   

QUESTION 17

  1. A 47-year-old African American male presents to the clinic with chief complaints of polyuria, polydipsia, polyphagia, and weight loss. He also said that his vison occasionally blurs and that his feet sometimes feel numb.  He has increased hunger despite weight loss and admits to feeling unusually tired. He also complains of “swelling” and enlargement of his abdomen.  

    Past Medical History (PMH) significant for HTN fairly well controlled with and ACE inhibitor; central obesity, and dyslipidemia treated with a statin, Review of systems negative except for chief complaint. Physical exam unremarkable except for decreased filament test both feet. Random glucose in office 290 mg/dl. The APRN diagnoses the patient with type II DM and prescribes oral medication to control the glucose level and also referred the patient to a dietician for dietary teaching. 

    Question:

    What is the basic underlying pathophysiology of Type II DM? 

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1 points   

QUESTION 18

  1. A 21-year-old male was involved in a motorcycle accident and sustained a closed head injury. He is waking up and interacting with his family and medical team. He complained of thirst that doesn’t seem to go away no matter how much water he drinks. The nurses note that he has had 3500 cc of pale-yellow urine in the last 24 hours. Urine was sent for osmolality which was reported as 122 mOsm/L. A diagnosis of probable neurogenic diabetes insipidus was made.  

    Question:

    What causes diabetes insipidus (DI)? 

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0.5 points   

QUESTION 19

  1. A 43-year-old female patient presents to the clinic with complaints of nervousness, racing heartbeat, anxiety, increased perspiration, heat intolerance, hyperactivity and palpitations. She states she had had the symptoms for several months but attributed the symptoms to beginning to care for her elderly mother who has Alzheimer’s Disease. She has lost 15 pounds in the last 3 months without dieting. Her past medical history is significant for rheumatoid arthritis that she has had for the last 10 years well controlled with methotrexate and prednisone. Physical exam is remarkable for periorbital edema, warm silky feeling skin, and palpable thyroid nodules in both lobes of the thyroid. Pending laboratory diagnostics, the APRN diagnoses the patient as having hyperthyroidism, also called Graves’ Disease.

    Question:

    Explain how the negative feedback loop controls thyroid levels.

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1 points   

QUESTION 20

  1. A 43-year-old female patient with known Graves’ Disease presents to the clinic with complaints of nervousness, racing heartbeat, anxiety, increased perspiration, heat intolerance, hyperactivity and severe palpitations. She states she had been given a prescription for propylthiouracil, an antithyroid medication but she did not fill the prescription as she claims she lost it. She had been given the option of thyroidectomy which she declined. She also notes that she is having trouble with her vision and often has blurry eyes. She states that her eyes seem “to bug out of her face”. She has had recurrent outs of nausea and vomiting. She was recently hospitalized for pneumonia.  Physical exam is significant for obvious exophthalmos and pretibial myxedema. Vital signs are temp 101.2˚F, HR 138 and irregular, BP 160/60 mmHg. Respirations 24. Electrocardiogram revealed atrial fibrillation with rapid ventricular response. The APRN recognizes the patient is experiencing symptoms of thyrotoxic crisis, also called thyroid storm. The patient was immediately transported to a hospital for critical care management. 

    Question:

    How did the patient develop thyroid storm? What were the patient factors that lead to the development of thyroid storm? 

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1 points   

QUESTION 21

  1. A 44-year-old woman presents to the clinic with complaints of extreme fatigue, weight gain, decreased appetite, cold intolerance, dry skin, hair loss, and sleepiness. She also admits that she often bursts into tears without any reason and has been exceptionally forgetful. Her vision is occasionally blurry, and she admits to being depressed without any social or occupational triggers. Past medical history noncontributory. Physicalexam Temp 96.2˚F, pulse 62 and regular, BP 108/90, respirations. Dull facial expression with coarse facial features. Periorbital puffiness noted. Based on the clinical history and physical exam, and pending laboratory data, the ARNP diagnoses the patient with hypothyroidism.  

    Question:

    What causes hypothyroidism? 

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0.5 points   

QUESTION 22

  1. A 44-year-old woman is brought to the clinic by her husband who says his wife has had some mental status changes over the past few days. The patient had been previously diagnosed with hypothyroidism and had been placed on thyroid replacement therapy but had been lost to follow-up due to moving to another city for the husband’s work approximately 4 months ago. The patient states she lost the prescription bottle during the move and didn’t bother to have the prescription filled since she was feeling better. Physical exam revealed non-pitting, boggy edema around her eyes, hands and feet as well as the supraclavicular area. The APRN recognizes this patient had severe myxedema and referred the patient to the hospital for medical management.  

    Question:

    What causes myxedema coma? 

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0.5 points   

QUESTION 23

  1. A 53-year-old woman presents to the primary care clinic with complaints of severe headaches, palpitations, highblood pressure and diaphoresis. She relates that these symptoms come in clusters and when she has these “spells”, she also experiences, tremor, nausea, weakness, anxiety, and a sense of doom and dread, epigastric pain, and flank pain. She had one of these spells when she was at the pharmacy and the pharmacist took her blood pressure which was recorded as 200/118. The pharmacist recommended that she immediately be evaluated for these symptoms. Past medical history significant for a family history of neurofibromatosis type 1 (NF1). Based on the presenting symptoms and family history of NF1, the APRN suspects the patient has a pheochromocytoma. Laboratory data and computerized tomography of the abdomen confirms the diagnosis. 
    Question 1 of 2:

    What is a pheochromocytoma and how does it cause the classic symptoms the patient presented with? 

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0.5 points   

QUESTION 24

  1. A 53-year-old woman presents to the primary care clinic with complaints of severe headaches, palpitations, highblood pressure and diaphoresis. She relates that these symptoms come in clusters and when she has these “spells”, she also experiences, tremor, nausea, weakness, anxiety, and a sense of doom and dread, epigastric pain, and flank pain. She had one of these spells when she was at the pharmacy and the pharmacist took her blood pressure which was recorded as 200/118. The pharmacist recommended that she immediately be evaluated for these symptoms. Past medical history significant for a family history of neurofibromatosis type 1 (NF1). Based on the presenting symptoms and family history of NF1, the APRN suspects the patient has a pheochromocytoma. Laboratory data and computerized tomography of the abdomen confirms the diagnosis. 
    Question 2 of 2:
    What are the treatment goals for managing pheochromocytoma? 

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Epidemiology Paper – 2025 Write a paper 2 000 2 500 words in which you apply the concepts of epidemiology and

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Epidemiology Paper – 2025

 

Write a paper (2,000-2,500 words) in which you apply the concepts of epidemiology and nursing research to a communicable disease. Refer to “Communicable Disease Chain,” “Chain of Infection,” and the CDC website for assistance when completing this assignment.

Communicable Disease Selection

  1. Chickenpox
  2. Tuberculosis
  3. Influenza
  4. Mononucleosis
  5. Hepatitis B
  6. HIV
  7. Ebola
  8. Measles
  9. Polio
  10. Influenza

Epidemiology Paper Requirements

  1. Describe the chosen communicable disease, including causes, symptoms, mode of transmission, complications, treatment, and the demographic of interest (mortality, morbidity, incidence, and prevalence). Is this a reportable disease? If so, provide details about reporting time, whom to report to, etc.
  2. Describe the social determinants of health and explain how those factors contribute to the development of this disease.
  3. Discuss the epidemiologic triangle as it relates to the communicable disease you have selected. Include the host factors, agent factors (presence or absence), and environmental factors. Are there any special considerations or notifications for the community, schools, or general population?
  4. Explain the role of the community health nurse (case finding, reporting, data collection, data analysis, and follow-up) and why demographic data are necessary to the health of the community.
  5. Identify at least one national agency or organization that addresses the communicable disease chosen and describe how the organizations contribute to resolving or reducing the impact of disease.
  6. Discuss a global implication of the disease. How is this addressed in other countries or cultures? Is this disease endemic to a particular area? Provide an example.

A minimum of three peer-reviewed or professional references is required.

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

Assessing Client Families – 2025 PLEASE FOLLOW THE INSTRUCTION BELOW FIVE REFERENCES ZERO PLAGIARISM Students will Assess client families presenting for

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Assessing Client Families – 2025

PLEASE FOLLOW THE INSTRUCTION BELOW 

FIVE REFERENCES

ZERO PLAGIARISM

Students will:
  • Assess client families presenting for psychotherapy
  • Develop genograms for client families presenting for psychotherapy
To prepare:
  • Select a client family that you have observed or counseled at your practicum site.
  • Review pages 137–142 of Wheeler (2014) and the Hernandez Family Genogram video in this week’s Learning Resources.
  • Reflect on elements of writing a comprehensive client assessment and creating a genogram for the client you selected.

Assignment

Part 1: Comprehensive Client Family Assessment

Create a comprehensive client assessment for your selected client family that addresses (without violating HIPAA regulations) the following:

  • Demographic information
  • Presenting problem
  • History or present illness
  • Past psychiatric history
  • Medical history
  • Substance use history
  • Developmental history
  • Family psychiatric history
  • Psychosocial history
  • History of abuse and/or trauma
  • Review of systems
  • Physical assessment
  • Mental status exam
  • Differential diagnosis
  • Case formulation
  • Treatment plan

Part 2: Family Genogram

Develop a genogram for the client family you selected. The genogram should extend back at least three generations (parents, grandparents, and great grandparents).

Epidemiology – 2025 Explain the two major types of bias Identify a peer reviewed epidemiology article that discusses potential issues with

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Epidemiology – 2025

  

Explain the two major types of bias. Identify a peer-reviewed epidemiology article that discusses potential issues with bias as a limitation and discuss what could have been done to minimize the bias (exclude articles that combine multiple studies such as meta-analysis and systemic review articles). What are the implications of making inferences based on data with bias? Include a link to the article in your reference. 

Great article on identifying and avoiding bias in research

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2917255/.