Write a brief Conclusion why you made these decisions and what will be the objective of obtaining an improvement in the condition of this patient .

Decision 1

The PMHNP will administer 10 mg of zyprexa orally at bed time and initiate 230mg of invega sustenna through intramuscular, in addition to 156 mg via the same route on day four. A similar dose will be administered within one months’ time. In addition the PMHNP will administer 10mg of Abfility orally at bed time. Expected outcome for this decision is a 25% decrease in the PANSS score (Stahl, 2013). This decision is also expected to alleviate the patient’s psychotic symptoms and achieve normalcy within one month. A slight weight gain is also expected as the drugs are known to increase weight in patients. Because I don’t select the other decisions, the patient is expected to have faster and noticeable changes in psychotic behavior within two weeks of treatment commencement. 

Decision 2

At this point the PMHNP will decide to continue with use of medications selected in decision 1 (Stahl, 2013). However the PMHNP will instruct the administering nurse to begin intramuscular injections of 300mg of Abfility and continue with 10 mg of the same drug in the morning. At this point, PANSS is expected to decrease by 50 % although the patient will also have noticeable weight gain due to use of invega sustenna (Stahl 2014). Because I don’t select other decisions, the patient is expected to have less cardiovascular drug toxicities and experience reduced risks for adverse drug reactions between Invega sustenna and Haldol Deaconoate. 

Decision 3

The decision at this point is to have the patient continue with Invega Sustenna and provide psychological counseling on the effects of the drugs associated with weight gain. It will be essential to explain to the patient that the weight gain from this drug is minimal in comparison with other drugs (Stahl, 2013). The PMHNP will set an appointment follow up date with the patient after one month duration and refer to the nutritionist and physical activity instructor. The difference between expected outcome in decision 3 and results of the decision is Abfility may not be efficacious for more than a period of 6 months given that it does not bind to D 2 receptors in a similar manner as Invega Sustenna. This will necessitate the PMHNP to change to Abfility Maintena because it is easily tolerated by patients on Abfility. 

Because I don’t select the other decisions, the patent will be able to utilize the same drug for the longest possible duration and optimize on their efficacy prior to switching to other types of medication (Stahl, 2013). Since the patient may not have the mental capacity to participate in the decision making process or make autonomous mental health decisions, it is essential to discuss treatment options with the spouse and explain the importance of adherence to treatment (Stein & Giordano, 2015). In addition, the mental health nurse is required to make those decisions which will benefit the patient and also outweigh the risk for adverse health outcomes. 

References

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Stahl, S. M. (2014). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Stein, D. J., & Giordano, J. (2015). Global mental health and neuroethics. BMC Medicine, 13(1), 44.  

Schizophrenia Treatment

Decision 1

The PMHNP will administer 10 mg of zyprexa orally at bed time and initiate 230mg of invega sustenna through intramuscular, in addition to 156 mg via the same route on day four. A similar dose will be administered within one months’ time. In addition the PMHNP will administer 10mg of Abfility orally at bed time. Expected outcome for this decision is a 25% decrease in the PANSS score (Stahl, 2013). This decision is also expected to alleviate the patient’s psychotic symptoms and achieve normalcy within one month. A slight weight gain is also expected as the drugs are known to increase weight in patients. Because I don’t select the other decisions, the patient is expected to have faster and noticeable changes in psychotic behavior within two weeks of treatment commencement. 

Decision 2

At this point the PMHNP will decide to continue with use of medications selected in decision 1 (Stahl, 2013). However the PMHNP will instruct the administering nurse to begin intramuscular injections of 300mg of Abfility and continue with 10 mg of the same drug in the morning. At this point, PANSS is expected to decrease by 50 % although the patient will also have noticeable weight gain due to use of invega sustenna (Stahl 2014). Because I don’t select other decisions, the patient is expected to have less cardiovascular drug toxicities and experience reduced risks for adverse drug reactions between Invega sustenna and Haldol Deaconoate. 

Decision 3

The decision at this point is to have the patient continue with Invega Sustenna and provide psychological counseling on the effects of the drugs associated with weight gain. It will be essential to explain to the patient that the weight gain from this drug is minimal in comparison with other drugs (Stahl, 2013). The PMHNP will set an appointment follow up date with the patient after one month duration and refer to the nutritionist and physical activity instructor. The difference between expected outcome in decision 3 and results of the decision is Abfility may not be efficacious for more than a period of 6 months given that it does not bind to D 2 receptors in a similar manner as Invega Sustenna. This will necessitate the PMHNP to change to Abfility Maintena because it is easily tolerated by patients on Abfility. 

Because I don’t select the other decisions, the patent will be able to utilize the same drug for the longest possible duration and optimize on their efficacy prior to switching to other types of medication (Stahl, 2013). Since the patient may not have the mental capacity to participate in the decision making process or make autonomous mental health decisions, it is essential to discuss treatment options with the spouse and explain the importance of adherence to treatment (Stein & Giordano, 2015). In addition, the mental health nurse is required to make those decisions which will benefit the patient and also outweigh the risk for adverse health outcomes. 

References

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Stahl, S. M. (2014). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Stein, D. J., & Giordano, J. (2015). Global mental health and neuroethics. BMC Medicine, 13(1), 44.

The purpose of this  assignment is to demonstrate your ability to critique one quantitative  or qualitative nursing research article of interest from any refereed  nursing journal.

Instructions:

1. Choose a nursing research article of interest from a refereed nursing journal.
2. Utilize at least 5 cite sources to substantiate your findings or critique.
3. Visit the following website for suggested guidelines:’ 
   • American Nurses association “Reading and critiquing a research Article”
4. Create a 3-4 page critique 
5. Follow APA style rules.

The first step of in completing your course project is to choose two compliance plans from the list of compliance violation areas below.

  1.Clinical staff members are not washing their hands between patients.

2.Employee attacks patients while under the influences of narcotics.

After you choose two areas (only two!), write a paragraph about each one to present to your faculty member. In each paragraph, explain why you believe the chosen area represents key issues in compliance and why you want to develop a compliance plan for this area. (1 page total)

n a paper (750‐1,000 words), summarize your analysis of this exercise and discuss the overall value of learning styles. Include the following:

1. Provide a summary of your learning style according the VARK questionnaire.
2. Describe your preferred learning strategies. Compare your current preferred learning strategies to the identified strategies for your preferred learning style.
3. Describe how individual learning styles affect the degree to which a learner can understand or perform educational activities. Discuss the importance of an educator identifying individual learning styles and preferences when working with learners.
4. Discuss why understanding the learning styles of individuals participating in health promotion is important to achieving the desired outcome. How do learning styles ultimately affect the possibility for a behavioral change? How would different learning styles be accommodated in health promotion?

I need 2 and half  or 3 pages reflection paper in APA format for my Capstone with resource page, it should cover this information:

in 5th week of doing my Capstone as a school nurse, i faced lots of new cases. 2 8th girls came to nursing office accompanied with their teacher because of ‘girls fight’.they pulled each other hair and slaped, bited each other! they reffered to administer, their parents informed, and got detention with possible suspended of school for 3 days.Also one teacher collapsed in her classroom, immediatly the nurse and i went and assessed her,following assessment her condition got worst and she stated of getting blurry vision, which we prefer call the pre-med to come and take her to hospital for more assessment. during this wek i got oppurtunity to inject insulin to student few times( normally they do for themselves). Another case was that autistic girl came to nursing office with chewing gum stuck in her long hair. I washed that portion of her hair with warm water and comb it to get the gum out of her hair. My preceptor especially thanked me for that intervention, since it looked so messy in her hair and she said during 12 years of being school nurse never i saw such a thing. one positive thing that i learned was  how the school nurse can be advocate for the students parents, they frequently call and ask their questions regarding health issues. it caused me to try my best to always be up to date and keep myself fresh by continuous learning. one negative effect was that i witnessed was that few student has chronic issues with hair lice and clearly their parent don’t care about treating them and frequently they forced to be out of the class to not spread it to others which is causes they learning procces intruppted. I talked to social worker and asked for taking serious step, this 5-7 years old girls definitely mistreated at home and need intervention.

Again it was really intereting week in a matter of learning and at this point i am almost confident that i am able to handle this job well and looking for more experiences in 2 more weeks left. Only thing i can say with 100% confident that i truly will miss this school and students.