In a short essay (500-750 words), answer the Question at the end of Case Study 2. Cite references to support your positions.  Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.  This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.  You are required to submit this assignment to Turnitin.Ms. A. is an apparently healthy 26-year-old white woman. Since the beginning of the current golf season, Ms. A has noted increased shortness of breath and low levels of energy and enthusiasm. These symptoms seem worse during her menses. Today, while playing in a golf tournament at a high, mountainous course, she became light-headed and was taken by her golfing partner to the emergency clinic. The attending physician’s notes indicated a temperature of 98 degrees F, an elevated heart rate and respiratory rate, and low blood pressure. Ms. A states, “Menorrhagia and dysmenorrheal have been a problem for 10-12 years, and I take 1,000 mg of aspirin every 3 to 4 hours for 6 days during menstruation.” During the summer months, while playing golf, she also takes aspirin to avoid “stiffness in my joints.”  Laboratory values are as follows: Hemoglobin = 8 g/dl Hematocrit = 32% Erythrocyte count = 3.1 x 10/mm RBC smear showed microcytic and hypochromic cells Reticulocyte count = 1.5% Other laboratory values were within normal limits.  Question Considering the circumstances and the preliminary workup, what type of anemia does Ms. A most likely have? In an essay of 500-750 words, explain your answer and include rationale.

40.0 % Accurate identification of anemia classification and rationale.

40.0 % Explanation of patient diagnosis with rationale from case findings. Outside sources and/or medical and nursing references used to support conclusions.

 Heart;Blood Vessels

  Anterior cross section showing the valves and chambers of the heart
What blood-tight partition divides the left heart from the right heart?

Which portion of the ECG represents a small deflection sometimes seen just after the T wave, representing the final phase of ventricular repolarization?

Does heart size increase or decrease with age? why?
Make a chart describing the characteristics of the following types of chest pain:

1. Angina
2. Esophageal
3. Pain from a peptic ulcer
4. Biliary
5. Arthritis or bursitis
6. Cervical
7. Musculoskeletal (chest)
8. Psychoneurotic

A patient is complaining of prolonged fever, signs of neurologic dysfunctions, and the sudden onset of congestive heart failure. What should be expected?

Name the five traditionally designated auscultatory areas

Is the absence of S3 and S4 an unusual finding?

Splitting of S2 is greatest during which part of respiration? 

Describe a pericardial friction rub.

Not all murmurs are the result of valvular defects. Name four other causes of murmurs

Which four cardiac defects make up the tetralogy of Fallot?

TY is a 67-year-old female patient who presents for follow-up for her hypertension and hyperlipidemia. Her PMH includes a diagnosis of aortic stenosis diagnosed 2 years ago, IBS, and a seizure disorder. Her family history includes her father, who died at age 55 years of a myocardial infarction and her mother, who is deceased, who had hypertension, diabetes, and coronary artery disease. Her social history is positive for smoking 1 PPD for 30 years; she quit 9 years ago. She is negative for alcohol and drug use. She lives in a two-bedroom condominium on one floor.

On examination, describe the murmur that you would hear for aortic stenosis.

Describe the cause of aortic stenosis. What is the cause for TY?

If TY’s past medical history did not include a diagnosis of aortic stenosis as well as cardiac risk factors, what other causes are there for a heart murmur?

If TY’s past medical history did not include a diagnosis of aortic stenosis as well as cardiac risk factors, describe a subaortic stenosis.

  Palpation of arterial pulses: Carotid, Brachial,  Radial, Femoral, Popliteal, Dorsalis pedis,  Posterior tibial.Define arterial blood pressure

Define arterial blood pressure

Which variables contribute to the characteristics of the pulses?

A pregnant patient (32 weeks’ gestation) is having difficulty with dependent edema and painful varicosities. What can you suggest to help this patient’s problem?

What should you do if you have trouble finding the patient’s pulse? 

Describe the scale of 0 to 4 with regard to the amplitude of the pulse

If a patient experiences pain in the calf muscles, which artery is probably obstructed? 

What two values are recorded for the blood pressure? 

What is the mechanism behind cardiac tamponade? 

Where are the most common places for venous ulcers to appear?

TB is a 56-year-old female patient with Raynaud phenomenon. Her past medical history includes spinal stenosis, systemic lupus erythematosus, bipolar disorder, and overactive bladder.

A-Differentiate the primary and secondary types of Raynaud phenomenon.

B-In the patient’s initial presentation what would be the chief complaint if the patient had primary Raynaud phenomenon? Secondary Raynaud phenomenon?

C-Based on TB’s presentation, what assessment results would you expect to find? What if is she had primary Raynaud phenomenon?

 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.