Mental health
Case Study - Anxiety Disorder/Obsessive Compulsive Disorder
Course Competency
Assemble nursing care interventions for clients with behavioral or cognitive disorders.
Scenario
Lauren has been diagnosed with Social Anxiety Disorder and experiences obsessive thoughts that result in compulsive behaviors. This has a major impact on her life and day to day functioning.
Instructions
View the videos segments 1, 2, and 3 for Lauren.
Notice how the nurse continues to gather information to assess the extent of Lauren’s illness. The content relates to the objective that you will be able to describe the symptoms of anxiety and OCD.
Segment 1
Segment 2
Segment 3
Create a document which contains this information:
Describe at least three clinical signs of Anxiety observed in the videos.
Describe at least three Obsessive-Compulsive behaviors observed in the videos.
Explain at least three therapeutic communication techniques used by the nurse in the videos.
Discuss at least two nursing interventions appropriate for Lauren. Support your choices with rationales.
Support your ideas with at least two credible resources.
Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates.
CDC Wonder
Purpose
This week's graded topic relates to the following Course Outcome:
CO8: Selects evidence for best practices when planning professional nursing care involving systems, processes, and devices for individuals, families, aggregates and communities. (PO#8)
Discussion
The Centers for Disease Control and Prevention, Division of Informatics and Surveillance website contains a number of resources nurses could innovatively incorporate in care delivery. The CDC Wonder site could be utilized by nurses in a number of ways. https://wonder.cdc.gov/ (Links to an external site.)
For this discussion you will:
Identify one of the resources at the CDC Wonder site above and describe how a nurse might use this information in practice.
How might nurses utilizing telehealth benefit from these resources?
Address what you find innovative about the link.
Feel free to share some of your nursing innovation ideas!
Grading
To view the grading criteria/rubric, please click on the 3 dots in the box at the end of the solid gray bar above the discussion board title and then Show Rubric.
Resources:
https://nccd.cdc.gov/dhdspatlas/ (Links
. https://wonder.cdc.gov/ (Links to an external site.)
American Nursing Association. (2015). Nursing: Scope and standards of practice (3rd ed.). American Nurses Publishing
Initial Post
For the initial post, consider three (3) of the following events:
Treaty of Versailles
Rise of fascism, militarism and imperialism
Failure of the League of Nations
Hitler and the Nazi Party
The Lend Lease Act
Japanese expansion and the bombing of Pearl Harbor
Based on your three selections, choose two (2) of the following and craft a response for your selections:
Assess if the United States foreign policy during the 1930s helped to promote World War II. Could the United States have prevented the outbreak of World War II? If so, how? If not, why not?
Explain if the United States, despite neutrality, aided the Allies against the Axis powers.
Analyze if the use of atomic (nuclear) weapons to defeat enemies in war is a setback for democracy (President Truman's decision to drop the atom bomb on Japan)
Discussion
,Discuss how nurse leaders serve as advocates for their employees. Describe how advocacy for employees affects patient care and outcomes
Assessing Back Pain,
BACK PAIN:
A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. In determining the cause of the back pain, based on your knowledge of anatomy, what nerve roots might be involved? How would you test for each of them? What other symptoms need to be explored? What are your differential diagnoses for acute low back pain? Consider the possible origins using the Agency for Healthcare Research and Quality (AHRQ) guidelines as a framework. What physical examination will you perform? What special maneuvers will you perform?
Episodic/Focused SOAP Note Template
Patient Information:
Initials, Age, Sex, Race
S.
CC (chief complaint) a BRIEF statement identifying why the patient is here - in the patient’s own words - for instance, ""headache"", NOT ""bad headache for 3 days”.
HPI: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form, not a list. If the CC was “headache”, the LOCATES for the HPI might look like the following example:
Location: head
Onset: 3 days ago
Character: pounding, pressure around the eyes and temples
Associated signs and symptoms: nausea, vomiting, photophobia, phonophobia
Timing: after being on the computer all day at work
Exacerbating/ relieving factors: light bothers eyes, Aleve makes it tolerable but not completely better
Severity: 7/10 pain scale
Current Medications: include dosage, frequency, length of time used and reason for use; also include OTC or homeopathic products.
Allergies: include medication, food, and environmental allergies separately (a description of what the allergy is ie angioedema, anaphylaxis, etc. This will help determine a true reaction vs intolerance).
PMHx: include immunization status (note date of last tetanus for all adults), past major illnesses and surgeries. Depending on the CC, more info is sometimes needed
Soc Hx: include occupation and major hobbies, family status, tobacco & alcohol use (previous and current use), any other pertinent data. Always add some health promo question here - such as whether they use seat belts all the time or whether they have working smoke detectors in the house, living environment, text/cell phone use while driving, and support system.
Fam Hx: illnesses with possible genetic predisposition, contagious or chronic illnesses. The reason for the death of any deceased first degree relatives should be included. Include parents, grandparents, siblings, and children. Include grandchildren if pertinent.
ROS: cover all body systems that may help you include or rule out a differential diagnosis You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe.
Example of Complete ROS:
GENERAL: No weight loss, fever, chills, weakness or fatigue.
HEENT: Eyes: No visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose or sore throat.
SKIN: No rash or itching.
CARDIOVASCULAR: No chest pain, chest pressure or chest discomfort. No palpitations or edema.
RESPIRATORY: No shortness of breath, cough or sputum.
GASTROINTESTINAL: No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.
GENITOURINARY: Burning on urination. Pregnancy. Last menstrual period, MM/DD/YYYY.
NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.
MUSCULOSKELETAL: No muscle, back pain, joint pain or stiffness.
HEMATOLOGIC: No anemia, bleeding or bruising.
LYMPHATICS: No enlarged nodes. No history of splenectomy.
PSYCHIATRIC: No history of depression or anxiety.
ENDOCRINOLOGIC: No reports of sweating, cold or heat intolerance. No polyuria or polydipsia.
ALLERGIES: No history of asthma, hives, eczema or rhinitis.
O.
Physical exam: From head-to-toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head to toe format i.e. General: Head: EENT: etc.
Diagnostic results: Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines)
A.
Differential Diagnoses (list a minimum of 3 differential diagnoses).Your primary or presumptive diagnosis should be at the top of the list. For each diagnosis, provide supportive documentation with evidence-based guidelines.
Decision Making When Treating Psychological Disorders
practice decision making when treating patients with psychological disorders. You will recommend the most effective pharmacotherapeutic to treat the psychological disorder presented and examine potential impacts of pharmacotherapeutics on a patient’s pathophysiology.
Post a brief explanation of the psychological disorder presented and the decision steps you applied in completing the interactive piece for the psychological disorder. Then, explain how the administration of the associated pharmacotherapeutics you recommended may impact the patient’s pathophysiology. How might these potential impacts inform how you would suggest treatment plans for this patient? Be specific and provide examples.
Generalized Anxiety Disorder
Middle-Aged White Male With Anxiety
BACKGROUND INFORMATION
The client is a 46-year-old white male who works as a welder at a local steel fabrication factory. He presents today after being referred by his PCP after a trip to the emergency room in which he felt he was having a heart attack. He stated that he felt chest tightness, shortness of breath, and feeling of impending doom. He does have some mild hypertension (which is treated with a low sodium diet) and is about 15 lbs. overweight. He had his tonsils removed when he was 8 years old, but his medical history since that time has been unremarkable. Myocardial infarction was ruled out in the ER and his EKG was normal. Remainder of physical exam was WNL.
He admits that he still has problems with tightness in the chest and episodes of shortness of breath- he now terms these “anxiety attacks.” He will also report occasional feelings of impending doom, and the need to “run” or “escape” from wherever he is at.
In your office, he confesses to occasional use of ETOH to combat worries about work. He admits to consuming about 3-4 beers/night. Although he is single, he is attempting to care for aging parents in his home. He reports that the management at his place of employment is harsh, and he fears for his job. You administer the HAM-A, which yields a score of 26.
Client has never been on any type of psychotropic medication.
MENTAL STATUS EXAM
The client is alert, oriented to person, place, time, and event. He is appropriately dressed. Speech is clear, coherent, and goal-directed. Client’s self-reported mood is “bleh” and he does endorse feeling “nervous”. The effect is somewhat blunted but does brighten several times throughout the clinical interview. Affect broad. The client denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, as is insight. He denies suicidal or homicidal ideation.
You administer the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26.
Diagnosis: Generalized anxiety disorder
Decision Point One
Begin Zoloft 50 mg orally daily
RESULTS OF DECISION POINT ONE
The client returns to the clinic in four weeks
The client informs you that he has no tightness in the chest, or shortness of breath
Client states that he noticed decreased worries about work over the past 4 or 5 days
HAM-A score has decreased to 18 (partial response)
Decision Point Two
Increase the dose to 75 mg orally daily
RESULTS OF DECISION POINT TWO
The client returns to the clinic in four weeks
Client reports an even further reduction in his symptoms
HAM-A score has now decreased to 10. At this point- continue the current dose (61% reduction in symptoms)
APA Citation 3 to 4 References with 5 years
School Health Occupational Health
Please read chapters 29 and 30 of the class textbook and review the attached PowerPoint presentations. Once done answer the following questions;
1. Discuss how Healthy People 2020 can be used to shape the care given in a school health setting. Give at least one example.
2. Identify and discuss the eight components of a comprehensive school health program.
3. Identify and discuss the skills and competencies germane to occupational health nursing.
4. Describe and discuss a multidisciplinary approach for the resolution of occupational health issues
INSTRUCTIONS:
As stated in the syllabus present your assignment in an APA format attached to the forum in the discussion tab of the blackboard titled “Week 15 discussion questions” and the SafeAssign exercise in the assignment tab of the blackboard(which is mandatory). A minimum of 3 evidence-based references besides the class textbook no older than 5 years must be used and quoted according to APA guidelines. You must post two replies to any of your peers sustained with the proper references no older than 5 years in two different days to verify attendance and as well make sure the references are properly quoted and mention to whom you are replying to. The reply is a comment to your peer, not an extension of what you posted in your assignment. What I mean is that you can’t post in your replies the same that you posted in your assignment. A minimum of 800 words is required. Please make sure to follow the instructions as given and use either spell-check or Grammarly before you post your assignment. I will also pay close attention to spelling and/or grammar.APA FORMAT ARIAL 12.
Course Reflection
Purpose
The purpose of this assignment is to provide the student an opportunity to reflect on selected RN- BSN competencies acquired through the NUR3165 course.
Course Outcomes
- The student will be able to produce a complete research paper.
- The student will identify the research methods, sources and application in nursing practice.
Requirements
The Course Reflection is worth 100 points (10%) and will be graded on quality of self- assessment, use of citations, use of Standard English grammar, sentence structure, and overall organization based on the required components as summarized in the directions and grading criteria/rubric.
Follow the directions and grading criteria closely. Any questions about your essay may be posted under the Q & A forum under the Discussions tab.
The length of the reflection is to be within three to six pages excluding title page and reference pages.
APA format is required with both a title page and reference page. Use the required components of the review as Level 1 headers (upper and lower case, centered):
Note: Introduction – Write an introduction but do not use “Introduction” as a heading in accordance with the rules put forth in the Publication manual of the American Psychological Association (2010, p. 63).
a. Course Reflection b. Conclusion
Preparing Your Reflection
The BSN Essentials (AACN, 2008) outline a number of healthcare policy and advocacy competencies for the BSN-prepared nurse. Reflect on the NUR3165 course readings, discussion threads, and applications you have completed across this course and write a reflective essay regarding the extent to which you feel you are now prepared to:
1. “Explain the interrelationships among theory, practice, and research.
2. Demonstrate an understanding of the basic elements of the research process and models for
applying evidence to clinical practice.
3. Advocate for the protection of human subjects in the conduct of research.
Evaluate the credibility of sources of information, including but not limited to databases and Internet resources.
Participate in the process of retrieval, appraisal, and synthesis of evidence
in collaboration with other members of the healthcare team to improve patient outcomes.
Integrate evidence, clinical judgment, interprofessional perspectives,
and patient preferences in planning, implementing, and evaluating outcomes of care.
Collaborate in the collection, documentation, and dissemination of evidence.
Acquire an understanding of the process for
how nursing and related healthcare quality and safety measures
are developed, validated, and endorsed.
Describe mechanisms to resolve identified practice discrepancies between
identified standards and practice that may adversely impact patient outcomes.” (p. 16)
Discussion
Sleep/Wake Disorders ,"Case 3: Volume 1, Case #5: The sleepy woman with anxiety
Post a response to the following:
Provide the case number in the subject line of the Discussion.
List three questions you might ask the patient if he or she were in your office. Provide a rationale for why you might ask these questions.
Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.
List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.
List two pharmacologic agents and their dosing that would be appropriate for the patient’s sleep/wake therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided.
Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations.
Case 3: Volume 1, Case #5: The sleepy woman with anxiety",######$$$$$$$$$##########
4900-2,"Use a provided template to develop a 3-5 page proposal for an intervention and implementation plan related to the health problem you defined in the first assessment.
Important: You must complete all of the assessments in order for this course.
For this assessment, you will be designing and planning the implementation for the intervention to improve the health problem you defined in the first assessment. You will also examine implications of interprofessional collaboration, technology, and organizational and governmental policies for your intervention and implementation plans.
Demonstration of Proficiency
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
Competency 3: Transform processes to improve quality, enhance patient safety, and reduce the cost of care.
Propose a plan, referencing relevant existing and newly created processes, to implement an intervention to improve quality and safety, and reduce costs within the context of a chosen health problem.
Competency 4: Apply health information and patient care technology to improve patient and systems outcomes.
Analyze technology within a chosen health care practice context to support a proposed plan.
Competency 5: Analyze the impact of health policy on quality and cost of care.
Explain the ways in which governmental or organizational policies could impact the proposed plan.
Competency 6: Collaborate interprofessionally to improve patient and population outcomes.
Explain strategies for communicating and collaborating with patients and interprofessional teams to improve health outcomes.
Competency 8: Integrate professional standards and values into practice.
Communicate professionally in clear, logically organized writing, using correct grammar, spelling, and APA style.
Important: You must complete all of the assessments in order for this course.
Professional Context
As a professional nurse, you perform a critical role in solving a host of health care problems. In this assessment, you will use the literature to plan best-practice strategies to foster positive health outcomes for your chosen patient or population.
Preparation
Your intervention and implementation plan should be carried out in an interprofessional context, aligned to your topic, and based on the work you did in the first assessment. You should find collaborators as soon as possible so you can solicit their feedback about intervention and implementation plans to inform your approach.
Instructions
Having identified a health problem relevant to your current or future nursing practice and reviewed the literature to support nursing standards, decision making, and improvement strategies, you should now plan an intervention to address the chosen health problem based on the research you conducted.
Construct a plausible plan that leverages the best practices and research collected to date as well as additional research into similar projects that you find in the literature. Be sure to frame your plan within the context of the health care setting in which you are completing your practicum hours. Incorporate relevant site-specific processes and policies into your implementation plan.
Use the Plan Proposal Template [DOC] ATTACHED TO THIS ASSESSMENT to complete this assessment.
As you develop your plan, be sure to address the following:
Collaboration and communication with patients and colleagues to improve health outcomes.
Governmental or organizational policies that could affect the plan.
Quality and safety improvement strategies.
Technology at the site that could be leveraged.
Scoring Guide Criteria
Propose a plan, referencing relevant existing and newly created processes, to implement an intervention to improve quality and safety, and reduce costs within the context of a chosen health problem.
Analyze technology within a chosen health care practice context to support a proposed plan.
Explain the ways in which existing governmental or organizational policies could impact the proposed plan.
Explain strategies for communicating and collaborating with patients and interprofessional teams to improve health outcomes.
Communicate professionally in writing that is clear, logically organized, and uses correct grammar, spelling, and APA style.
Additional Requirements
Length of submission: Use the provided template. Most submissions will be 3 to 5 pages. You do not need to include a title page. Be sure to complete the reference page at the end of the template.
Number of references: Cite a minimum of 5 sources of scholarly or professional evidence that support your central ideas. Resources should be no more than five years old.
APA formatting: Make sure that in-text citations and reference list follow current APA style.
Portfolio Prompt: Remember to save the assessment to your ePortfolio. After you complete your program you may want to consider leveraging your Portfolio as part of a job search or other demonstration of your academic competencies.",######$$$$$$$$$##########
Diabetes prevention in elderly population of my community.,"Primary health Plan focused on preventive services.
Title: Diabetes prevention in elderly population of my community.
APA style, 10 pages long, not including references and presentation page.
Identify a health problem in your community, in which you can develop a preventive program. (I choose Obesity prevention in adolescents of my community).
Create a clinical question using the PICOT (problem/patient/or population, intervention/indicator, comparison, outcome, and time element or type of study).
Objectives of the presentation
· Define preventive services commonly offered to different types of communities, using Healthy People 2020.
· Explain how to develop and write a practical policy for preventive services
· Define the steps to develop Primary Health Plan.
· Explain the evaluation criteria of a primary health plan.
· Explain the commonly used methods for evaluating a preventive health program.
· Identify a health problem in which it is important to develop a preventive health program.
Introduction.
Abstract
Literature that support the project
Description of the proposed solution.
Theory of change.
Problem identification, intended participant, Setting selection.
Objective and goals.
Intervention
Community involvement.
Develop materials and activities
Implementation and monitoring the intervention.
Choose one of the four overarching goals to work on the project:
· Attain high quality, longer lives free of preventable disease, disability, injury, and premature death.
· Achieve health equity, eliminate disparities, and improve the health of all groups.
· Create social and physical environments that promote good health for all.
· Promote quality of life, healthy development, and healthy behaviors across all life stages.
Evaluation.
Practice.
Conclusion.
References.
Pros-con position paper
Required Resources
Read/review the following resources for this activity:
Lesson: Week 6; review Week 5 (organizational patterns)
Link (Word doc): Pro-Con Position Paper Template
Minimum of 5 scholarly sources (including at least two peer-reviewed sources)
Apply the following writing resources to your posts:
Link (multimedia presentation): APA Basics (Links to an external site.) (Review this tutorial for formatting an APA paper and title page.)
Link (multimedia presentation): Citing References in Text (Links to an external site.)
Link (website): APA Citation and Writing (Links to an external site.)
Instructions
For this assignment, you will submit a draft of your paper to your instructor for review. The essay draft should follow one of the two organizational patterns from the Week 5 lesson. Use the Pro-Con Essay Template (in Required Resources) to complete your draft.
Writing Requirements (APA format)
Length: 4-5 pages (not including title page or references page)
1-inch margins
Double spaced
12-point Times New Roman font
Title page
References page (minimum of 5 scholarly resources, including at least two peer-reviewed sources)
Grading
This activity will be graded using the Pro-Con Position Draft Grading Rubric. Instructors will be providing broadfeedback based on the designated rubric areas. You are expected to use this feedback, additional writing and APA resources, and revision and proofreading strategies to fully improve the essay for final submission.
