Advanced Pathophysiology

1) **********minimum 2 full pages (1 page each document) ( not words)**************************** (cover or reference page not included)

2)¨**********APA norms, please use headers  (All paragraphs must be narrative and cited in the text- each paragraphs- bulleted responses are not accepted- do not write in the first person.)

3)********** It will be verified by Turnitin and SafeAssign

4) Minimum 4 references not older than 5 years

5) Each answer must be identified according to the question number. Check the list of questions. Your answer should start objectively answering the question

Question:

1)…………

2)…………

3)…………

Answer:

1)…………

2)…………

3)…………

_______________________________________________________

You must answer (4) question 2 times. 

You must submit 2 documents (each 1 page).

Copy and paste will not be admitted. 

You should address the questions with different wording, different references, but always, objectively answering the questions.

___________________________________________________________

Case: 

 

Mr. J, age 42, is a construction worker in Las Vegas. He recently noticed that a mole on his face seemed to be getting larger and darker. At first he did not worry because he was in the sun a lot and assumed the change may have been caused by sunburn. After a month, not only was the mole larger and darker, but it appeared to be “bumpy.” His doctor diagnosed a malignant melanoma skin cancer following biopsy of the nevus. Mr. J reports pain in his right shin that does not go away when he puts his feet up or sleeps.

Discussion Questions

  • 1) Relate Mr. J’s skin changes to the warning signs for malignant melanoma.
  • 2) Discuss the normal progression of this malignancy.
  • 3) What is the significance of the bone pain that Mr. J is experiencing?
  • 4)Discuss the treatment available for this patient and the prognosis for recovery

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The sleepy woman with anxiety

The Case:

The sleepy woman with anxiety

This week’s discussion presents a case study involving a 44-year old woman with a chief complaint of anxiety beginning at age 15 years old. She has a long history of mental illness and continued therapies. The purpose of this discussion is to analyze her case history to determine medication and treatment effectiveness.

Client Questions

Question 1. Are you having feelings of harming yourself or harming someone else?

Rationale: This is a possibly uncomfortable yet important set of questions to ask each client. Primary care providers may be in a unique position to prevent suicide due to their frequent interactions with suicidal patients. Reviews suggest that among patients who committed suicide, 80 percent had contact with primary care clinicians within one year of their death, whereas only 25 to 30 percent of decedents had contact with psychiatric clinicians within the year of their death (Stene-Lars & Reneflot, 2017).

Question 2. What was happening in your life as a teenager when the anxiety started and you began to self-medicate?

Rationale: Per our report, this patient began suffering signs and symptoms of anxiety at 15-years old. Asking these types of questions we may gain insight into an underlying cause or triggering event. Anxiety disorders are the most common psychiatric disorders with onset in childhood, with prevalence estimates ranging from 10 to 30 percent. Nearly 37 percent of behaviorally inhibited preschool-age children had social anxiety disorder at age 15, compared with 15 percent of non- behaviorally inhibited children. Children with anxiety disorders are more likely to have persistent anxiety disorders into adulthood. (Rapee, 2014).

Question 3. What was happening in your life a year ago when these symptoms returned and became debilitating? Let’s discuss what the triggering events may have been.

Rationale: Self-discovery of triggering events may help the client to come to terms with the determinants of her anxiety and depression. Studies have shown that specific types of stressors were found to differentially predict increases in specific facets of anxiety sensitivity; health-related stressors predicted increases in disease-related concerns and fear of mental incapacitation, whereas stressors related to family discord predicted increases in fear of feeling unsteady, fear of mental incapacitation, and fear of having publicly observable symptoms of anxiety (McLaughlin & Hatzenbuehler, 2009).

Support System

The support system as reported by our client is her husband. She states he is supportive and has little to no contact with the family of origin. She has a few friends and a few outside interests. As PMHNP, discussing relationships with the client is one avenue to gain insight into anxiety patterns and coping mechanisms as seen by outside support. With the client’s permission, speaking to her husband may assist us in this situation. Learning how the patient functions at home, what critical changes have occurred with this recent bout of depression and what coping mechanisms are utilized by the couple may assist us in reaching a state of remission. In addition, these disorders are associated with significant decreases in patient well-being and social functioning and can cause considerable pain and suffering, not only for affected individuals but for their family and friends as well. Despite the availability of proven treatments, both disorders remain underrecognized and undertreated (Ballenger, 2000).

  1. Are you aware of when your wife is entering a state of anxiety or depression?
  2. What have you noticed happening in your lives when this occurs?
  3. When these events occur, what response does that create for you?
  4. What coping mechanisms do you utilize for yourself and your relationship when these events occur?

Physical Exams and Diagnostic Tests

First a complete physical assessment of the patient is required to rule out any underlying medical issues. This would also include a full blood panel with CBC, CMP, TSH and urinalysis and toxicology. Research findings suggest that mood and anxiety symptoms result from a disruption in the balance of impulses from the brain’s limbic system. A 2015 study reported that individuals with comorbid depression and anxiety have increased resting-state functional connectivity of the limbic network when compared with depression or anxiety alone. FK506 binding protein 51 (FKBP5) is a co-chaperone binding protein which modulates the function of glucocorticoid receptors. In a study examining allelic variants of FKBP5, the T allele was more frequent among patients with comorbid depression and anxiety (Pannekoek et al., 2015). Additionally, rating scales have shown good reliability for assessing anxiety and depression. The Depression and Anxiety Stress Scale (DASS) is suitable for assessing clients with co-occurring depression and anxiety.

Differential Diagnoses

  1. Post-Traumatic Stress Disorder (PTSD)- This patient could be showing physical manifestations of PTSD. Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are prevalent and frequently co-occurring psychiatric illnesses that are both highly associated with disturbed sleep. PTSD affects an estimated 5 million people in the U.S. each year and is characterized by an inability to recover from a stress reaction following exposure to a traumatic event (Vandrey et al., 2014).
  2. Generalized Anxiety Disorder (GAD)- This patient falls into the DSM-V criteria for anxiety. Generalized anxiety disorder produces fear, worry, and a constant feeling of being overwhelmed. Generalized anxiety disorder is characterized by persistent, excessive, and unrealistic worry about everyday things. This worry could be multifocal such as finance, family, health, and the future. It is excessive, difficult to control, and is often accompanied by many non-specific psychological and physical symptoms (Munir & Takov, 2019).
  3. Polypharmacy and (GAD)- This patient may be suffering issues relating to polypharmacy as evidenced by sleep disturbances combined with anxiety disorder. As the number of available medication options increases, so does the potential for polypharmacy, a practice with possible complications. Such complications include a greater number of side effects with the initiation of additional medications and the consequences of drug-drug interactions.

Pharmacologic

This patient does not appear to be a good self-historian regarding medication, compliance and lacks the ability to determine medication effectiveness. It is the thought of the PMHNP that the patients issue with narcolepsy is related to medication and polypharmacy issues. Simplifying the patients eight medications by discontinuing sodium oxybate, pramipaxole and DDAVP seem to improve her daytime sleepiness. This patient was taking several medication relating to sleep, causing other issues including bed-wetting for which she was prescribed DDAVP (Desmopressin), and reports it is not very helpful. By tapering and discontinuing these medications and educating the patient on sleep hygiene and perhaps sleep studies, we can assist this patient into improved sleep at night without excessive daytime sleepiness.

Lessons Learned

This case is an excellent example of long term mental health issues and polypharmacy. This patient seemed to be a good candidate for Vagus Nerve Stimulation (VNS) to which she received relief from sleep disturbances. Many patients with chronic anxiety have a poor quality of life. The education of both the patient and family by the pharmacist, nurse, and provider as a team is important to reduce the high morbidity and addiction problems with treatment medications. Family members should help ensure medication compliance and provide a supportive environment. Unfortunately, despite optimal treatment, relapse rates are high (Dold et al., 2017).

References

Ballenger J. C. (2000). Anxiety and Depression: Optimizing Treatments. Primary care companion to the Journal of clinical psychiatry2(3), 71–79. https://doi.org/10.4088/pcc.v02n0301

Dold M, Bartova L, Souery D, Mendlewicz J, Serretti A, Porcelli S, Zohar J, Montgomery S, Kasper S. Clinical characteristics and treatment outcomes of patients with major depressive disorder and comorbid anxiety disorders – results from a European multicenter study. J Psychiatr Res. 2017 Aug;91:1-13.

McLaughlin, K. A., & Hatzenbuehler, M. L. (2009). Stressful life events, anxiety sensitivity, and internalizing symptoms in adolescents. Journal of abnormal psychology118(3), 659–669. https://doi.org/10.1037/a0016499

Munir S, Takov V. Generalized Anxiety Disorder (GAD) [Updated 2019 Nov 22]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441870/

Rapee RM. Preschool environment and temperament as predictors of social and nonsocial anxiety disorders in middle adolescence. J Am Acad Child Adolesc Psychiatry 2014; 53:320.

Stene-Larsen K, Reneflot A. Contact with primary and mental health care prior to suicide: A systematic review of the literature from 2000 to 2017. Scand J Public Health 2019; 47:9.

Pannekoek JN, van der Werff SJ, van Tol MJ, et al. Investigating distinct and common abnormalities of resting-state functional connectivity in depression, anxiety, and their comorbid states. Eur Neuropsychopharmacol 2015; 25:1933.

Vandrey, R., Babson, K. A., Herrmann, E. S., & Bonn-Miller, M. O. (2014). Interactions between disordered sleep, post-traumatic stress disorder, and substance use disorders. International review of psychiatry (Abingdon, England), 26(2), 237–247. https://doi.org/10.3109/09540261.2014.901300

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Have you had any thoughts of suicide or causing harm to yourself or others in the past month?

Three Questions I might ask the client

  1. Have you had any thoughts of suicide or causing harm to yourself or others in the past month? I am asking this question because if the client has major depressive disorder and the client is currently taking Paxil which can increase the risk for suicide in adults (Wiese, 2011).
  2. How would you describe your sleeping patterns? The client stated she was abused as a child, therefore I want to establish if she is having nightmares or trouble sleeping related to the memories and flashbacks. This question can also help me establish if the client may have a sleeping disorder as well.
  3. Do you have friends or close family members that you spend time with? Or friends that you go out with? Depression can have an impact on the client’s daily lifestyle which means she may not participate in her usual activities. The client may also withdraw from social activities and become uninterested in spending time with people.

Identify People in the client’s life I need to speak to

The client’s family history includes having family members with major depressive disorder (MDD) which means that her family members are the first people to interview to gain better insight about her behavior and patterns. The interviews can focus on past psychiatric history and if they are aware of anything she may have left out from her statements or medical history. I think it may be beneficial to interview the attending physician to see if he has something to add to her initial evaluation notes. The primary care physician can help if she has pre-existing conditions that may contribute to her current psychiatric symptoms. The client also mentioned attending psychotherapy sessions. I would want to interview the therapists to know if the patient is compliant with therapy goals and medication regimen during treatment. The purpose of the interviews it to develop an effective treatment plan for the client.

Diagnostic Tests and Physical Exams

The client has a history of substance abuse and has been attending support groups but it is still important to get a urine drug screen. The thyroid stimulating hormone (TSH) levels should be checked due to the thyroid gland being linked to having an influence on the brain with impacting the mood (Pilhatsch, Marxen, Winter, Smolka, & Bauer, 2011). The client should also receive a mental health examination considering we are trying to rule out different diagnosis and it is our first time with the client. The mental health examination will help establish a baseline like an annual physical.

Differential Diagnosis

  1. Post-Traumatic Stress Disorder – According to the American Psychiatric Association (2013) PTSD involves exposure and serious injury which client experienced abuse as a child. The client reported having nightmares and flashbacks. PTSD symptoms also exist with other conditions such as the client’s history of alcohol and substance abuse (National Alliance on Mental Illness, 2017). I feel that the client mostly identifies with this diagnosis.
  2. Major Depressive Disorder – The client’s PTSD and agitation are causing her to be depressed. Her depression is secondary and triggered by her nightmares. A persistent feeling of sadness and loss of interest that interferes with the client’s daily functioning.
  3. Substance Use Disorder – The client has used alcohol and other substances to cope with her PTSD symptoms. The use of alcohol and other substances is commonly seen with individual’s that experience PTSD symptoms as a coping mechanism. Half of the individuals seeking treatment for SUD have symptoms of PTSD (Berenz, 2012).

Two Pharmacologic Agents

Sertraline – The medication is indicated for use with major depression disorder and posttraumatic stress disorder. The medication should be started at 25mg orally daily and then re-evaluated at the follow up appointment in 4 weeks. One of the side effects is weight gain so the client would need diet and exercise counseling as well.

Wellbutrin – This medication would be good to add as an augmenting agent to be taken in the morning daily. The extended release tablet can be started at 150mg. The client should be able to report a decrease in insomnia symptoms. The preferred combination treatment by some clinicians is to use Wellbutrin and Zoloft together to improve symptoms (Stahl, 2013).

Follow up checkpoints

I believe the client would have benefited from Sertraline and received a more positive outcome at the follow up visits. Sertraline combined with the Wellbutrin would have been more effective with treating the depressive symptoms and PTSD.  The follow up appointments revealed that the client’s appetite was curved and there were no problems with weight gain. The medication was also treating her depressive symptoms. The client should still be monitored for suicidal thoughts because she is always at risk for suicide while having depressive episodes and taking antidepressant medications.

Lesson Learned

Client safety is always the goal when prescribing medications for treatment. The PMHNP should fully understand that monotherapy may not be effective to treat the symptoms and to consider combination therapy for certain clients. The client has more than one disorder showing that polypharmacy may be indicated for more effective results in treatment. The treatment plan should be revisited at every follow up appointment and make the necessary changes as needed dependent on how the client is responding to the current treatment. The PMHNP will take into consideration how the client feels and any decisions she may have about her treatment.

References

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

Berenz, E. (2012). Treatment of co-occurring posttraumatic stress disorder and substance use disorders. Current Psychiatry Reports, 14(5), 469-477. doi: 10.1007/s11920-012-0300-0

National Alliance on Mental Illness. (2017). Posttraumatic Stress Disorder. Retrieved from https://www.nami.org/learn-more/mental-health-conditions/posttraumatic-stress-disorder

Pilhatsch, M., Marxen, M., Winter, C., Smolka, M., & Bauer, M. (2011). Hypothyroidism and mood disorders: Integrating novel insights from brain imaging techiniques. Thyroid Research, 4(S3). Retrieved from https://thyroidresearchjournal.biomedcentral.com/articles/10.1186/1756-6614-4-S1-S3

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

Wiese, B. (2011). Geriatric depression: The use of antidepressants in the elderly. BC Medical Journal, 53(47), 341-347. Retrieved from https://www.bcmj.org/articles/geriatric-depression-use-antidepressants-elderly

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Assignment 2: Week 6 Practicum Journal: Reimbursement Rates

Assignment 2: Week 6 Practicum Journal: Reimbursement Rates

Reimbursement rates and medical coding can be almost as complicated as treating some mental illnesses. As a PMHNP, you will be faced with varying rates that may be different than other health care providers you may work with.

In this Practicum Journal Assignment, you will analyze reimbursement rates for mental health treatments you will likely use in your practice and compare those rates to other provider rates.

Learning Objectives

Students will:

· Analyze reimbursement rates for mental health treatments

To prepare for this Practicum Journal:

· Research reimbursement rates for various treatment modalities.

· Compare NP rates to other provider rates.

For this Practicum Journal:

Complete the Reimbursement Rate Template in your Learning Resources using the five types of services you are likely to use in your practice.

NURS 6670 

Reimbursement Rate Template

 

Type of Service

eg. -New office visit

-Established office visit

-Inpatient hospital

-individual psychotherapy

-group psychotherapy (see examples below)

CPT code

Private insurer reimbursement rate for PMHNP

Private insurer reimbursement rate for physicians

Medicare

reimbursement rate for PMHNP

Medicare

reimbursement rate for physician

 

 

 

 

 

As the PMHNP becomes proficient in diagnosing and treating, it is also important to learn how to bill for your time. The CMS sets up codes to identify the type of service you are providing. You will generally complete this task at the end of the visit as you are documenting the visit with the client. Here are examples of the codes to know:

CPT Codes for Psychiatric and Psychological Procedures

HMSA recognizes the following service codes for the reporting of psychiatric and psychological services. (See Code Books for information on how to obtain the books.)

 

CPT   Code

Footnote(s)

Description

 

90791

1

Psychiatric   diagnostic evaluation

 

90792

1,3

Psychiatric diagnostic evaluation with medical services

 

90832

2

Psychotherapy, 30 minutes with patient and/or family member

 

90833

2,3

Psychotherapy, 30 minutes with patient and/or family member when   performed with an evaluation and management service

 

90834

4

Psychotherapy, 45 minutes with patient and/or family member

 

90836

3,4

Psychotherapy, 45 minutes with patient and/or family member when   performed with an evaluation and management service

 

90837

6

Psychotherapy,   60 minutes with patient and/or family member

 

90838

3,6

Psychotherapy, 60 minutes with patient and/or family member when   performed with an evaluation and management service

 

90839

6

Psychotherapy for crisis; first 60 minutes

 

90840

2

each additional 30 minutes

 

90846

4

Family psychotherapy (without the patient present)

 

90847

4

Family psychotherapy (conjoint psychotherapy) (with patient   present)

 

90849

4

Multiple-family group psychotherapy

 

90853

4

Group psychotherapy (other than of a multiple-family group)

 

90870

1, 5

Electroconvulsive therapy (includes necessary monitoring)

 

96101

1

Psychological   testing (includes psychodiagnostic assessment of personality,   psychopathology, emotionality, intellectual abilities, e.g., WAIS-R,   Rorschach, MMPI) with interpretation and report, per hour.

Note: All hours   of psychological testing done on a single day will be counted as one visit   (either inpatient or outpatient as appropriate) toward the patient’s   inpatient or outpatient visit maximum. However, payment will be made to the   participating provider on a per-hour basis.

 

96118

1

Neuropsychological   testing battery (e.g., Halstead-Reitan, Luria, WAIS-R) with interpretation   and report, per hour

Note: All hours   of psychological testing done on a single day will be counted as one visit   (either inpatient or outpatient as appropriate) toward the patient’s   inpatient or outpatient visit maximum. However, payment will be made to the   participating provider on a per-hour basis.

Links to websites that discuss this:

https://www.psychiatry.org/psychiatrists/practice/practice-management/coding-reimbursement-medicare-and-medicaid/coding-and-reimbursement

http://www.mb-guide.org/medical-coding-guidelines.html

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How might your personal model of leadership be applied in your professional setting?

As a nurse leader, it is important to understand a variety of leadership models and styles. This will help you adapt to different settings and apply strategies to support and inspire others. It may also be necessary to apply models in different professional settings to satisfy certification requirements. Write a 1,000-1,250 word paper about your personal model of leadership, including the following:

How might your personal model of leadership be applied in your professional setting?
Compare your personal leadership model to servant leadership, transformational leadership, and at least one other model of leadership.
Describe your personal worldview, including the religious, spiritual, and cultural elements that you think most influence your personal philosophy of practice and attitude towards leadership.
Describe how your professional leadership behaviors can inspire others.
Use a minimum of three peer-reviewed resources (published within the last 5 years) as evidence to support your views.

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.

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Topic Proposal And Problem Statement Paper

The purpose of this assignment is to develop a strong, working foundation for your final paper. You will identify a topic area and develop a problem- or issue-related topic within that area of interest. As you develop this specific topic, keep in mind that your eventual goal is to formulate and present a solution to the healthcare issue or problem you identify.

Your topic proposal should include the following items and address the following:

Describe the topic you wish to pursue.

It may be somewhat broad at this point and it may imply a problem. Use the Additional Resources in your course materials to help you search for ideas.
Identify your purpose: Why are you interested in this topic? (Narrow your topic.)

Specifically explain what it is that fascinates you or draws you to this topic.
Clearly describe the topic’s relevance in the field today.
Identify a purpose for a paper on this topic:
What might you accomplish in exploring this problem?
What is your intended goal?
To evoke change
To make new connections (new cause and effect)
To introduce a new theory, solution, or idea
Is this goal realistic?
Identify a problem within the topic and draft a problem statement. (It will likely evolve and be revised as you progress through your research.)

Identify a problem related to your topic and state it.
The problem statement should be specific and indicate the focus of your final paper.
Not too narrow, not too broad
Intellectually challenging (a simple solution is not apparent)
Who would benefit from a solution to this problem (who is the target population)?
Your paper should be 1–2 pages. Adhere to APA Style throughout.

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Compare And Contrast Two Mental Health Theories

Submit a paper which compares and contrasts two mental health theories:

You may choose your theories from the textbook or from other sources.
Describe each theory, including some history about the person who developed the theory and the major ideas and applications of the theory.
Describe the ways in which the two theories are similar, and how they differ.
Include a statement of how each theory could be used in your nursing practice. Include specific patient examples if you have them. You may also critique the theory: Is there anything with which you disagree or are there any problems you can identify?
It is expected that this essay will be 2-3 pages in length (not including the title page), double-spaced. Your paper should include an introduction and conclusion and proper APA citations from any source material you use, including your text.
Rubric

2 (20.00%) : Identifies and describes with detail 2 mental health theories AND the major ideas AND applications of these theories

(20.00%) : Identifies and describes with detail the history of the person (s) who developed 2 mental health theories

2 (20.00%) : Identifies and describes with detail the Similarities & Differences of 2 mental health theories

2 (20.00%) : Identifies and describes with detail how 2 theories could be used in nursing practice WITH description of specific client example

2 (20.00%) : Paper is properly formatted in APA, evidence based references are cited in paper and in reference page, use of complete sentences and errors do not detract reader from message, paper is 2-3 pages in length

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Masters In Nursing , Transforming Nursing And Health Care Through Technology

To Prepare:

Review the Resources and reflect on the impact of clinical systems on outcomes and efficiencies within the context of nursing practice and healthcare delivery.
Conduct a search for recent (within the last 5 years) research focused on the application of clinical systems. The research should provide evidence to support the use of one type of clinical system to improve outcomes and/or efficiencies, such as “the use of personal health records or portals to support patients newly diagnosed with diabetes.”
Identify and select 5 peer-reviewed articles from your research.
The Assignment: (4-5 pages)

In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Be sure to address the following:

Identify the 5 peer-reviewed articles you reviewed, citing each in APA format.
Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples.
Rubric

In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Be sure to address the following:

· Properly identify 5 peer-reviewed articles selected.
· Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples.

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.

Written Expression and Formatting – English writing standards:

Correct grammar, mechanics, and proper punctuation

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.

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Assessing And Treating Clients With Psychosis And Schizophrenia

The Assignment

Examine Case Study: Pakistani Woman with Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

Decision #1
Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

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Cultural Considerations In Mental Health Nursing

Submit an evidence-based practice paper about cultural competency in mental health nursing. An evidence-based practice paper allows you to explore best practice and help improve client outcomes on a psychiatric unit. Your paper should describe how you, as a nurse, will include – or have included – cultural awareness in a client diagnosed with a mental illness. The person you describe could be someone in your clinical setting, someone you have worked with in the past, or a theoretical client.

Remember that culture can also include gender equality, sexual orientation, and other cultures besides race and religion – including cultures unique to one particular family. Your paper should be at least 3 pages (double-spaced, not including the title or reference pages) in APA Format and include:

Assessment: Discuss what you would assess in regard to a client’s culture. For example, are there specific dietary requirements? Are schedule changes necessary to avoid conflicts with religious practices? Who is the spokesperson for the family? What would you assess?
Diagnosis: List any mental health nursing diagnoses this person has or may be at risk for. Include at least one cultural diagnosis.
Planning: What planning needs to be done to ensure the cultural and emotional safety of the client?
Implementation: What are interventions that would ensure the safety of your client in regard to culture? Include at least two interventions. For example, if your client has religious beliefs that affect the ability to take medications, what interventions would you create to ensure the client’s safety? What can you do to make sure the client’s cultural needs are met?
Evaluation: How will you evaluate whether your implementation was effective? Make sure the parameters are objective and measurable.
In your summary, discuss whether any completed interventions were successful. What could be done differently in the future? If the interventions have not yet been carried out, you might discuss some institutional changes that could be made to ensure cultural safety for all clients in that setting.
Your paper should utilize proper APA guidelines and include at least three scholarly sources to support your paper. A scholarly source is a source that has been peer reviewed and has appropriate authors that are credentialed. For more information on APA, please visit the Online Library.

Rubric:

Patient Description

Points: 1 (10.00%)

Complete description of the client including (6 items): age, race, religion, marital status, children, and living environment

Assessment

Points: 1 (10.00%)
Complete assessment including assessment in regard to culture

Diagnosis

Points: 2 (20.00%)
3 complete nursing diagnoses, including at least one cultural diagnosis. Each nursing diagnosis includes 3 components: diagnosis, related to, and defining characteristics.

Planning

Points: 2 (20.00%)
Includes outcomes in SMART goal format for each of 3 nursing diagnoses

Implementation
Points: 2 (20.00%)
Includes 2-3 Nursing Interventions for each outcome

Evaluation

Discussion of success or changes needing to be made to make the plan successful. If plan not yet carried out, potential institutional changes to setting for cultural safety.

Grammar

Points: 1 (10.00%)
Paper is properly formatted in APA, 3 scholarly sources are cited in the paper and in reference page, use of complete sentences and errors do not detract the reader from the message, the paper is 3-4 pages in length

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