Week 3 Learning Exercise Analysis: Organizational, Political, and Personal Power/Organizing Patient Care

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Solve one of the following Learning Exercises from Huston’s Leadership Roles and Management Functions in Nursing, 11th edition.

  • Learning Exercise 13.3 (page 321)
  • Learning Exercise 13.8 (pages 334-335)
  • Learning Exercise 13.10 (page 336)

List which Learning Exercise you are solving at the start of your analysis and provide a brief summary of the case. Be sure to apply an appropriate problem-solving/decision-making model (Traditional Problem-Solving Process, Managerial Decision-Making Model, The Nursing Process, or the Integrated Ethical Problem-Solving Model) in determining what you should do. Justify your decision with supporting evidence

Unit 9 ADHD Medications. 800w. 4 references. Due 10-26-23

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Unit 9 ADHD Medications. 800w. 4 references. Due 10-26-23

Thomas Deliver, a 36-year-old male patient, enters your office for his initial appointment.  According to the intake paperwork, Mr. Deliver is a computer programmer who is complaining of problems with concentration, completing tasks, and being terrible at listening during company meetings and even at home.  He explains that he has difficulty starting and completing work projects and trouble being on time or keeping appointments and commitments.  He has divorced 3 months ago and has joint custody of two daughters ages 6 and 10 years old.  On most days, he sleeps late and he has trouble keeping a regular schedule and getting his children to their lessons and extracurricular appointments on time. 

Mr. Deliver believes the lack of concentration and poor communication with his wife led to the divorce, and Mr. Deliver worries that his trouble with organization and attention may affect his custody agreement and prevent him from keeping his job. 

Mr. Deliver’s employer and his family and friends have suggested to him that he should get evaluated for ADHD, but he has resisted because of concerns about the stigma of a psychiatric diagnosis and the risks of taking a psychotropic medication.

Mr. Deliver is 5'11″ and his weight is 165 lb.  He takes a men’s multivitamin daily, HCTZ at 25 mg for hypertension, fish oil 1,000 mg at bedtime for hyperlipidemia, and a rescue inhaler that he keeps with him although he hasn’t had to use it for many years.

1. What screening tools can be used to affirm your initial diagnosis that Mr. Deliver meets the criteria for ADHD?

2. Further assessment determines that Mr. Deliver does meet the criteria for ADHD, inattentive type. What is the current recommendation for pharmacological treatment for Mr. Deliver?

Assume that instead of Mr. Deliver being 36-years-old, Thomas is a 13-year-old male that also meets the diagnostic criteria for ADHD, hyperactive type (Thomas is not on any medications at this age).  How will your pharmacological treatment change?

Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.

Please be sure to validate your opinions and ideas with in-text citations and corresponding references in APA format.

Please review the rubric to ensure that your response meets the criteria.

1. What screening tools can be used to affirm your initial diagnosis that Mr. Deliver

meets the criteria for ADHD?

 The first tool I would use to affirm that this patient meets the criteria for ADHD would be

the DSM-5. The DSM-5 lists the diagnostic criteria for ADHD as needing six or more of

the symptoms in either category 1 (inattention) or category 2 (hyperactivity and

impulsivity) that last for at least 6 months and to a degree that negatively impacts social,

academic or occupations activities. These symptoms also need to be present in two or

more settings, be present prior to age of 12 years and do not occur exclusively during

the course of schizophrenia or another psychotic disorder and are not better explained

by another mental disorder (American Psychiatric Association, 2013). There are also

many screening tools to use in addition to the DSM-5. Rating scales are used in

conjunction with the DSM-5 to help with diagnosis of ADHD. Rating scales specifically

designed for use in adults include: Brown Attention-Deficit Disorder Symptom

Assessment Scale for Adults (BADDS); Adult ADHD Clinical Diagnostic Scale (ACDS);

ADHD Rating Scale-IV With Adult Prompts (ADHD-RS-IV); and the Adult ADHD SelfReport Scale (ASRS) (Gualtieri & Johnson, 2005).

This study source was downloaded by 100000769192234 from CourseHero.com on 10-21-2023 15:58:26 GMT -05:00

https://www.coursehero.com/file/123197904/discussion-9docx/

2. Further assessment determines that Mr. Deliver does meet the criteria for ADHD,

inattentive type. What is the current recommendation for pharmacological

treatment for Mr. Deliver?

I would recommend either an amphetamine or methylphenidate. I am slightly

concerned about this patient’s history of hypertension and hyperlipidemia, as both

of these psychostimulant classes have been shown to raise blood pressure. Long

term studies have shown that stimulant use is not associated with increased risk of

heart attacks, cardiac death or stroke. Those with well-controlled hypertension have

been shown to manage ADHD symptoms effectively with amphetamines and

methylphenidates. This still does not negate the fact however, that the product

labels of stimulants state that “caution is indicated” when treating patients with preexisting hypertension (Fairman et al., 2018). I would also be sure to encourage this

patient to partake in behavioral therapy as well as using prescription medication.

3. Assume that instead of Mr. Deliver being 36-years-old, Thomas is a 13-year-old male

that also meets the diagnostic criteria for ADHD, hyperactive type (Thomas is not on

any medications at this age). How will your pharmacological treatment change?

For an adolescent patient the treatment plan is not a lot different than for adults

with ADHD. Stimulants are more effective than non-stimulants, but there can be a

risk for growth restriction. There are other non-stimulant medications that could be

tried first (atomoxetine, guanfacine, clonidine, bupropion, and modafinil). As with

adults with ADHD, I would also recommend concurrent behavioral therapy (Heldt,

2017).

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(5th ed.). Arlington, VA: American Psychiatric Publishing

Fairman, K. A., Davis, L. E., Peckham, A. M., & Sclar, D. A. (2018). Diagnoses of

Cardiovascular Disease or Substance Addiction/Abuse in US Adults Treated for ADHD

with Stimulants or Atomoxetine: Is Use Consistent with Product Labeling? Drugs – Real

World Outcomes, 5(1), 69–79. https://doi.org/10.1007/s40801-017-0129-2

This study source was downloaded by 100000769192234 from CourseHero.com on 10-21-2023 15:58:26 GMT -05:00

https://www.coursehero.com/file/123197904/discussion-9docx/

Gualtieri, C. T., & Johnson, L. G. (2005). ADHD: Is Objective Diagnosis Possible? Psychiatry

(Edgmont (Pa. : Township)), 2(11), 44–53.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993524/

Heldt, J. P. (2017). Memorable psychopharmacology. Createspace Independent Publishing

Platform

1.What screening tools can be used to affirm your initial diagnosis that Mr. Deliver meets the criteria for ADHD?

The DSM-5 would be the first resource I would consult to confirm if this patient satisfies the requirements for ADHD. According to the DSM-5, six or more symptoms from either group—category 1 (inattention) or category 2 (hyperactivity and impulsivity)—must be present for at least six months and have a detrimental influence on a person's ability to engage in social, academic, or occupational activities. Additionally, these symptoms must appear in two or more contexts, appear before the age of twelve, not only occasionally during the course of schizophrenia or another psychotic condition, and not be better explained by another mental illness (American Psychiatric Association, 2013).The DSM-5 is just one of several screening instruments available. The DSM-5 and rating scales are combined to assist in the diagnosis of ADHD. The Brown Attention-Deficit Disorder Symptom Assessment Scale for Adults (BADDS), the Adult ADHD Clinical Diagnostic Scale (ACDS), the ADHD Rating Scale-IV With Adult Prompts (ADHD-RS-IV), and the Adult ADHD SelfReport Scale (ASRS) are among the rating scales created expressly for use in adults (Gualtieri & Johnson, 2005).

 

 

2.Further assessment determines that Mr. Deliver does meet the criteria for ADHD, inattentive type. What is the current recommendation for pharmacological treatment for Mr. Deliver?

 

Either an amphetamine or methylphenidate is what I would advise. The patient's history of hypertension and hyperlipidemia causes me a little anxiety because it has been demonstrated that both of these kinds of psychostimulants can increase blood pressure. Studies conducted over an extended period of time have revealed no link between stimulant usage and an increased risk of heart attacks, cardiac death, or stroke. Amphetamines and methylphenidate have been demonstrated to help people with well-controlled hypertension manage their ADHD symptoms. However, this does not change the fact that while treating patients with preexisting hypertension, caution is advised on the product labels of stimulants (Fairman et al., 2018). In addition to prescription medication, I would make sure to encourage this patient to engage in behavioral treatment.

 

3.Assume that instead of Mr. Deliver being 36-years-old, Thomas is a 13-year-old male that also meets the diagnostic criteria for ADHD, hyperactive type (Thomas is not on any medications at this age). How will your pharmacological treatment change?

The treatment strategy is mostly the same for adolescents and adults with ADHD. Although stimulants are more effective than non-stimulants, there is a chance that they may limit growth. There are more non-stimulant drugs that might be tried initially (atomoxetine, guanfacine, clonidine, bupropion, and modafinil). In the same way that I would advise concurrent behavioral therapy for people with ADHD (Heldt, 2017)

Step-by-step explanation

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing

 

 Fairman, K. A., Davis, L. E., Peckham, A. M., & Sclar, D. A. (2018). Diagnoses of Cardiovascular Disease or Substance Addiction/Abuse in US Adults Treated for ADHD with Stimulants or Atomoxetine: Is Use Consistent with Product Labeling? Drugs – Real World Outcomes, 5(1), 69-79. https://doi.org/10.1007/s40801-017-0129-2

 

Gualtieri, C. T., & Johnson, L. G. (2005). ADHD: Is Objective Diagnosis Possible? Psychiatry (Edgmont (Pa. : Township)), 2(11), 44-53. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993524/ 

 

Heldt, J. P. (2017). Memorable psychopharmacology. Createspace Independent Publishing Platform. 

Discussion

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 1) Does a person in need of an organ transplant have a moral right to obtain that transplant, supposing the availability of the needed organ?

 2) How should we choose who gets a transplant, supposing that there are not enough organs for all who need them?

 3) Please cite the textbook and any other source used in APA format.

nursing

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 Describe the seven “levels of evidence” and provide an example of the type of practice change that could result from each. 

Introduction to Statistics

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It has long been a requirement for health care workers to take an Introduction to Statistics class. Why is it important for a person working in health care to understand statistical concepts? To answer this question, please provide two specific examples incorporating two different statistical terms from “Visual Learner Statistics,” located in the Topic 1 Resources. Do not use the same examples as those in a prior post. You may reference other articles in this topic or conduct your own scholarly research if more statistical terms are needed.

Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format. Responses to peers or faculty should be 100-150 words and include one reference. Refer to “HLT-362V Discussion Question Rubric” and “HLT-362V Participation Rubric,” located in Class Resources, to understand the expectations for initial discussion question posts and participation posts, respectively.

disscusion 6psych

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 Analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research.Scenario:

C.Z. is a 20-year-old Caucasian male who is in his second year of college. He is seeking treatment due to persistent fears that campus security and the local police are tracking and surveilling him. He cites occasional lags in his internet speed as evidence that surveillance devices are interfering with his electronics. His intense anxiety about this has begun getting in the way of his ability to complete schoolwork, and his friends are concerned – he says they have told him, “you’re not making sense.”

C.Z. occasionally laughs abruptly and inappropriately and sometimes stops speaking mid-sentence, looking off in the distance as though he sees or hears something. He expresses concern about electronics in the room (phone, computer) potentially being monitored and asks repeatedly about patient confidentiality, stating that he wants to be sure the police won’t be informed about his treatment. His beliefs are fixed, and if they are challenged, his tone becomes hostile.

Questions:

Remember to answer these questions from your textbooks and NP guidelines. At all times, explain your answers. 

  1. Discuss the etiology, course, and the structural/functional abnormalities of schizophrenia. 
  2. Discuss the evidence-based pharmacological and nonpharmacological treatment for this patient using the US Clinical Guidelines.

Submission Instructions:

  • Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.  Your initial post is worth 8 points.
  • You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 
  • All replies must be constructive and use literature where possible.
  • Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
  • Late work policies, expectations regarding proper citations, acceptable means of responding to peer feedback, and other expectations are at the discretion of the instructor.
  • You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.

Safe Practices for Medication Administration

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Due 10-11-23 @10am

Nursing

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 Describe the three health care settings that you explored as proposed sites for an EBP QI project. ( Community Mental Health Clinic, Crisis inpatient. Substance Use Clinic.  

questions

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Original Work, No Plagiarism, Cite and Reference

Hugo is a graduate student working on a research study that is seeking to explore the efficacy of a new medicine for the prevention of chemotherapy-induced peripheral neuropathy.  As part of his duties, he is asked to make himself available during participant recruitment to clarify any questions that the recruitment personnel or the participants may have. On one of these occasions, a research nurse named Phoebe is obtaining informed consent from a young adult named Simon. 

The informed consent form includes information on the purpose of the study, a double-blinded, randomized intervention trial to test the efficacy of a medicine for the prevention of chemotherapy-induced peripheral neuropathy.  The form explains the risks and benefits of participation at length, including the anticipated side effects of the new medicine. 

The benefits are thought to outweigh the risks.  The participants in the treatment arm of the study may benefit from the medicine's hypothesized prevention of chemotherapy-induced peripheral neuropathy. Participants in both groups will receive close monitoring of neuropathy symptoms and evidence-based care while being in the study. Finally, the form explains that the information collected may help to lead to the discovery of an agent that may reduce chemotherapy-induced peripheral neuropathy, of which there are currently no none effective preventative treatments. 

As Phoebe is reviewing the informed consent form, Simon appears somewhat uncomfortable and apprehensive. Hugo thinks that his response may be related to the surroundings and/or situation. They are sitting in the exam room shortly after Simon learned of the treatment options for advanced stage colorectal cancer and the doctor left without answering all of his questions. Simon also has additional oncology appointments shortly after the consent discussion. 

Hugo is also struck by Simon's interaction with Phoebe. He nods and his occasional brief responses sound more like someone receiving a set of instructions than an indication of understanding.

During the time it takes to complete the informed consent form, which is quite lengthy, Hugo begins to wonder whether Simon truly understands the research study and his part in it.  Hugo also questions whether Simon understands what randomization is and how this technique will affect him as a research participant. Hugo is distracted from his thoughts by movement from across the room. Simon is ready to place his signature on the informed consent form. He seems to be eager to do so. The form states that study subjects have the right to refuse to participate and that they may withdraw at any time, but Hugo begins to question whether Simon truly has a choice in giving his consent. Do the benefits from this study, overwhelm any concerns he may feel regarding being in the study?

Hugo is unsure how to address his discomfort with the informed consent process that he has just witnessed and he begins to deliberate about what course of action he should take to address his concerns.

Discussion Questions:

1. How could the informed consent form or the process of obtaining informed consent be modified to address Hugo's concerns?

2. What types of questions or techniques could have Phoebe provided to assess Simon's understanding of the study?

3. How would you describe “randomization” to a prospective study participant?

4. How would you respond to a participant who says “can we skip the rest of this and sign the form” during the informed consent discussion?