Janet, a 20 year-old college student, is experiencing a five-week history of itchy eyes and nasal congestion with watery nasal discharge. She also complains of a tickling cough, especially at night, and she has had episodes of repetitive sneezing. Janet gets frequent colds every spring and fall.

Physical Examination

Vital Signs: Temp, 98.8; BP 110/68; Pulse 72; Respirations 18

Skin: Flaking erythematous rash on the flexor surfaces of both arms

Head, Eyes, Ears, Nose, and Throat: Tender over maxillary sinuses; sclera red and slightly swollen with frequent tearing; outer nares with red, irritated skin; internal nares with red, boggy, moist mucosa and one medium-sized polyp on each side; pharynx slightly erythematous, with clear postnasal drainage

Lungs: Clear to auscultation and percussion

Discussion Questions:
1. Provide three differential diagnoses based on Janets subjective and objective data and discuss your reasoning for each.

2. What additional history questions would be useful in your evaluation of Janet?

3. Discuss the pathophysiological process of your primary diagnosis.

4. Differentiate the types of hypersensitivity mechanisms.

5. As per your analysis, what type of hypersensitivity reaction is Janet experiencing?

 

Some adolescents go to a professional social worker because their parents make them.  When this happens, how can a social worker openly address this issue with the teenager?  Explain your answer.  What barriers might the social worker expect during this frank discussion?  Explain your answer.

  Instructions 

We have been looking at different psychological theories and the way we can use them to better examine social media. For this assignment, you should choose yourself or another person (such as a celebrity or a politician). Spend some time looking through your/their social media accounts: Facebook, Twitter, Instagram, Pinterest, etc. Then write your analysis, being sure to cover these points:

• A good introduction including who your subject is and a good overview of them and their social media use
• Examples and discussion of schema/script theory in your subject
• Examples and discussion of cultivation theory in your subject
• Examples and discussion of agenda-setting theory in your subject
• Examples and discussion of social learning in your subject
• Examples and discussion of uses and gratifications theory in your subject
• Conclusions

 The basic story of Florence Nightingale is familiar to most nurses. This week we learned more about Nightingale’s life and work. Select at least one piece of the Nightingale legacy that was new to you and tell us how this changed your understanding of this great woman and her contributions to nursing. 

  

The Assignment

Examine Case Study: A Young Caucasian Girl With ADHD 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 clients pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

Decision #1

o Which decision did you select?

o Why did you select this decision? Support your response with evidence and references to the Learning Resources.

o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

o Explain any difference between what you expected to achieve with 

Decision #1 and the results of the decision. Why were they different?

Decision #2

o Why did you select this decision? Support your response with evidence and references to the Learning Resources.

o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

o Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

Decision #3

o Why did you select this decision? Support your response with evidence and references to the Learning Resources.

o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

o Explain any difference between what you expected to achieve with 

o 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 no more than five years old in APA Format

Attention Deficit Hyperactivity Disorder
A Young Girl With ADHD

BACKGROUND

Katie is an 8 year old Caucasian female who is brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katies teacher suggested that she may have ADHD. Katies parents reported that their PCP felt that she should be evaluated by psychiatry to determine whether or not she has this condition.

The parents give the PMHNP a copy of a form titled Conners Teacher Rating Scale-Revised. This scale was filled out by Katies teacher and sent home to the parents so that they could share it with their family primary care provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. The teacher opined that she lacks interest in school work and is easily distracted. Katie is also noted to start things but never finish them, and seldom follows through on instructions and fails to finish her school work.

Katies parents actively deny that Katie has ADHD. She would be running around like a wild person if she had ADHD reports her mother. She is never defiant or has temper outburst adds her father.

 
 

SUBJECTIVE

Katie reports that she doesnt know what the big deal is. She states that school is OK- her favorite subjects are art and recess. She states that she finds her other subjects boring, and sometimes hard because she feels lost. She admits that her mind does wander during class to things that she thinks of as more fun. Sometimes Katie reports I will just be thinking about nothing and the teacher will call my name and I dont know what they were talking about.

Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. Offers no other concerns at this time.

 
 

MENTAL STATUS EXAM

The client is an 8 year old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. Affect is bright. Katie denies visual or auditory hallucinations, no delusional or paranoid thought processes readily appreciated. Attention and concentration are grossly intact based on Katies attending to the clinical interview and her ability to count backwards from 100 by serial 2s and 5s. Insight and judgment appear age appropriate. Katie denies any suicidal or homicidal ideation.

Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation

Decision Point One:

Begin Wellbutrin (bupropion) XL 150 mg orally daily

RESULTS OF DECISION POINT # ONE

Client returns to clinic in four weeks

Katies parents inform you that they stopped giving Katie the medication because about 2 weeks into the prescription, Katie told her parents that she was thinking about hurting herself. This scared the parents, but they didnt want to bother you by calling the office, so they felt that it would be best to just stop the medication as they would be seeing you in two weeks

Decision Point #Two:

Select what the PMHNP should do next:

Educate the parents that Bupropion sometimes causes suicidal ideation in children and that this is normal, and restart the drug at the previous dose

RESULTS OF DECISION POINT TWO

Client returns to clinic in four weeks

Katie’s parents again report that after about a week of treatment with the Bupropion, Katie began telling her parents that she wanted to hurt herself and began having dreams about being dead. This scared her parents and they stopped giving her the medication

At this point, they are quite upset with the results of their daughters treatment and are convinced that medication is not the answer

Decision Point # Three:

Select what the PMHNP should do next:

Refer the parents to a pediatric psychologist who can use behavioral therapy to treat Katies ADHD

Guidance to Student

Bupropion is used off-label for ADHD and is used more commonly in adults. Its mechanism of action results in increasing the neurotransmitters norepinephrine/noradrenaline and dopamine. Since dopamine is inactivated by norepinephrine reuptake in frontal cortex, (which largely lacks dopamine transporters) bupropion can increase dopamine neurotransmission in this part of the brain, which may explain its effectiveness in ADHD. However, Bupropion as well as other antidepressants have been linked to suicidal ideation in children and adolescents- despite the fact that it was being used initially to treat ADHD, it is still an antidepressant.

At this point, the parents are probably quite frustrated as no parent wants to hear their child talking about hurting themselves or having dreams about being dead. If the parents are adamant about no more medications, referral to a pediatric psychologist or similar therapist skilled in the use of behavioral therapies to treat ADHD in children. However, it should be noted that behavioral therapies work best when combined with medication, however, if the parents are insistent, then behavioral therapy may be the only alternative left in the treatment of Katie.

In terms of the pathophysiology of ADHD, whereas it may be true that increasing age may demonstrate some improvement in symptoms (some people will actually experience complete resolution of symptoms by adulthood), it is not helping Katie in the here and now. Katie still needs help with her symptoms which are causing academic issues.

The PMHNP should attempt to repair the rupture in the therapeutic alliance (the parents now believe that medications are not the answer) by explaining rationale for the use of Bupropion (many people like to start with Bupropion because it has a low-risk for addiction). The family should be encouraged to allow the PMHNP to initiate Adderall as it has a very good track record in terms of its efficacy in treating ADHD.

This week, you will develop a PowerPoint presentation reviewing the theories from each module. Please select one theory from each module (1-8) and answer the following questions. You should have two slides per theory:

• Describe the theory
• Provide 3 examples of how the theory applies to current practice (Obstetrics)
• Provide 3 positive patient outcomes resulting from utilizing the theory
• Explain 3 benefits to nursing satisfaction when utilizing the theory
• Describe two barriers to using the theory in practice and at least one method for overcoming each barrier (support methods with sources)
• Support from literature clearly noted throughout

The PowerPoint presentation should include at least two outside references and the textbook. The presentation should contain 2 to 4 slides per theory, for a total of 16 to 32 slides.

Mod 1 – Nightingale 

Module 2- peplau, Henderson and orem 

Module 3- Johnson and Orlando

Module 4- King and Rogers

Module 5- Roy and Neuman 

Module 6- Leininger, Newman and Watson

Module 7- Parse, Erickson and Swain

Module 8- Theories of 1980’s and 1990’s

  

A. Read Chapter 3: The Skeletal System 

Text Book: Medical Terminology for Health Professions. Seventh edition. Author: Ann Ehrlich.

B. Answer Learning Exercises 

* Matching words parts 1, 2, and 3

* Definitions Pages 

* Which is the Correct Medical Term,

C. Answer the following questions base in chapter 3:

1. What the skeletal system does? Mention, describe and explain its functions.

2. Bones come in many sizes and shapes, cite and illustrate the different types of bones, state examples.

3. There are two types of bones: compact and spongy. Mention and describe the principal characteristics of each type, also state their function and cell organization.

4. Mention the arrangement of the compact and spongy tissue in a long bone; also explain the parts of the long bones.

5. The skeleton is dividing into the axial and the appendicular skeleton. Mention and explain all the bones that are include only in the AXIAL SKELETON.

6. Mention and explain all the bones that are include only in the Appendicular SKELETON

D. Read Chapter 4:

Text Book: Medical Terminology for Health Professions. 

E. Answer Learning Exercises

* Matching word parts 1, 2

* Definitions: 

* Labeling Exercises 

F. Answer the following questions base in chapter 4:

1. There are three types of Muscles: Skeletal, Smooth, and Skeletal. Mention, describe and cite the cellular appearance, location in the human body, anatomical description, and function of the each type of muscle.

2. State and illustrate the structure of the whole muscle, including layers of connective tissue and muscle attachments. 

 

After reading Chapter 3 and reviewing the lecture power point (located in lectures tab),  please answer the following questions.  Each question must have at least 3 paragraphs and you must use at 3 least references included in your post.

Additionally, you are expected to reply to two other students and include a reference that justifies your post.  Your reply must be at least 3 paragraphs.

Discussion questions:

1.  What are your beliefs about the major concepts in nursing- person, environment, health, nursing?

2. Do you believe there is more than one right answer to situations?  How do you value the whole individual?  What barriers prevent us from responding to the contextual needs of our patients?

Please change to different words only.

1. Nurse Practitioner student.

2. 5 years of RN experience acute care setting.

3. Psychiatric Nurse Experience  Adult/Children.

4. Substance abuse experience.

One paragraph only. In the sample format, change the previous one around.

 

Herbal Supplements:

The practice of using herbal supplements dates back thousands of years. Today, there is a renewal in the use of herbal supplements among American consumers. However, herbal supplements are not for everyone. In fact, some herbal products may cause problems for people treatments for chronic ailments. Because they are not subject to scrutiny by the FDA or other governing agencies, the use of herbal supplements is controversial.

Herbal supplements are products made from plants for use in the treatment and management of certain diseases and medical conditions. Many prescription drugs and over-the-counter medicines are also made from plant derivatives. These products contain only purified ingredients and, unlike herbal supplements, are closely regulated by the FDA. Herbal supplements may contain entire plants or plant parts. Herbal supplements come in all forms: dried, chopped, powdered, capsule, or liquid, and can be used in various ways. Please address the followings:

1.     Discuss advantages and disadvantages of dietary supplements, including adverse reactions, drug-drug interactions, drug-food interactions, and specific laboratory issues that may arise from using these products.

2.     Discuss the position of the FDA and other governmental agencies on over the counter herbal supplements. Support your post with at least 2 evidenced-based guidelines published within the last 5 years.