Explain how health and governmental policy impact disaster recovery efforts.

Develop a disaster recovery plan to lessen health disparities and improve access to community services after a disaster. Then, develop and record an 8-10 slide presentation (PowerPoint preferred) of the plan with audio for the Vila Health system, city officials, and the disaster relief team.

As you begin to prepare this assessment, you are encouraged to complete the Disaster Preparedness and Management activity. The information gained from completing this activity will help you succeed with the assessment as you think through key issues in disaster preparedness and management in the community or workplace. Completing activities is also a way to demonstrate engagement.

Professional Context
Nurses fulfill a variety of roles, and their diverse responsibilities as health care providers extend to the community. The decisions we make daily and in times of crisis often involve the balancing of human rights with medical necessities, equitable access to services, legal and ethical mandates, and financial constraints. When an unanticipated event occurs, such as an accident or natural disaster, issues can arise that complicate decisions about meeting the needs of an individual or group, including understanding and upholding their rights and desires, mediating conflict, and applying established ethical and legal standards of nursing care. As a nurse, you must be knowledgeable about disaster preparedness to safeguard those in your care. You are also accountable for promoting equitable quality of care for community residents.

This assessment provides an opportunity for you to apply the concepts of emergency preparedness, public health assessment, triage, management, and surveillance after a disaster. You will also focus on hospital evacuation and extended displacement periods.

Demonstration of Proficiency
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

Competency 1: Analyze health risks and health care needs among distinct populations.
Describe the determinants of health and the cultural, social, and economic barriers that impact safety, health, and disaster recovery efforts in a community.
Competency 2: Propose health promotion strategies to improve the health of populations.
Present specific, evidence-based strategies to overcome communication barriers and enhance interprofessional collaboration to improve disaster recovery efforts.
Competency 3: Evaluate health policies, based on their ability to achieve desired outcomes.
Explain how health and governmental policy affect disaster recovery efforts.
Competency 4: Integrate principles of social justice in community health interventions.
Explain how a proposed disaster recovery plan will lessen health disparities and improve access to community services.
Competency 5: Apply professional, scholarly communication strategies to lead health promotion and improve population health.
Present a compelling case to community stakeholders to obtain their approval and support for a proposed disaster recovery plan.
Note: Complete the assessments in this course in the order in which they are presented.

Preparation
When disaster strikes, community members must be protected. A comprehensive recovery plan, guided by the MAP-IT (Mobilize, Assess, Plan, Implement, Track) framework, is essential to help ensure everyone’s safety. The unique needs of residents must be assessed to lessen health disparities and improve access to equitable services after a disaster. Recovery efforts depend on the appropriateness of the plan, the extent to which key stakeholders have been prepared, and the allocation of available resources. In a time of cost containment, when personnel and resources may be limited, the needs of residents must be weighed carefully against available resources.

In this assessment, you are a member of a community task force responsible for developing a disaster recovery plan for the Vila Health community using MAP-IT, which you will present to city officials and the disaster relief team.

To prepare for the assessment, complete the Vila Health: Disaster Recovery Scenario simulation.

In addition, you are encouraged to complete the Disaster Preparedness and Management activity. The information gained from completing this activity will help you succeed with the assessment as you think through key issues in disaster preparedness and management in the community or workplace. Completing activities is also a way to demonstrate engagement.

Begin thinking about:

Community needs.
Resources, personnel, budget, and community makeup.
People accountable for implementation of the disaster recovery plan.
Healthy People 2020 goals.
A timeline for the recovery effort.
You may also wish to:

Review the MAP-IT (Mobilize, Assess, Plan, Implement, Track) framework, which you will use to guide the development of your plan:
Mobilize collaborative partners.
Assess community needs.
Plan to lessen health disparities and improve access to services.
Implement a plan to reach Healthy People 2020 objectives.
Track community progress.
Review the assessment instructions and scoring guide to ensure that you understand the work you will be asked to complete.
Note: Remember that you can submit all, or a portion of, your draft recovery plan to Smarthinking Tutoring for feedback, before you submit the final version for this assessment. If you plan on using this free service, be mindful of the turnaround time of 24–48 hours for receiving feedback.

Note: If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact DisabilityServices@capella.edu to request accommodations.

Instructions
Complete the following:

Develop a disaster recovery plan for the Vila Health community that will lessen health disparities and improve access to services after a disaster. Refer back to the Vila Health: Disaster Recovery Scenario to understand the Vila Health community.
Assess community needs.
Consider resources, personnel, budget, and community makeup.
Identify the people accountable for implementation of the plan and describe their roles.
Focus on specific Healthy People 2020 goals.
Include a timeline for the recovery effort.
Use the MAP-IT (Mobilize, Assess, Plan, Implement, Track) framework to guide the development of your plan:
Mobilize collaborative partners.
Assess community needs.
Plan to lessen health disparities and improve access to services.
Implement a plan to reach Healthy People 2020 objectives.
Track community progress.
Develop a slide presentation of your disaster recovery plan with an audio recording of you presenting your assessment of the Vila Health: Disaster Recovery Scenario for city officials and the disaster relief team.
Presentation Format and Length
You may use Microsoft PowerPoint (preferred) or other suitable presentation software to create your slides and add your voice-over. If you elect to use an application other than PowerPoint, check with your instructor to avoid potential file compatibility issues.

Be sure that your slide deck includes the following slides:

Title slide.
Recovery plan title.
Your name.
Date.
Course number and title.
References (at the end of your presentation).
Your slide deck should consist of 8–10 content slides plus title and references slides. Use the speaker’s notes section of each slide to develop your talking points and cite your sources as appropriate.

The following resources will help you create and deliver an effective presentation:

Record a Slide Show With Narration and Slide Timings.
This Microsoft article provides steps for recording slide shows in different versions of PowerPoint, including steps for Windows, Mac, and online.
Microsoft Office Software.
This Campus page includes tip sheets and tutorials for Microsoft PowerPoint.
PowerPoint Presentations Library Guide.
This library guide provides links to PowerPoint and other presentation software resources.
SoNHS Professional Presentation Guidelines [PPTX].
This presentation, designed especially for the School of Nursing and Health Sciences, offers valuable tips and links, and is itself a PowerPoint template that can be used to create a presentation.
Supporting Evidence
Cite at least three credible sources from peer-reviewed journals or professional industry publications to support your plan.

Graded Requirements
The requirements outlined below correspond to the grading criteria in the scoring guide, so be sure to address each point:

Describe the determinants of health and the cultural, social, and economic barriers that impact safety, health, and recovery efforts in the community.
Consider the interrelationships among these factors.
Explain how your proposed disaster recovery plan will lessen health disparities and improve access to community services.
Consider principles of social justice and cultural sensitivity with respect to ensuring health equity for individuals, families, and aggregates within the community.
Explain how health and governmental policy impact disaster recovery efforts.
Consider the implications for individuals, families, and aggregates within the community of legislation that includes, but is not limited to, the Americans with Disabilities Act (ADA), the Robert T. Stafford Disaster Relief and Emergency Assistance Act, and the Disaster Recovery Reform Act (DRRA).
Present specific, evidence-based strategies to overcome communication barriers and enhance interprofessional collaboration to improve the disaster recovery effort.
Consider how your proposed strategies will affect members of the disaster relief team, individuals, families, and aggregates within the community.
Include evidence to support your strategies.
Present a compelling case to community stakeholders to obtain their approval and support for the proposed disaster recovery plan.
Develop your presentation with a specific purpose and audience in mind.
Adhere to scholarly and disciplinary writing standards and APA formatting requirements.
Additional Requirements
Before submitting your assessment, proofread all elements to minimize errors that could distract readers and make it difficult for them to focus on the substance of your presentation.

Portfolio Prompt: Remember to save the assessment to your ePortfolio so that you may refer to it as you complete the final capstone course.

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Evaluate educational session outcomes in terms of progress made toward Healthy People 2020 goals and leading health indicators.

Build a slide presentation (PowerPoint preferred) of the health promotion plan you developed in the first assessment. Then, implement your health promotion plan by conducting a face-to-face educational session addressing the health concern and health goals of your selected community member or group. In addition, collaborate with any participants in setting goals for the session, evaluating session outcomes, and suggesting possible revisions to improve future sessions.
As you begin to prepare this assessment, you are encouraged to complete the Vila Health: Conducting an Effective Educational Session activity. The information gained from completing this activity will help you succeed with the assessment as you consider key issues in conducting an effective educational session for a selected audience. Completing activities is also a way to demonstrate engagement.
Professional Context
Health education is any combination of learning experiences designed to help community individuals, families, and aggregates improve their health by increasing knowledge or influencing attitudes (WHO, 2018). Education is key to health promotion, disease prevention, and disaster preparedness. The health indicator framework identified in Healthy People 2020 helps motivate action in such areas as health service access, clinical preventive services, environmental quality, injury or violence, maternal, infant and child health, mental health, nutrition, substance abuse, and tobacco use.
Nurses provide accurate evidence-based information and education in various formal and informal settings. They draw upon evidence-based practice to provide health promotion and disease prevention activities to create social and physical environments conducive to improving and maintaining community health. When provided with the tools to be successful, people demonstrate lifestyle changes (self-care) that promote health and help reduce readmissions. They are better able to tolerate stressors, including environmental changes, and enjoy a better quality of life. In times of crisis, a resilient community is a safer community (ODPHP, n.d.; Flanders, 2018).
This assessment provides an opportunity for you to apply teaching and learning concepts to the presentation of a health promotion plan.
Demonstration of Proficiency
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

Competency 3: Evaluate health policies, based on their ability to achieve desired outcomes.
Evaluate educational session outcomes in terms of progress made toward Healthy People 2020 goals and leading health indicators.
Competency 4: Integrate principles of social justice in community health interventions.
Evaluate educational session outcomes and the attainment of agreed-upon health goals in collaboration with participants.
Competency 5: Apply professional, scholarly communication strategies to lead health promotion and improve population health.
Present a health promotion plan to an individual or group within a community.
References
U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion (ODPHP). (n.d.). Healthy People 2020. Retrieved from https://www.healthypeople.gov/
Flanders, S. A. (2018). Effective patient education: Evidence and common sense. Medsurg Nursing, 27(1), 55–58.
Note: This is the second part of a two-part assessment. You must complete Assessment 1 before completing this assessment.
Preparation
This assessment builds upon Assessment 1 where you contacted and secured local individuals or group in your community who were open to a presentation about a health concern and health promotion strategies. Once again, you will assume the role of a community nurse tasked with addressing the specific health concern within your chosen community. This time, you will implement the health promotion plan that you developed in Assessment 1 as a PowerPoint presentation. This presentation must be live and face-toface. You know that you must determine an effective teaching strategy, communicate the plan with professionalism and cultural sensitivity, obtain input on the value of the plan to the individual or group, and revise the plan, as applicable, to improve future educational sessions. To engage your audience, you decide to develop a slide presentation to communicate your plan. A copy of the slide presentation could also be given to the individual or group for future reference.
Remember that your first assessment (Assessment 1) MUST be satisfactorily completed to initiate this assessment (Assessment 4). These assessments meet the three-hour clinical learning experience required in this course
Please review the assessment scoring guide for more information.
To prepare for the assessment, you are encouraged to complete the Vila Health: Conducting an Effective Educational Session simulation. You may also wish to review the health promotion plan presentation assessment and scoring guide to ensure that you understand all requirements.
Note: Remember that you can submit all, or a portion of, your draft plan to Smarthinking Tutoring for feedback before you submit the final version for this assessment. If you plan on using this free service, be mindful of the turnaround time of 24–48 hours for receiving feedback.
Instructions
Complete the following:

Prepare a PowerPoint presentation of the health promotion plan you developed in Assessment 1, with detailed speaker’s notes that include your evaluation of session outcomes. Speaker notes should reflect what you will actually say when you conduct the face-to-face session.
Implement your health promotion plan by conducting a face-to-face educational session addressing the health concern and health goals of your chosen participants. Collaborate with the participants in setting session goals, evaluating outcomes, and suggesting possible revisions to improve future sessions.
As you begin to prepare this assessment, you are encouraged to complete the Vila Health: Conducting an Effective Educational Session activity. The information gained from completing this activity will help you succeed with the assessment as you consider key issues in conducting an effective educational session for a selected audience. Completing activities is also a way to demonstrate engagement.
Completion of this assessment, and the course, requires that you spend a minimum of three hours face-to-face working with your identified patient who may be a community member or group. Remember that it is a requirement to log your direct clinical hours in the CORE ELMS system.
Please be advised that the Volunteer Experience form requires that you provide the name and contact information for at least one individual with whom you worked as part of your direct clinical activity. Your faculty may reach out to this individual to verify that you have accurately documented and completed your clinical hours.
Presentation Format and Length
You may use Microsoft PowerPoint (preferred) or other suitable presentation software to create your slides. If you elect to use an application other than PowerPoint, check with your faculty to avoid potential file compatibility issues.
The number of content slides in your presentation is dictated by nature and scope of your health promotion plan. Be sure to include title and references slides per the following:

Title slide:
Health promotion plan title.
Your name.
Date.
Course number and title.
References (at the end of your presentation).
Be sure to apply correct APA formatting to your references.
The following resources will help you create and deliver an effective presentation:

Record a Slide Show With Narration and Slide Timings.
This Microsoft article provides steps for recording slide shows in different versions of PowerPoint, including steps for Windows, Mac, and online.
Microsoft Office Software.
This Campus page includes tip sheets and tutorials for Microsoft PowerPoint.
PowerPoint Presentations Library Guide.
This library guide provides links to PowerPoint and other presentation software resources.
SoNHS Professional Presentation Guidelines [PPTX].
This presentation, designed especially for the School of Nursing and Health Sciences, offers valuable tips and links, and is itself a PowerPoint template that can be used to create a presentation.
Supporting Evidence
Support your plan with at least three professional or scholarly references, which may include peer-reviewed articles, course study resources, and Healthy People 2020 resources.
Graded Requirements
The requirements outlined below correspond to the grading criteria in the assessment scoring guide, so be sure to address each point. Read the performance-level descriptions for each criterion to see how your work will be assessed.

Present your health promotion plan to your chosen audience.
Tailor the presentation to the needs of your audience.
Adhere to scholarly and disciplinary writing standards and APA formatting requirements.
Evaluate educational session outcomes and the attainment of agreed-upon health goals in collaboration with participants.
Which aspects of the session would you change?
How might those changes improve future outcomes?
Evaluate educational session outcomes in terms of progress made toward Healthy People 2020 goals and leading health indicators.
What changes would you recommend to better align the session with Healthy People 2020 goals and leading health indicators?
Additional Requirements
Before submitting your assessment, proofread your presentation slides and speaker’s notes to minimize errors that could distract readers and make it difficult for them to focus on the substance of your presentation.
Reminder: It is required that you log the face-to-face time in the CORE ELMS system. The time you spent securing individual or group participation in Assessment 1 and the time you spend presenting your final health promotion plan to the selected individual or group in Assessment 4 counts as direct clinical contact and must total at least three hours. The CORE ELMS link is located in the left-hand navigation pane.
Portfolio Prompt: Remember to save the assessment to your ePortfolio so that you may refer to it as you complete the final capstone course.

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Discuss the link between the PICOT question, the research articles, and the nursing practice problem you identified.

Prepare this assignment as a 1,500-1,750 word paper using the instructor feedback from the previous course assignments and the guidelines below.

PICOT Question

Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor.

The final PICOT question will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).

Research Critiques

In the Topic 2 and Topic 3 assignments, you completed a qualitative and quantitative research critique on two articles for each type of study (4 articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question.

Refer to “Research Critiques and PICOT Guidelines – Final Draft.” Questions under each heading should be addressed as a narrative in the structure of a formal paper.

Proposed Evidence-Based Practice Change

Discuss the link between the PICOT question, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes.

General Requirements

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

AttachmentsNRS-433V-RS5-ResearchCritiquePICOTGuidelines.docx

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Describe your preferred learning strategies.

Learning styles represent the different approaches to learning based on preferences, weaknesses, and strengths. For learners to best achieve the desired educational outcome, learning styles must be considered when creating a plan. Complete “The VARK Questionnaire,” located on the VARK website, and then complete the following:

Click “OK” to receive your questionnaire scores.
Once you have determined your preferred learning style, review the corresponding link to view your learning preference.
Review the other learning styles: visual, aural, read/write, kinesthetic, and multimodal (listed on the VARK Questionnaire Results page).
Compare your current preferred learning strategies to the identified strategies for your preferred learning style.
Examine how awareness of learning styles has influenced your perceptions of teaching and learning.
In a paper (750‐1,000 words), summarize your analysis of this exercise and discuss the overall value of learning styles. Include the following:

Provide a summary of your learning style according the VARK questionnaire.
Describe your preferred learning strategies. Compare your current preferred learning strategies to the identified strategies for your preferred learning style.
Describe how individual learning styles affect the degree to which a learner can understand or perform educational activities. Discuss the importance of an educator identifying individual learning styles and preferences when working with learners.
Discuss why understanding the learning styles of individuals participating in health promotion is important to achieving the desired outcome. How do learning styles ultimately affect the possibility for a behavioral change? How would different learning styles be accommodated in health promotion?
Cite to at least three peer‐reviewed or scholarly sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Cente

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Describe how family systems theory can be applied to solicit changes in family members that, in turn, initiate positive changes to the overall family functions over time.

Family Health Assessment Part

Understanding family structure and style is essential to patient and family care. Conducting a family interview and needs assessment gathers information to identify strengths, as well as potential barriers to health. This information ultimately helps develop family-centered strategies for support and guidance.

1. This family health assessment is a two-part assignment. The information you gather in this initial assignment will be utilized for the second assignment in Topic 3.

Develop an interview questionnaire to be used in a family-focused functional assessment. The questionnaire must include three open-ended, family-focused questions to assess functional health patterns for each of the following:

a. Values/Health Perception

b. Nutrition

c. Sleep/Rest

d. Elimination

e. Activity/Exercise

f. Cognitive

g. Sensory-Perception

h. Self-Perception

i. Role Relationship

j. Sexuality

k. Coping

Select a family, other than your own, and seek permission from the family to conduct an interview. Utilize the interview questions complied in your interview questionnaire to conduct a family-focused functional assessment. Document the responses as you conduct the interview.

2. Upon completion of the interview, write a 750-1,000-word paper. Analyze your assessment findings. Submit your questionnaire as an appendix with your assignment.

Include the following in your paper:

a. Describe the family structure. Include individuals and any relevant attributes defining the family composition, race/ethnicity, social class, spirituality, and environment.

b. Summarize the overall health behaviors of the family. Describe the current health of the family.

c. Based on your findings, describe at least two of the functional health pattern strengths noted in the findings. Discuss three areas in which health problems or barriers to health were identified.

d. Describe how family systems theory can be applied to solicit changes in family members that, in turn, initiate positive changes to the overall family functions over time.

Cite at least three peer-reviewed or scholarly sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Cen

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What regulations/license(s) are you governed under?

Contact a Substance Abuse Center

Contact the office manager and set up an appointment to interview either him/her or the physician.

Complete and submit the pre-set interview questions

Site Interview Questions:

How long have you been in business?
What degree(s) do you need to operate your business?
What are the type(s) of clients you serve?
What regulations/license(s) are you governed under?
How do you ensure the completeness, timeliness, and accuracy of records?
Are you bound by HIPAA rules/regulations? If not, how do you maintain security and confidentiality of the patient/client health record?
Do you have an electronic health record? if yes- what is the name of system? If not, what type of filing system do you have for patient/client health records?
What does the role of a health information management/medical record professional look like at the organization?

One Page

All Questions Need Answered

Format Instructions Attached Below

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Discuss how your local health department, state, or government are addressing these issues.

Option 1: Environmental influences on population health, advocacy, and groups
Watch and listen to the video Primary Care Public Health in the Community This video, produced by the Institute of Medicine (IOM), highlights a recent report on the integration of primary care and public health. The integration of primary care and public health can enhance the capacity of both sectors to carry out their respective missions and link with other stakeholders to catalyze a collaborative, intersectoral movement toward improved population health.
In your post:

Choose one global environmental issue that may cause health problems in populations.
Provide a brief description of the relationship between this environmental issue and subsequent health problems.
Include local or regional health statistics you discover. (Don’t forget to provide a reference for these!)
Discuss how your local health department, state, or government are addressing these issues.

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Differentiate the types of hypersensitivity mechanisms.

1. Provide three differential diagnoses based on Janet’s subjective and objective data and discuss your reasoning for each.

Hay fever, food allergies and viral infection that presents as a cold with allergic symptoms would be the top three indications based off of the signs and symptoms being presented by Janet (Mayo Clinic, 2019b). Hay fever causes seasonal allergies along with a clear runny nose, post-nasal drip and irritated nares. Food allergies can cause eczema and allergic symptoms affecting the ear note and throat (Mayo Clinic, 2017). A viral infection such as the common cold can also exacerbate a runny nose, sneezing, post-nasal drainage and inflamed lymph nodes (Mayo Clinic, 2019a).

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

You can ask valid questions such like when did the symptoms begin? Have you been around anyone else who is sick? What makes the symptoms worse? Have you had a recent in change in environment or food? What makes the symptoms seem worse or better? Have you tried taking any medication and if so, what has worked/not worked? Does anyone in your family suffer from any allergies? Have you had seasonal/food allergies ever checked?

3. Discuss the pathophysiological process of your primary diagnosis.

Janet is suffering from Hay fever during the changes in seasons during Spring and Fall which is when pollen counts are elevated. According to Mayo Clinic (2019) Hay fever, also called allergic rhinitis, causes cold-like signs and symptoms, such as a runny nose, itchy eyes, congestion, sneezing and sinus pressure. But unlike a cold, hay fever isn’t caused by a virus. Hay fever is caused by an allergic response to outdoor or indoor allergens, such as pollen, dust mites, or tiny flecks of skin and saliva shed by cats, dogs, and other animals with fur or feathers (pet dander).

4. Differentiate the types of hypersensitivity mechanisms.

Type I hypersensitivity is also known as immediate or anaphylactic hypersensitivity. The reaction may involve skin (urticaria and eczema), eyes (conjunctivitis), nasopharynx (rhinorrhoea, rhinitis), bronchopulmonary tissues (asthma) and gastrointestinal tract (gastroenteritis). The reaction may cause a range of symptoms from minor inconvenience to death. The reaction usually takes 15 – 30 minutes from the time of exposure to the antigen, although sometimes it may have a delayed onset of 10-12 hours (Ghaffar, 2016).

Type II hypersensitivities are also known as cytotoxic hypersensitivities and may affect a variety of organs and tissues. The antigens are normally endogenous, although exogenous chemicals (haptens) which can attach to cell membranes and lead to type II hypersensitivity. Drug-induced hemolyticanemia, granulocytopenia and thrombocytopenia are examples. The reaction time is minutes to hours. Type II hypersensitivity are primarily mediated by antibodies of the IgM or IgG classes and complement. Phagocytes and K cells may also play a role (Ghaffar, 2016).

Type III hypersensitivity is also known as immune complex hypersensitivity. The reaction may be general such as serum sickness or may involve individual organs including skin like systemic lupus erythematosus, an Arthur reaction, kidneys, lupus-nephritis, lungs-aspergillosis, blood vessels-polyarteritis, joints-rheumatoid arthritis, or other organs. This reaction may be the pathogenic mechanism of diseases caused by many microorganisms.

Type IV hypersensitivity is involved in the pathogenesis of many autoimmune and infectious diseases (tuberculosis, leprosy, blastomycosis, histoplasmosis, toxoplasmosis, leishmaniasis, etc.) and granulomas due to infections and foreign antigens. Another form of delayed hypersensitivity is contact dermatitis such as with poison ivy, and heavy metals (Ghaffar, 2016).

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

Allergic disorders (type I hypersensitivity) associated with asthma, hay fever, and drug reactions, as well as parasitic infections (particularly with metazoan parasites) are often cited as causes. Allergic reactions can present as the patient having and increased number in eosinophilia is an absolute increase (more than 450/μL) in the total numbers of circulating eosinophils (McCance&Huether, 2014).
References

Ghaffar, A. (2016, April 2). Hypersensitivity reactions. Retrieved from http://www.microbiologybook.org/ghaffar/hyper00.htm

Mayo Clinic. (2019, April 20). Common cold Symptoms and causes. Retrieved from https://www.mayoclinic.org/diseases-conditions/common-cold/symptoms-causes/syc-20351605

Mayo Clinic. (2017, May 2). Food allergy Symptoms and causes.Retrieved from https://www.mayoclinic.org/diseases-conditions/food-allergy/symptoms-causes/syc-20355095

Mayo Clinic. (2019, March 19). Hay fever symptoms and causes.Retrieved from https://www.mayoclinic.org/diseases-conditions/hay-fever/symptoms-causes/syc-20373039

McCance, K., Huether, S. (2014). Pathophysiology: The Biologic Basis for Disease in Adults and Children, (7th Ed). Mosby, St. Louis, Missouri. [Vital Book File]. HASDOIHFOCINDLKCNBION

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List two pharmacologic agents and their dosing that would be appropriate for the patient’s ADHD therapy based on pharmacokinetics and pharmacodynamics.

Discussion Assignment:

Respond to the following Case study:

Explain how you might apply knowledge gained from the Response case studies to your own practice in clinical settings.

· Share additional interview and communication techniques that could be effective with your colleague’s selected patient.

·

· Suggest additional health-related risks that might be considered.

·

· Validate an idea with your own experience and additional research.

·

· Explain your reasoning using at least TWO different references from current evidence-based literature in APA Format.

Case Study Response

Case 1: Volume 1, Case #13: The 8-year-old girl who was naughty

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

1.How are you performing in school?

Rationale: Children with ADHD portray academic underachievement due to inattentiveness and disruptive as well as disruptive behavior. Their general academic achievement is affected by these behaviors and the results are challenges in reading, spelling and math (Leahy, 2018).

2.How is your relationship with your family members, your teachers and your friends?

Rationale: This question is meant to elicit information regarding this patient’s social skills. Most ADHD children have problematic peer relations as well as emotional dysregulation . Therefore, it is possible that this patient will report always being in trouble with teachers, as well as not being like by her peers due to her poor social skills ( Sjowall, D., & Thorell, L. B. 2014)

3. Do you find it hard to read and follow instructions, and do you have a hard time understanding and finishing your assignments?

Rationale: Most children with ADHD have trouble following instructions, either because they do not understand the instructions or because they do not want to. Most children are therefore academically challenged ( Parker, 2005)

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.

The patient’s parents( Mother, father), the patient’s grandparents if they are close to the child, the child’s siblings, peers, and teachers who interact with the patient.

The questions would include

1.When did you start getting concerned about her symptoms?

Rationale: This question would be asked to parents or grandparents who help take care of the patient . Most children generally have inattentiveness and hyperactivity. Most of them cannot adequately follow orders or concentrate on a task for a long time. However, there is that time when a parent gets concerned about these symptoms and decide to seek for professional opinion or diagnosis.

2. Is there somebody in either her father’s or mother’s side of the family that has ADHD?

This question is to the parents and grandparents who know the patient’s background. This question is meant to find out if ADHD runs in the family and if it is genetic.

3. To the mother: Were you smoking or drinking when you were pregnant with the patient?

Rationale: Alcohol and tobacco use during pregnancy can cause a child to be born with ADHD.

4. Is the patient able to finish her homework on time?

Rationale: This question can be asked to both the parents and the teacher. This is to find out if the patient is able to complete her tasks.

5. Is the patient able to interact and play normally with friends?

Rationale: This is a question to her teachers and her friends. Most ADHD patients do not have social skills and so they prefer to stay on their own and do not play well with their peers (CDC 2019).

6. Is the patient disruptive in class?

Rationale: This question is to the teacher. Most ADHD patients have disruptive behavior, they talk too much, are overly active and have trouble controlling impulses.

7.What learning disabilities does the patient have?

Rationale: Most children with ADHD have problems with math, reading and spelling (Wender, 2000).

Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.

As of date, there is no single laboratory test that is used to diagnose ADHD. Psychiatrists rely on continuous performance tests( CPT) for the diagnosis This is an automated scoring test whose results analysis and interpretation are also automated ( Boutros, Fraenkel, & Feingold, 2005).

A neurologic exam such as EEG or MRI of the brain would also be necessary to ensure that the patient does not have any brain injury since one of the causes of ADHD is brain injury. A DSM5 diagnostic exam would be done to find out if the patient has all the symptoms of ADHD ( Leahy, 2018).

Head to toe physical exam would be the first thing to conduct on this patient. Since the patient comes in with fever and sore throat, it is important to first find out why she has fever and sore throat. Throat cultures will be collected to check for the organisms causing t sore throat. Also, blood cultures will need to be sent to find out if the patient has systemic infection. The other test to conduct would be the hearing and vision test. This is to make sure that these problems are not causing all these issues (CDC2019).

List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.

Attention-Deficit and Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) is a Inability to pay attention, control impulses and behaviors as well as overactivity. Although most children will have some of these characteristics, ADHD is set apart by the intensity, pattern and persistence of these characteristics (CDC 2019).

Some symptoms of ADHD include extreme day dreaming,, forgetfulness, loosing or displacing things a lot, over talkativeness, making careless mistakes as well as extreme fidgeting and squirming ( CDC 2019). The causes of ADHD include alcohol and tobacco consumption by the mother while pregnant, low birth weight, brain injury, premature delivery and exposure to pollutants such as lead ( Parker,2005).

Diagnosis of ADHD is often difficult since the symptoms resemble characteristic behavior of some normal children and therefore, no one particular test has been discovered and tried out to successfully diagnose ADHD. Tests may include physical exams to rule out deficits such as hearing and vision, which could be responsible for some behaviors.

Attention-Deficit and Hyperactivity Disorder and

Oppositional Defiant Disorder (ODD) co morbidity

Oppositional Defiant Disorder (ODD), is a condition in which a child exhibits extreme anger, irritability, temper tantrums, refuses to follow orders and directions and is easily annoyed, for a period of at least 6 months (Ehmke, 2019). According to Wender, (2000), between 20-30% of children with ADHD also have learning disabilities, while 35% of those with ADHD have Oppositional Defiant Disorder(ODD).Children with ADHD are likely to have learning disabilities such as problems reading, spelling and math (Wender, 2000).

Developmental Delays

Children who have developmental or intellectual delays normally have learning, behavior, physical and language challenges in life. Developmental delay begins at infancy, but proper diagnosis is only possible after 5 years of age when IQ tests can be performed reliably . Children with developmental delays are always lagging behind in achieving age-related milestones. When a child lags behind in more than one area of development, they are said to have global developmental delays(Stojanovic,2020).

The cause of developmental delays is not clearly known, but premature birth, genetic factors, infection during pregnancy are thought to be some of the causes of developmental delay. Developmental delays may also be a sign of other underlying problems such as Down’s Syndrome, autism, cerebral palsy, fetal alcohol spectrum disorders and Angelman’s Syndrome among other neurological and genetic conditions(Chung et al, 2011).

List two pharmacologic agents and their dosing that would be appropriate for the patient’s ADHD 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.

Methylphenidate (D,L) is an FDA approved central nervous system stimulant which is commonly prescribed to both children and adults for the treatment of ADHD. According to CDC (2019), children on fast acting methylphenidate have between 70-80% decrease in ADHD symptoms. Methylphenidate inhibits dopamine reuptake while at the same time it increases norepinephrine and dopamine activity, thus enhancing concentration, attention and wakefulness ( Fairman, Peckham, & Sclar, 2020).

At this age, the patient can get the transdermal patch with a starting dose of 10mg every 9 hours, with an increase of 5mg weekly to a maximum dose of 30mg every 9 hours (Stahl,2014b). The pharmacokinetics of methylphenidate (D.L.) in children present a delay in minimum peak concentrations and second peak concentrations when compared to adults causing children to have higher concentrations of the drug, due to their smaller body size and the total volume of distribution(Rafael, 2008).

Guanfacine XR is a selective adrenoreceptor agonist that works on alpha 2A agonist sites on the prefrontal cortex of the brain It is an FDA approved non-stimulant medication for children and adolescents with ADHD and Oppositional Defiant Disorder symptoms ( Ngairita, 2007).

Guanfacine increases attention,, improves memory, planning and control, as well as reduces impulsivity. Dosage is calculated on mg/kg basis (0.05mg/kg to 0.12mg/kg) to be taken once daily. It may take days for full benefits of Guanfacine to be realized ( Stahl,2014b). Guanfacine should be swallowed whole with a small amount of water or milk and high fat foods should be avoided as they cause an increase in the blood levels of guanfacine (Guanfacine extended release (XR). (2013 ).

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.

This case shows several weeks of ADHD treatment with little success. Although the diagnosis of ADHD was properly diagnosed and was being treated as a solo case, the Physicians did not diagnose ODD as an accompanying diagnosis for this patient. The patient experiences increased attention while on Lisdexamfetamine and dextroamphitamine, but has no improvement on Symptoms related to ODD. To top it all, the patient has insomnia, which could be as a result of D-methylphenidate XR stimulant in the initial stages.

Multi drug therapy approaches should have been initiated to help decrease ODD symptoms (Vitiello et al., 2015). A combination therapy of guanfacine XR and lisdexamfetamine should have been utilized as they have been proven to be effective for these two conditions. (Diane Christopher, 2010).

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.
Discussion Assignment:

Respond to the following Case study:

Explain how you might apply knowledge gained from the Response case studies to your own practice in clinical settings.

· Share additional interview and communication techniques that could be effective with your colleague’s selected patient.

·

· Suggest additional health-related risks that might be considered.

·

· Validate an idea with your own experience and additional research.

·

· Explain your reasoning using at least TWO different references from current evidence-based literature in APA Format.

Case Study Response

Case 1: Volume 1, Case #13: The 8-year-old girl who was naughty

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

1.How are you performing in school?

Rationale: Children with ADHD portray academic underachievement due to inattentiveness and disruptive as well as disruptive behavior. Their general academic achievement is affected by these behaviors and the results are challenges in reading, spelling and math (Leahy, 2018).

2.How is your relationship with your family members, your teachers and your friends?

Rationale: This question is meant to elicit information regarding this patient’s social skills. Most ADHD children have problematic peer relations as well as emotional dysregulation . Therefore, it is possible that this patient will report always being in trouble with teachers, as well as not being like by her peers due to her poor social skills ( Sjowall, D., & Thorell, L. B. 2014)

3. Do you find it hard to read and follow instructions, and do you have a hard time understanding and finishing your assignments?

Rationale: Most children with ADHD have trouble following instructions, either because they do not understand the instructions or because they do not want to. Most children are therefore academically challenged ( Parker, 2005)

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.

The patient’s parents( Mother, father), the patient’s grandparents if they are close to the child, the child’s siblings, peers, and teachers who interact with the patient.

The questions would include

1.When did you start getting concerned about her symptoms?

Rationale: This question would be asked to parents or grandparents who help take care of the patient . Most children generally have inattentiveness and hyperactivity. Most of them cannot adequately follow orders or concentrate on a task for a long time. However, there is that time when a parent gets concerned about these symptoms and decide to seek for professional opinion or diagnosis.

2. Is there somebody in either her father’s or mother’s side of the family that has ADHD?

This question is to the parents and grandparents who know the patient’s background. This question is meant to find out if ADHD runs in the family and if it is genetic.

3. To the mother: Were you smoking or drinking when you were pregnant with the patient?

Rationale: Alcohol and tobacco use during pregnancy can cause a child to be born with ADHD.

4. Is the patient able to finish her homework on time?

Rationale: This question can be asked to both the parents and the teacher. This is to find out if the patient is able to complete her tasks.

5. Is the patient able to interact and play normally with friends?

Rationale: This is a question to her teachers and her friends. Most ADHD patients do not have social skills and so they prefer to stay on their own and do not play well with their peers (CDC 2019).

6. Is the patient disruptive in class?

Rationale: This question is to the teacher. Most ADHD patients have disruptive behavior, they talk too much, are overly active and have trouble controlling impulses.

7.What learning disabilities does the patient have?

Rationale: Most children with ADHD have problems with math, reading and spelling (Wender, 2000).

Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.

As of date, there is no single laboratory test that is used to diagnose ADHD. Psychiatrists rely on continuous performance tests( CPT) for the diagnosis This is an automated scoring test whose results analysis and interpretation are also automated ( Boutros, Fraenkel, & Feingold, 2005).

A neurologic exam such as EEG or MRI of the brain would also be necessary to ensure that the patient does not have any brain injury since one of the causes of ADHD is brain injury. A DSM5 diagnostic exam would be done to find out if the patient has all the symptoms of ADHD ( Leahy, 2018).

Head to toe physical exam would be the first thing to conduct on this patient. Since the patient comes in with fever and sore throat, it is important to first find out why she has fever and sore throat. Throat cultures will be collected to check for the organisms causing t sore throat. Also, blood cultures will need to be sent to find out if the patient has systemic infection. The other test to conduct would be the hearing and vision test. This is to make sure that these problems are not causing all these issues (CDC2019).

List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.

Attention-Deficit and Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) is a Inability to pay attention, control impulses and behaviors as well as overactivity. Although most children will have some of these characteristics, ADHD is set apart by the intensity, pattern and persistence of these characteristics (CDC 2019).

Some symptoms of ADHD include extreme day dreaming,, forgetfulness, loosing or displacing things a lot, over talkativeness, making careless mistakes as well as extreme fidgeting and squirming ( CDC 2019). The causes of ADHD include alcohol and tobacco consumption by the mother while pregnant, low birth weight, brain injury, premature delivery and exposure to pollutants such as lead ( Parker,2005).

Diagnosis of ADHD is often difficult since the symptoms resemble characteristic behavior of some normal children and therefore, no one particular test has been discovered and tried out to successfully diagnose ADHD. Tests may include physical exams to rule out deficits such as hearing and vision, which could be responsible for some behaviors.

Attention-Deficit and Hyperactivity Disorder and

Oppositional Defiant Disorder (ODD) co morbidity

Oppositional Defiant Disorder (ODD), is a condition in which a child exhibits extreme anger, irritability, temper tantrums, refuses to follow orders and directions and is easily annoyed, for a period of at least 6 months (Ehmke, 2019). According to Wender, (2000), between 20-30% of children with ADHD also have learning disabilities, while 35% of those with ADHD have Oppositional Defiant Disorder(ODD).Children with ADHD are likely to have learning disabilities such as problems reading, spelling and math (Wender, 2000).

Developmental Delays

Children who have developmental or intellectual delays normally have learning, behavior, physical and language challenges in life. Developmental delay begins at infancy, but proper diagnosis is only possible after 5 years of age when IQ tests can be performed reliably . Children with developmental delays are always lagging behind in achieving age-related milestones. When a child lags behind in more than one area of development, they are said to have global developmental delays(Stojanovic,2020).

The cause of developmental delays is not clearly known, but premature birth, genetic factors, infection during pregnancy are thought to be some of the causes of developmental delay. Developmental delays may also be a sign of other underlying problems such as Down’s Syndrome, autism, cerebral palsy, fetal alcohol spectrum disorders and Angelman’s Syndrome among other neurological and genetic conditions(Chung et al, 2011).

List two pharmacologic agents and their dosing that would be appropriate for the patient’s ADHD 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.

Methylphenidate (D,L) is an FDA approved central nervous system stimulant which is commonly prescribed to both children and adults for the treatment of ADHD. According to CDC (2019), children on fast acting methylphenidate have between 70-80% decrease in ADHD symptoms. Methylphenidate inhibits dopamine reuptake while at the same time it increases norepinephrine and dopamine activity, thus enhancing concentration, attention and wakefulness ( Fairman, Peckham, & Sclar, 2020).

At this age, the patient can get the transdermal patch with a starting dose of 10mg every 9 hours, with an increase of 5mg weekly to a maximum dose of 30mg every 9 hours (Stahl,2014b). The pharmacokinetics of methylphenidate (D.L.) in children present a delay in minimum peak concentrations and second peak concentrations when compared to adults causing children to have higher concentrations of the drug, due to their smaller body size and the total volume of distribution(Rafael, 2008).

Guanfacine XR is a selective adrenoreceptor agonist that works on alpha 2A agonist sites on the prefrontal cortex of the brain It is an FDA approved non-stimulant medication for children and adolescents with ADHD and Oppositional Defiant Disorder symptoms ( Ngairita, 2007).

Guanfacine increases attention,, improves memory, planning and control, as well as reduces impulsivity. Dosage is calculated on mg/kg basis (0.05mg/kg to 0.12mg/kg) to be taken once daily. It may take days for full benefits of Guanfacine to be realized ( Stahl,2014b). Guanfacine should be swallowed whole with a small amount of water or milk and high fat foods should be avoided as they cause an increase in the blood levels of guanfacine (Guanfacine extended release (XR). (2013 ).

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.

This case shows several weeks of ADHD treatment with little success. Although the diagnosis of ADHD was properly diagnosed and was being treated as a solo case, the Physicians did not diagnose ODD as an accompanying diagnosis for this patient. The patient experiences increased attention while on Lisdexamfetamine and dextroamphitamine, but has no improvement on Symptoms related to ODD. To top it all, the patient has insomnia, which could be as a result of D-methylphenidate XR stimulant in the initial stages.

Multi drug therapy approaches should have been initiated to help decrease ODD symptoms (Vitiello et al., 2015). A combination therapy of guanfacine XR and lisdexamfetamine should have been utilized as they have been proven to be effective for these two conditions. (Diane Christopher, 2010).

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.

From this case, I have learnt that an effective diagnosis leads to effective and timely treatment. In this case, there was delay in achievement of full therapeutic effects of treatment because the diagnosis was not completed on time. I have also learnt that at times, it is necessary to try a multi-drug therapy instead of using just one drug for the treatment of some conditions. In this case, the original belief was that Guanfacine XR alone would be sufficient in the treatment of the patient because unlike methylphenidate its efficacy in the treatment both ADHD and ODD is known. However, after reviewing the outcome, it was decided that this patient required Multidrug therapy in order to achieve full therapeutic benefits. From this case, it is clear that PMHNP should keep their knowledge on mental health up to date in order to be effective in diagnosing and treating mental health disorders.

It is also clear from this case that in order for diagnosis and therapy to be effective, there should be cooperation from family members, teachers and peers. Sometimes parents tend to cover up for their children and excuse their behavior, leading to delayed diagnosis and start of therapy.
From this case, I have learnt that an effective diagnosis leads to effective and timely treatment. In this case, there was delay in achievement of full therapeutic effects of treatment because the diagnosis was not completed on time. I have also learnt that at times, it is necessary to try a multi-drug therapy instead of using just one drug for the treatment of some conditions. In this case, the original belief was that Guanfacine XR alone would be sufficient in the treatment of the patient because unlike methylphenidate its efficacy in the treatment both ADHD and ODD is known. However, after reviewing the outcome, it was decided that this patient required Multidrug therapy in order to achieve full therapeutic benefits. From this case, it is clear that PMHNP should keep their knowledge on mental health up to date in order to be effective in diagnosing and treating mental health disorders.

It is also clear from this case that in order for diagnosis and therapy to be effective, there should be cooperation from family members, teachers and peers. Sometimes parents tend to cover up for their children and excuse their behavior, leading to delayed diagnosis and start of therapy.

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Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

76-year-old Iranian Male with Alzheimer’s Disease

BACKGROUND

Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CT-scan of the head) were normal.

According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.”

Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficult “finding the right words” in a conversation and then will shift to an entirely different line of conversation.

SUBJECTIVE

During the clinical interview, Mr. Akkad is pleasant, cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so the PMHNP performs a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia.

MENTAL STATUS EXAM

Mr. Akkad is 76 year old Iranian male who is cooperative with today’s clinical interview. His eye contact is poor. Speech is clear, coherent, but tangential at times. He makes no unusual motor movements and demonstrates no tic. Self-reported mood is euthymic. Affect however is restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. He is alert and oriented to person, partially oriented to place, but is disoriented to time and event [he reports that he thought he was coming to lunch but “wound up here”- referring to your office, at which point he begins to laugh]. Insight and judgment are impaired. Impulse control is also impaired as evidenced by Mr. Akkad’s standing up during the clinical interview and walking towards the door. When the PMHNP asked where he was going, he stated that he did not know. Mr. Akkad denies suicidal or homicidal ideation.

Diagnosis: Major neurocognitive disorder due to Alzheimer’s disease (presumptive)

Decision Point One #1

Select what the PMHNP should do:

Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks

RESULTS OF DECISION POINT ONE

Client returns to clinic in four weeks

The client is accompanied by his son who reports that his father is “no better” from this medication. He reports that his father is still disinterested in attending religious services/activities, and continues to exhibit disinhibited behaviors

You continue to note confabulation and decide to administer the MMSE again. Mr. Akkad again scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall

Decision Point Two #2

Select what the PMHNP should do:

Increase Exelon to 4.5 mg orally BID

RESULTS OF DECISION POINT TWO

Client returns to clinic in four weeks

Client’s son reports that the client is tolerating the medication well, but is still concerned that his father is no better

He states that his father is attending religious services with the family, which the son and the rest of the family is happy about. He reports that his father is still easily amused by things he once found serious

Decision Point Three #3

Select what the PMHNP should do next:

Increase Exelon to 6 mg orally BID

Guidance to Student

At this point, the client is reporting no side effects and is participating in an important part of family life (religious services). This could speak to the fact that the medication may have improved some symptoms. The PMHNP needs to counsel the client’s son on the trajectory of presumptive Alzheimer’s disease in that it is irreversible, and while cholinesterase inhibitors can stabilize symptoms, this process can take months. Also, these medications are incapable of reversing the degenerative process. Some improvements in problematic behaviors (such as disinhibition) may be seen, but not in all clients.

At this point, the PMHNP could maintain the current dose until the next visit in 4 weeks, or the PMHNP could increase it to 6 mg orally BID and see how the client is doing in 4 more weeks. Augmentation with Namenda is another possibility, but the PMHNP should maximize the dose of the cholinesterase inhibitor before adding augmenting agents. However, some experts argue that combination therapy should be used from the onset of treatment.

Finally, it is important to note that changes in the MMSE should be evaluated over the course of months, not weeks. The absence of change in the MMSE after 4 weeks of treatment should not be a source of concern.

The Assignment

Examine Case Study: An Elderly Iranian Man With Alzheimer’s Disease.

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:

·

o Decision #1

o

§ 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?

§

o Decision #2

o

§ 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?

o Decision #3

o

§ 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.

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