Theoretical and Scientific Foundations of Nursing
CRITICAL QUESTION
CRITICAL QUESTION
Psychiatric Diagnosis and DSM 5 Diagnostic Criteria |
History of Present Psychiatric Illness (Presenting signs & symptoms/ Previous Psychiatric Admission / Outpatient Mental Health Services) |
CON
CEPT MAP
Pathophysiology – (to the cellular level)
Medical Diagnosis
Clinical Manifestations (all data subjective and objective: labs, radiology, all diagnostic studies) (What symptoms does your client present with?)
Complications
Treatment (Medical, medications, intervention and supportive)
Risk Factors (chemical, environmental, psychological, physiological and genetic)
Nursing Diagnosis
Problem statement: (NANDA)
Related to: (What is happening in the body to cause the issue?)
Manifested by: (Specific symptoms)
General Appearance |
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Presenting Appearance (nutritional status, physical deformities, hearing impaired, glasses, injuries, cane) |
Gait and Motor Coordination (awkward, staggering, shuffling, rigid, trembling with intentional movement or at rest), |
Level of Participation in the Program/Activity (Group attendance and milieu participation, exercise) |
Manner and Approach |
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Interpersonal Characteristics and Approach to Evaluation (oppositional/resistant, submissive, defensive, open and friendly, candid and cooperative, showed subdued mistrust and hostility, excessive shyness) |
Behavioral Approach (distant, indifferent, unconcerned, evasive, negative, irritable, depressive, anxious, sullen, angry, assaultive, exhibitionistic, seductive, frightened, alert, agitated, lethargic, needed minor/considerable reinforcement and soothing). |
Speech (normal rate and volume, pressured, slow, loud, quiet, impoverished) Expressive Language (no problems expressing self, circumstantial and tangential responses, difficulties finding words, echolalia, mumbling) Receptive Language (normal, able to comprehend questions, |
Orientation, Alertness, and Thought Process |
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Recall and Memory (recalls recent and past events in their personal history). |
Alertness (sleepy, alert, dull and uninterested, highly distractible) |
Concentration and Attention (naming the days of the week or months of the year in reverse order, spelling the word “world”, their own last name, or the ABC's backwards) |
Thought Processes (loose associations, confabulations, flight of ideas, ideas of reference, illogical thinking, grandiosity, magical thinking, obsessions, perseveration, delusions, reports of experiences of depersonalization). |
Hallucinations and Delusions (presence, absence, denied visual but admitted olfactory and auditory, denied but showed signs of them during testing, denied except for times associated with the use of substances, denied while taking medications) |
Judgment and Insight (based on explanations of what they did, what happened, and if they expected the outcome, good, poor, fair, strong) |
Mood and Affect |
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Mood or how they feel most days (happy, sad, despondent, melancholic, euphoric, elevated, depressed, irritable, anxious, angry). |
Rapport (easy to establish, initially difficult but easier over time, difficult to establish, tenuous, easily upset) |
Response to Failure on Test Items (unaware, frustrated, anxious, obsessed, unaffected) |
Lab |
Range |
Value |
Reason Obtained |
Risk Assessment: Suicidal and Homicidal Ideation (ideation but no plan or intent, clear/unclear plan but no intent) Self-Injurious Behavior (cutting, burning) Hypersexual, Elopement, Non-adherence to treatment |
Discharge Plans and Instruction: Placement, outpatient treatment, partial hospitalization, sober living, board and care, shelter, long term care facility, 12 step program |
Teaching Assessment and Client / Family Education: (Disease process, medication, coping, relaxation, diet, exercise, hygiene) Include barriers to learning and preferred learning styles |
A nurse at the local Senior Center made the following notation about a client: A 74-year-old female client wearing eyeglasses with bifocal lenses and hearing aid in her left ear. Walks with a shuffling gait, using a cane for support. Wearing house slippers and housedress. States, “My other doctor says I should have my eyes looked at by an expert. It’s been a while, and my eyes seem to be acting up lately. I can’t see so good anymore.” The client states that she takes medication for “sugar” and her blood pressure and has worn glasses for years with the last prescription changed about 3 years ago. “I was a seamstress for many years and quit when I couldn’t see to thread the needles anymore-just in time too. These new materials are too hard to work with!” Denies using any eye drops. Describes vision changes as difficulty seeing well at night, especially if trying to read. Uses a magnifying glass to help when reading. No eye pain or discharge, although eyes sometimes feel “dry and scratchy,” with the left eye being worse than the right. Admits to rubbing eyes but without relief.
Develop a Plan of Care for this patient that includes:
Mr. Rivera is a 72-year-old patient with end stage COPD who is in the care of Hospice. He has a history of smoking, hypertension, obesity, and type 2 Diabetes. He is on Oxygen 2L per nasal cannula around the clock. His wife and 2 adult children help with his care. Develop a concept map for Mr. Rivera. Consider the patients Ethnic background (he and his family are from Mexico) and family dynamics. Please use the concept map form provided.
Topic: Organizational Planning/Planned Change
-How do you typically respond to change? Do you embrace it? Seek it out? Accept it reluctantly? Avoid it at all cost? Is this behavior like that of your friends and that of your family? Has your behavior always fit this pattern, or has the pattern changed throughout your life? If so, what life events have altered how you view and respond to change?
– A brief introductory paragraph introduces the topic of the discussion. One or more succinct paragraphs are needed to answer each of the discussion board questions. Use current literature (5 years old or less) to support your views. Be sparing in your use of quotes. Learn to paraphrase the information you are sharing from a source. A paragraph at the end gives a brief summary of the discussion. The initial posting for each topic should be a minimum of 500 words in length (not including the references).
The diagnosis of psychiatric emergencies can include a wide range of problems—from serious drug reactions to abuse and suicidal ideation/behaviors. Regardless of care setting, the PMHNP must know how to address emergencies, coordinate care with other members of the health care team and law enforcement officials (when indicated), and effectively communicate with family members who are often overwhelmed in emergency situations. In their role, PMHNPs can ensure a smooth transition from emergency mental health care to follow-up care, and also bridge the physical–mental health divide in healthcare.
In this week’s Assignment, you explore legal and ethical issues surrounding psychiatric emergencies, and identify evidence-based suicide and violence risk assessments.
TO PREPARE
· Review this week’s Learning Resources and consider the insights they provide about psychiatric emergencies and the ethical and legal issues surrounding these events.
THE ASSIGNMENT
In 2–3 pages, address the following:
· Explain your state laws for involuntary psychiatric holds for child and adult psychiatric emergencies. Include who can hold a patient and for how long, who can release the emergency hold, and who can pick up the patient after a hold is released.
· Explain the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.
· Explain the difference between capacity and competency in mental health contexts.
· Select one of the following topics, and explain one legal issue and one ethical issue related to this topic that may apply within the context of treating psychiatric emergencies: patient autonomy, EMTALA, confidentiality, HIPAA privacy rule, HIPAA security rule, protected information, legal gun ownership, career obstacles (security clearances/background checks), and payer source.
· Identify one evidence-based suicide risk assessment that you could use to screen patients.
· Identify one evidence-based violence risk assessment that you could use to screen patients.
Please see the attachment for the instructions
Thank You Letter Guidelines:
· Layout:
o Submit a word document
o Use Calibri (body) font, size 12, black
o Single spaced
o Set margins to: top 2”; bottom 1”; left 0.7”; right 0.7”
o Please limit your letter to one page!
o Typically 2-3 paragraphs, with around 300-500 words
· Information to include:
o Make sure to include your name and the name of the scholarship you are receiving.
§ You could say something like “My name is Kyrah Coone and I am a 2023 recipient of the Lettie Pate Whitehead Scholarship in the VCU School of Nursing. Thank you so much for making this scholarship possible!”
o Say thank you! Remember you are able to receive this scholarship because of the donor(s) you are writing to. This is your opportunity to show your appreciation.
o Make sure to include Dear Donor and Sincerely, your name
· Things you could write about:
o Your career aspirations (PMHNP)
o Why you chose VCU for your college education
o Why you choose nursing
o How are you enjoying VCU School of Nursing so far
o How this scholarship impacts your life and education
due @10am 11-12-23
To Prepare:
The Assignment (Evidence-Based Project)
Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
Create a 6- to 7-slide PowerPoint presentation in which you do the following:
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