Case Study Module 4 MSN5550.pdf 

 School board trustees are requesting public comment before they vote on a vaccination policy for all children in a local school district. 

Previous class

PRAC 6665/6675 Clinical Skills 

Self-Assessment Form

Desired Clinical Skills for Students to Achieve	Confident (Can complete independently)	Mostly confident (Can complete with supervision)	Beginning (Have performed with supervision or needs supervision to feel confident)	New (Have never performed or does not apply)
Comprehensive psychiatric evaluation skills in:
Recognizing clinical signs and symptoms of psychiatric illness across the lifespan		X
Differentiating between pathophysiological and psychopathological conditions		X
Performing and interpreting a comprehensive and/or interval history and physical examination (including laboratory and diagnostic studies)		X
Performing and interpreting a mental status examination		X
Performing and interpreting a psychosocial assessment and family psychiatric history		X
Performing and interpreting a functional assessment (activities of daily living, occupational, social, leisure, educational).		X
Diagnostic reasoning skill in:
Developing and prioritizing a differential diagnoses list		X
Formulating diagnoses according to DSM 5-TR based on assessment data		X
Differentiating between normal/abnormal age-related physiological and psychological symptoms/changes		X
Pharmacotherapeutic skills in:
Selecting appropriate evidence based clinical practice guidelines for medication plan (e.g., risk/benefit, patient preference, developmental considerations, financial, the process of informed consent, symptom management)		X
Evaluating patient response and modify plan as necessary		X
Documenting (e.g., adverse reaction, the patient response, changes to the plan of care)		X
Psychotherapeutic Treatment Planning:
Recognizes concepts of therapeutic modalities across the lifespan		X
Selecting appropriate evidence based clinical practice guidelines for psychotherapeutic plan (e.g., risk/benefit, patient preference, developmental considerations, financial, the process of informed consent, symptom management, modality appropriate for situation)		X
Applies age-appropriate psychotherapeutic counseling techniques with individuals and/or any caregivers		X
Develop an age-appropriate individualized plan of care		X
Provide psychoeducation to individuals and/or any caregivers		X
Promote health and disease prevention techniques		X
Self-assessment skill:
Develop SMART goals for practicum experiences		X
Evaluating outcomes of practicum goals and modify plan as necessary		X
Documenting and reflecting on learning experiences		X
Professional skills:
Maintains professional boundaries and therapeutic relationship with clients and staff	X
Collaborate with multi-disciplinary teams to improve clinical practice in mental health settings	X
Identifies ethical and legal dilemmas with possible resolutions	X
Demonstrates non-judgmental practice approach and empathy	X
Practices within scope of practice	X
Selecting and implementing appropriate screening instrument(s), interpreting results, and making recommendations and referrals:
Demonstrates selecting the correct screening instrument appropriate for the clinical situation		X
Implements the screening instrument efficiently and effectively with the clients		X
Interprets results for screening instruments accurately		X
Develops an appropriate plan of care based upon screening instruments response		X
Identifies the need to refer to another specialty provider when applicable		X
Accurately documents recommendations for psychiatric consultations when applicable		X

Summary of strengths:

With my previous clinical rotations, the guidance of my preceptor and my classes, today I can say that my knowledge has advanced, and I can apply it as a professional to patients and their families. I feel very safe working with other professionals, working as a team and applying and identifying ethical and legal dilemmas. I have observed the progress in issues of psychiatric evaluation, in pharmacology, in psychotherapies that in these next clinical rotation and classes I must continue advancing to achieve my complete confidence.

Opportunities for growth:

Despite my confidence in my knowledge of psychiatric evaluations and pharmacotherapeutics, practice may help me diagnose patients and create treatment strategies. I may also require more competence in selecting evidence-based clinical practice guidelines when designing psychotherapy treatments. I can enhance my screening instrument implementation and data interpretation to make recommendations and referrals. This self-assessment gave me goals and objectives to help me learn these skills.

Now, write three to four (3–4) possible goals and objectives for this practicum experience. Ensure that they follow the SMART Strategy, as described in the Learning Resources.

1. Goal: Confidant in psychiatric evaluation a. Objective: To recognize more confidently in children and adolescents the signs and symptoms in psychiatric evaluations. b. Objective: To recognize more confidently in adults and older adults the signs and symptoms in psychiatric evaluations. c. Objective: To be most confident (independent) At the end of my clinical rotation with the recognition of signs and symptoms. 2. Goal: Improve the development and prioritization of the list of differential diagnoses. a. Objective: To review the diagnostic criteria of the DSM and the list of differential diagnoses during my clinical rotation. b. Objective: Create a differential diagnosis list and discuss with my preceptor. c. Objective: To be more confident in the formulation of the diagnosis based on DSM -TR and to discuss it with my preceptor. 3. Goal: To choose evidence-based clinical practice recommendations for a medication strategy. a. Objective: To systematically evaluate the pharmaceutical classes and the literature on side effects. b. Objective: Evaluate and choose evidence-based medication strategies for children and adolescents. c. Objective: Evaluate and choose evidence-based medication strategies for adults and older adults.

Signature: Nasihely Echemendia Lozano

Date:05/29/2023

Course/Section: PRAC-6665F

Discussion 4 (Vitamins)

Vitamins are energy building nutrients that contribute to sound nutritional health. Water, on the other hand, is responsible for carrying necessary nutrients and removing waste products throughout our body. A human body is made out of mostly water and is critical to our health. Similarly, minerals and electrolytes are essential to human health and can be obtained in our diet from different foods. When humans are too sick to consume a regular diet, digestion and absorption may impact the supply of necessary nutrients, requiring specialized nutritional support to meet their nutritional needs.

After studying 

Module 4: Lecture Materials & Resources
, read the case study and answer the prompts:

Sharyn Bartell is a 24-year-old student who suffered multiple fractures when she fell from a cliff when hiking. As a result of the accident, she is immobile, in traction, and had a small bowel resection. She is able to keep her head up to 45 degrees. Sharyn used to weigh 140 pounds but has lost 8 pounds since the accident. The healthcare team agrees that Sharyn will need a feeding tube before her nutritional status deteriorates any further.

1. Navigate the web, research a high protein formula that can be administered via feeding tube and share 1) name of formula, 2) nutrient composition, and 3) indications for use.

2. Navigate to the Oley Foundation: 

Dietary Recommendations for Patients with Intestinal Failure – Oley FoundationLinks to an external site.
, read “Physiological Considerations” and discuss in at least one paragraph with two (2) effects of the small bowel resection on Sharyn’s fluid and electrolyte balance.

3. Navigate to the Oley Foundation: 

Living with Enteral Feeds – Oley FoundationLinks to an external site.
 and provide two (2) physical or psychosocial adjustments Sharyn will have to make when living with a feeding tube.

Discussion 5 (Nutrients)

All people need the same nutrients, but the amounts will vary depending on their stage in life such as infants, children, adolescents, pregnancy, adults, and older adults. For example, a pregnant woman will need to make sure she has a proper diet before, during, and after the pregnancy. A poor diet before and during the pregnancy may affect the health and development of her infant. She will also need to make sure and maintain a nutritionally balanced diet after the pregnancy, especially if she plans to breastfeed her infant.

After studying 

Module 5: Lecture Materials & Resources
, answer the following:

1. Review figure 10-3 Comparison of Selected Nutrient Recommendations for Nonpregnant, Pregnant, and Lactating Women in text and compare the recommended percent allowances for:

A. Iron – Who (nonpregnant, pregnant, lactating) needs it more and why?

2. Ellen is an 18-year-old single mother of a six-month infant; she works at a convenience store and makes minimum wage. Ellen has limited financial means and needs assistance. Navigate to Floridahealth.gov: 

https://www.floridahealth.gov/programs-and-services/wic/wic-program-info.htmlLinks to an external site.
 and share at least two (3) examples of how food assistance programs can help Ellen’s infant and one (1) example of why nutrition is important for an infant – provide a full paragraph.

3. Miguel is a 75-year older adult and has been diagnosed with early macular degeneration. Explain what macular degeneration is and share 2 vitamins or minerals that help reduce progression of the disease.

 

Discussion 6 (Chronic Disease)

 According to the Centers of Disease Control and Prevention (CDC, 2023), six out of ten adults in the United States have at least one chronic disease, and about four in ten have two or more chronic diseases. Chronic diseases include cardiovascular conditions, cancers, diabetes mellitus, and Alzheimer’s. Diet is a lifestyle factor that affects the development of many chronic conditions and even some neurological diseases.

After studying 

Module 6: Lecture Materials & Resources
, read the case study and answer the following:

Lenora is a 57-year-old Jamaican American female who works as a desk clerk. Her job requires her to sit all day from 9 a.m. to 5 p.m., then she drives for one hour to go home. She lives alone in a studio apartment. By the time she gets home, she is tired and barely has time to pick up some fast food. She was recently diagnosed with hypertension and diabetes type 2. She is 5’ 5” tall and weighs 180 pounds with a BMI of 30.1. Her blood pressure was 150/105 and her HbA1C of 7.5%. The healthcare team starts Lenora on atenolol (Tenormin) for her hypertension and metformin (Glucophage) for her diabetes.

References: Centers of Disease Control and Prevention. (2023). 
About chronic diseases. https://www.cdc.gov/chronicdisease/about/index.htm#risks

In paragraph form:

1. Provide at least two (2) complications of uncontrolled hypertension and diabetes.

2. Provide at least two (2) risk factors that may contribute to Lenora’s development of hypertension (see Appendix J: Body Mass Index (BMI) of your textbook)

3. Describe what is HbA1C and how is it used to monitor diabetes? (see Chapter 20, page 564 of your textbook).

4. Discuss what dietary counseling will Lenora need to control her hypertension and diabetes? Provide at least two (2) examples.

 

Discussion 7 (Cancers & HIV)

While cancers and human immunodeficiency virus (HIV) are different diseases, they both have debilitating effects that influence nutritional needs – and if nutritional needs are not met, both advanced stages of cancer and HIV can lead to severe body wasting. Cancer and HIV require highly individualized nutrition therapy.

After studying 

Module 7: Lecture Materials & Resources
, answer the following:

Navigate to HIVinfo by the NIH.gov: 

https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-nutrition-and-food-safetyLinks to an external site.
 – read the webpage and scroll to Healthy Living with HIV.

1. Describe how foods may affect HIV treatment (provide at least 2 examples).

2. Explain how to prevent opportunistic infections through their diet in people living with HIV.

3. Describe the type of cancer frequently associated with HIV and explain how this cancer’s symptoms may cause anorexia on those with HIV (see page 663 in your textbook).