Nursing

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Title: “The Benefits and Challenges of Breastfeeding: Exploring Breastfeeding Resources for Empowered Mothers and Healthy Infants” 

Guidelines: 

APA Format 

MUST utilize credible data sources such as CINAHL, MEDLINE, Embase, ClinicalKey, The Cochrane Library. Library resources can be accessed from the Library page at the FNU.edu website. FNU Librarians are available to assist each student with retrieving the required scholarly content.

Research paper must be 650-1000 words. 

3 or more scholarly sources must be utilized

Sources must be within the last 5 years 

Must have a minimum of 3 Sources 

All article sources must be cited by including them in reference sheet (separate).


Nursing module 3 assignment

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please follow all directions 

mental health

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Rasmussen University – Mental Health Care Plan

A. Patient identifiers:

Age: Gender: Ht: Wt. Code Status:

Isolation:

Development Stage (Erikson): Give the stage and rationale for your evaluation

Health Status

Date of admission:

Activity level: Diet:

Fall risk (indicate reason)

Client’s description of health status

Allergies: (include type of reaction)

Reason for admission:

Past medical history that relates to admission:

Socio-cultural Orientation

Cultural and Ethnic Background with current practices:

Socialization:

Family system: (Support system)

Spiritual:

Occupation: (across the lifespan)

Patterns of living: (define past and current)

Barriers to independent living:

Healthcare systems elements (continued) ALLERGIES:

Medications: List all medications, dosages, classifications and the rational for the medications prescribed for this patient include major considerations for administration and the possible negative outcomes associated with this medication.

DEFINE 1: What the medications Mechanism of Action AND 2: Why the patient is taking the medication?

Medication Classification Dosage Rationale Possible negative outcomes

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

Presenting Appearance (nutritional status, physical deformities, hearing impaired, glasses, injuries, cane)
Basic Grooming and Hygiene (clean, disheveled and whether it is appropriate attire for the weather)

Gait and Motor Coordination (awkward, staggering, shuffling, rigid, trembling with intentional movement or at rest),
posture (slouched, erect),
any noticeable mannerisms or gestures

Level of Participation in the Program/Activity (Group attendance and milieu participation, exercise)

Manner and Approach

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).
Coping and stress tolerance.

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

Recall and Memory (recalls recent and past events in their personal history).
Recalls three words (e.g., Cadillac, zebra, and purple)
Orientation (person, place, time, presidents, your name)

Alertness (sleepy, alert, dull and uninterested, highly distractible)
Coherence (responses were coherent and easy to understand, simplistic and concrete, lacking in necessary detail, overly detailed and difficult to follow)

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).
Values and belief system

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

Mood or how they feel most days (happy, sad, despondent, melancholic, euphoric, elevated, depressed, irritable, anxious, angry).
Affect or how they felt at a given moment (comments can include range of emotions such as broad, restricted, blunted, flat, inappropriate, labile, consistent with the content of the conversation.

Rapport (easy to establish, initially difficult but easier over time, difficult to establish, tenuous, easily upset)
Facial and Emotional Expressions (relaxed, tense, smiled, laughed, became insulting, yelled, happy, sad, alert, day-dreamy, angry, smiling, distrustful/suspicious, tearful, pessimistic, optimistic)

Response to Failure on Test Items (unaware, frustrated, anxious, obsessed, unaffected)
Impulsivity (poor, effected by substance use)
Anxiety (note level of anxiety, any behaviors that indicated anxiety, ways they handled it)

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

NRS DX:

Problem Statement:

R/T: (What is the cause of the symptom?)

Manifested by: (specific symptoms)

Short term goal: Create a SMART goal that relates to hospital stay.

Long term goal: Create a SMART goal that is appropriate for discharge.

This is specific to the patient that you are caring for. A list of planned actions that will assist the patient to achieve the desired goal. (i.e. obtain foods that the patient can eat/ likes)

Identify what the patients response or “outcome is to the goal or care that you have provided. i.e. patient ate 45% of lunch)

Was it met or not met there is no partially met.

References:

customers d2

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Discuss the needs of potential customers who could benefit from your nursing expertise. What are some of the known attributes of successful entrepreneurs?

Expectations

Initial Post:

  • Length: A minimum of 250 words, not including references
  • Citations: At least one high-level scholarly reference in APA from within the last 5 years

Discussion

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1) Review your state’s Nurse Practice Act and rules and regulations.

2) As a coworker, what are you required to do if you believe a nurse has a problem with chemical dependency? As the nurse manager, what are your obligations? Please cite the Nurse Practice Act. 

methology

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Week 2 Methodology

· Points 75

 This week, you will submit the methodology portion of your project. In this section, you will explain your proposed research design and the foundation for your data collection. While you will not collect data for your study, you will be expected to explain how you would implement your study. 

In your methodology section, include the following: 

Statement of purpose

· What was studied and why? 

· The population studies (if appropriate) and how they will be selected for the study

Description of the methodology

· Is your study qualitative or quantitative and why did you choose this method? 

· If you chose quantitative, is your study:

· Descriptive, correlational, quasi-experimental or experimental and why?

· If you chose qualitative, is your study:

· A case study, grounded theory, phenomenology, ethnography, or historical study and why? 

· What other methods were considered but discarded? 

Data collection

· How will you collect the data that correlates to your research method?

· What are the factors that influence this data collection choice? 

· Identify and explain the data collection instrument and if they are published instruments or created by the researcher. 

· Where will the data be collected and who will collect it? How will it be recorded? 

· How is the data collection connected to the research questions? 

· What is the plan for data analysis? 

Trustworthiness

Describe how you will ensure your study is trustworthy: 

· Qualitative: Explain strategies for credibility, dependability confirmability, and transferability. 

· Quantitative: Explain strategies for internal and external validity, reliability, and objectivity

Your methodology section should be 8–10 pages with cited references and support from your research. 

Review the rubric for grading criteria.

Points Possible: 75

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Nursing

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Can you help me with my homework.

Response

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  Due 09/13/23 1900 EST

Respond to this DB using APA and include at least 2 scholarly references

Competing Needs in Healthcare Policy Development: National Healthcare Issue of Healthcare Workers Shortage 

Different needs can have a big effect on how policies are made to deal with the shortage of health care workers. As a graduate student in nursing who also works in a psychiatric hospital, I know how difficult things can get.
Haddad, L. M., Annamaraju, P., and Toney-Butler, T. J. (2020) say that nurses are an important part of health care and make up the most important part of the health field. The World Health Statistics Report says that there are about 29 million nurses and midwives in the world, with 3.9 million of them working in the United States. 

From an academic and evidence-based point of view, competing needs include restricted budgets, different goals among stakeholders, different places where people can get health care depending on where they live, and changing patient demographics. These things can cause tension and problems when making laws.
There aren’t enough nurses for a few main reasons: bad planning and allocation of the workforce; lack of new staff due to lack of resources; bad recruitment, retention, and “return” policies; inefficient use of nursing resources due to the wrong mix and use of skills; bad incentive structures; and lack of career support. 

                                                       Effects of Competing Needs on Healthcare Workers Shortage 

For instance, if you know a lot about psychology, you could show how important it is to have mental health experts. But because of shortages, other parts of health care may also need help. To find a balance and meet these needs, workforce estimates must be based on facts and take into account how many people are retiring and how many people are being born. 

Getting to population health, universal health coverage (UHC), and fair access to health care depends on having a health staff with enough capacity, capability, and quality to meet epidemiological challenges and changing needs. WHO says that by 2030, there will be 40 million more jobs in health and social care because more people will need them around the world. In most countries, nurses are the most highly skilled workers, and they make up about half of the world’s health care workers. 

                                                              Solving The Issue Of Competing Needs through Policy 

In this situation, it would be important for healthcare managers, policymakers, educators, and professionals from other areas to work together to make policy. Research that shows what works can help businesses decide how to hire, train, and keep workers. By recognizing and addressing these different needs, plans can be made to deal with the lack of healthcare workers and take psychiatric nursing experience into account. 

When it comes to psychology, having different needs can have a big impact on how healthcare decisions are made. As a psychiatry nurse practitioner, for example, you might run into situations where the patient’s need for freedom conflicts with the need to give the right care and make sure the patient is safe. Finding a balance between individual rights and the bigger goals of treatment success and patient well-being requires healthcare professionals, policymakers, and patients to make decisions based on evidence and work together. When making plans to deal with these hard problems, it is important to think about study, clinical standards, and ethical principles. 

Most people who talk about nurse shortages say that lawmakers should pay attention to all parts (called “policy bundles”) and not make policies based on simple, linear thinking. There is proof of this in both high- and low-income countries, where programs that only focus on growing nurse training have not increased the number of nurses entering the workforce or filled gaps in priority areas where there have been shortages in the past. 

To deal with the lack of health care workers, we need a plan with many parts, including laws that help hire, keep, and train people. Some ways to improve access to healthcare are to pay healthcare workers more money, expand training programs, improve working conditions, and use telemedicine. Evidence-based policies can be made by looking at trends in the workforce, figuring out how different actions affect the situation, and involving stakeholders to make sure the policies are well applied. 

                                                                                                   References 

V.M. Drennan and Fiona Ross What’s going on, what it means, and what can be done to fix the problem The British Medical Bulletin, 130(1), pages 25–37 

Organization for World Health. Workforce 2030 is a global plan for using people to improve health. Retrieved September 11, 2023, from https://www.who.int/hrh/resources/pub_globstrathrh-2030/en/Links to an external site.. 

Shortage of Nurses | StatPearls | NCBI Bookshelf | NCBI Visit www.merlot.org/merlot/viewMaterial.htm?id=773408731 for more information. 

w9postresp1P

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Answer these 2 questions.

1. What other therapy approaches can be easily applied to this patient? (different therapy than the one she developed here)

2. How can we help the patient stick to the treatment plan?( based on what it says here, how I can help the patient.)

At least 2 references

Complex Case Study Presentation

CC (chief complaint): “I need medication. I don't feel good.”

HPI: C is a 15-year-old African American female who came for a psychiatric evaluation with her case manager. She states, ” I need medication. I don't feel good.” The client noted that the other day, she had a breakdown where she was crying and laughing. Also, she mentioned that she started thinking about bad things. Most of the time she feels sad, that is why she feels “better when I’m with my friends.” She also noted that she can be agitated very easily. Her concentration is poor, and she said “everything” stresses her out. The client denies any symptoms of suicidal ideations, but she said, “I don't want to kill anybody, but when I'm upset, I make threats to kill people.” She said she suddenly has difficulty meeting new people, has problems with crowds in the grocery store or big box stores, and feels judged when out in person. The client reports verbal, physical, and sexual abuse that started in childhood. She experiences painful flashbacks and nightmares in the past. She reports abuse and misuse of ADHD medications and no complaints with medications. Also, she mentioned to be on probation, and she would like to be out of prison.

Diagnostic Impression:

Major depressive disorder

Approximately 12.8% of people between 12-17 years have been diagnosed with Major depression in the United States. (Mullen, 2018) The client presents most of the diagnosis criteria for this disease. She is showing a depressed mood irritation that is typical for adolescents. She has a poor interest in activities, low energy, and poor appetite. Also, she mentioned that she has trouble falling asleep and staying asleep. These symptoms caused social impairment, evidenced by the frequent fights. It is essential to mention that her family is dysfunctional, and her mom and brother are diagnosed with major depression.

Generalized anxiety disorder F41.1

Generalized anxiety disorder is a common mental health disorder affecting more females. Anxiety leads to restlessness, feeling keyed up or on edge, fear, and difficulty concentrating. (APA,2022 ) The client presents excessive anxiety and difficulty controlling worry and concern that something will happen. She has problems being around crowds, feels anxious, and feels judged. Also, she is always irritable, losing her temper, involving her in multiple fights. This client's diagnosis criteria are restlessness, difficulty concentrating, irritability, sleep disturbance, and muscle tension.

Post-Traumatic Stress Disorder F43.10

This disorder results from exposure to one or more traumatic events. Usually, the symptoms start showing up within three months of the traumatic events. The symptoms interfere with the daily tasks. The client reports verbal, physical, and sexual abuse that started in childhood, and she experiences painful flashbacks and nightmares from the event. This situation met the first criterion for this diagnosis because she was exposed to a traumatic event. Also, she mentioned recurrent and intrusive thoughts about something terrible that would happen. She avoids speaking about the incident and has persistent negative feelings. The client said to be hypervigilance.

Reflection:

The client comes for the first-time evaluation, saying she needs medications because she doesn't feel good. This client is presenting almost all the symptoms of major depression. She lacks energy, and most of the time, she is irritated, evidenced by getting involved in many fights. Also, she stated being sad almost every day and having breakdowns. She was sexually, mentally, and physically abused, which is most likely why she presents all those symptoms. Women victims of child sexual assault are twice as likely to have more depression and anxiety than no female victims. Also, major depressive episodes among those with PTSD have a higher risk of suicide than those with PTSD. (Alix,2020) She mentioned the sexual abuse and said that she was thinking about crazy stuff. We suspect she was thinking about suicide, which is why the primary diagnosis is Major depression. Alix (2020) states that self-blame is an internal attribution, a cognitive process by which some individuals with traumas can attribute the event of an unfavorable event to themselves. She also said that she feels guilty about what happened to her.

The second diagnosis is Generalized anxiety disorder because the client finds it difficult to control her concern about something wrong will happen. She stated feeling restless, having problems concentrating, muscle tension, and sleep disturbance. Also, she is presenting poor concentration. This affects her daily tasks even though she mentioned that she couldn't be around people anymore. De Beru (2020) states that the only two disorders significantly associated with suicide ideation were MDD and GAD. For this reason, this will be my secondary diagnosis and the one I will pay more attention to.

The third differential diagnosis will be post-traumatic stress disorder. As mentioned above, this client came from a household where she suffered a lot of violence, including physical, sexual, and emotional damage. She has problems falling asleep due to the trauma and avoided discussing the incident by changing the topic. The US Department of Veteran Affairs (2018) states that survivors of child sexual abuse show symptoms of PTSD that include agitated behavior, and they may exhibit anxiety. Also, another behavior that they may exhibit is inappropriate sexual behavior or seductiveness. The school sent her to a psychiatry evaluation in the 6th grade because of her aggressiveness and promiscuity. That was one of the indicators that she was suffering from sexual abuse. Also, she mentioned recurrent and intrusive thoughts about something terrible that would happen.

I agree with the PMHNP treatment plan, where she will start working with the depression symptoms. Since the client reports feeling sad, having low energy, and thinking about “crazy stuff,” we will prioritize those symptoms and treat them to avoid future serious problems like Suicide Ideations.

Case Formulation and Treatment Plan

C is a 15-year-old African American female client being seen for a first-time psychiatric evaluation. She is alert and oriented in person, place, time, and situation. She is restless, acting out, and looks irritable but cooperative. She mentioned being referred to a psychiatry evaluation in 6th grade, and since then, she has been in and out of treatment. The client presents depression symptoms like sadness, low energy, decreased activities that cause joy, irritability, poor concentration, and sleep disturbance. Also, she mentioned the difficulty in controlling her concern about something terrible will happen. She verbalizes a history of sexual, physical, and emotional abuse. The client avoids talking about the abuse. However, she will follow recommendations and continue with a treatment plan.

Most adolescents with major depression symptoms reported severe impairment in home life, school/work, family relationships, and social life. Studies have revealed that neurologic changes happen in the brain structure of those who have suffered sexual abuse during their childhood, and, therefore, they become more predisposed to suffer depression, anxiety, substance use, and other mental and behavioral problems. (Gokten, 2021) It is essential to start working with the adolescent since symptoms are notable, like in this client's case. The PMHNP chose Lexapro 5 mg PO daily; this medication is one of the two approved by the FDA. Lexapro has been approved for use in adolescents aged 12 years and older. (FDA, Nd) Jiang (2017) mentioned in his research that Lexapro helps to decrease depression and anxiety levels and significantly improve the quality of life, helping with the enjoyment and satisfaction of patients taking this medication. Besides the depression, she suffers from anxiety, which is why this medication is the first line of treatment since it helps to improve the two primary diagnoses for her. Anvari (2020) also recommends using Lexapro as a first-line antidepressant treatment for children and adolescents, optimally in conjunction with cognitive behavior therapy. He stated the conjunction of this therapy should optimize school, peer, and family communication, given a patient's sense of connectedness.

The second medication that the PMHNP prescribed is Lamotrigine 25 mg PO daily. Lamotrigine is an anticonvulsant medication that can be used as adjunctive treatment as a mood stabilizer. Prabhavalkar (2015) found Lamotrigine to be outstandingly effective in preventing bipolar depression in patients experiencing episodes of major depression. Lamotrigine can be a mood stabilizer that calms mood swings by lifting the depression symptoms. Also, he found that in 64.5% of the adjunctive treatment using lamotrigine, the symptoms of depression improved during the initial treatment and maintained for about one year.

Psychotherapy will be crucial to the treatment plan; changing the behavior and developing coping skills can benefit her treatment goal. Cognitive behavioral therapy is showing efficacy in GAD and MDD symptom reduction. In his research, Oud (2019) found that 63% of the child/adolescent has less risk of having a depressive disorder at follow-up and a 36% more chance of recovery. Also, CBT can be used to treat clients with PTSD. For that reason, this will be the therapy of choice.

Also, as part of the plan, the PMHNP ordered blood work CBC, BMP, Vit D, lipid panel, and thyroid function test. EKG will be ordered as well.

The risks, benefits, side effects, and dosage schedules of medication were explained to the client. Otherwise, the benefits of continuing psychotherapy were explained for managing and controlling her emotions. We will recommend daily exercise, good hygiene, and a balanced diet. She was educated and encouraged about abstinence from drugs and alcohol. The potential risks, long-term consequences of Tardive Dyskinesia, and treatment alternatives were discussed with and understood by the client. The client has emergency numbers: Emergency Services 911, Suicide & Crisis Lifeline 988, and National Suicide Prevention Lifeline 1800-273-8255