NUR1172, NUTRITIONAL PRINCIPLES IN NURSING

what are the three components of the DRI? 

describe how RDA. AI, AND UL influence health

after reviewing your results on the interactive DRI, how well are you meeting the RDAs suggested 

what two changes can you make to improve

Blog

 blog on evidence-based practice in the healthcare organization where you practice. (psychiatry)Drawing on your understanding of EBP and your firsthand observations within your organization, include the following content in your blog: 

Theoretical and Scientific Foundations of Nursing

  

DISCUSSION RESPONSE

CLARIFYING CONNECTIONS: PRACTICE PROBLEM, EVIDENCE, CHANGING PRACTICE

case study week 9

Examine 
Case Study: A Young Caucasian Girl with ADHD. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

· Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

· Which decision did you select?

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

· Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

Case

BACKGROUND

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

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

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

SUBJECTIVE

Katie reports that she doesn’t know what the “big deal” is. She states that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds her other subjects boring, and sometimes hard because she feels “lost”. She admits that her mind does wander during class to things that she thinks of as more fun. “Sometimes” Katie reports “I will just be thinking about nothing and the teacher will call my name and I don’t know what they were talking about.”

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

MENTAL STATUS EXAM

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

Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation

RESOURCES

§ Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998). Revision and restandardization of the Conners' Teacher Rating Scale (CTRS-R): Factors, structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279-291.

Decision Point One

Begin Wellbutrin (bupropion) XL 150 mg orally daily

RESULTS OF DECISION POINT ONE

·  Client returns to clinic in four weeks

·  Katie’s parents inform you that they stopped giving Katie the medication because about 2 weeks into the prescription, Katie told her parents that she was thinking about hurting herself. This scared the parents, but they didn’t want to “bother you” by calling the office, so they felt that it would be best to just stop the medication as they would be seeing you in two weeks

Decision Point Two

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

RESULTS OF DECISION POINT TWO

Client returns to clinic in four weeks

Katie's parents again report that after about a week of treatment with the Bupropion, Katie began telling her parents that she wanted to hurt herself and began having dreams about being dead. This scared her parents, and they stopped giving her the medication At this point, they are quite upset with the results of their daughter’s treatment and are convinced that medication is not the answer

Decision Point Three

Refer the parents to a pediatric psychologist who can use behavioral therapy to treat Katie’s ADHD.

Guidance to Student

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

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

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

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

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FOCUSED SOAP NOTE AND PATIENT CASE PRESENTATION, 21

  

Respond at least 2 times each . The goal is for the discussion forum to function as robust clinical conferences on the patients. Provide a response to 1 of the 3 discussion prompts that your colleagues provided in their video presentations. You may also provide additional information, alternative points of view, research to support treatment, or patient education strategies you might use with the relevant patient.

PSYCHOTHERAPY FOR CLIENTS WITH ADDICTIVE DISORDERS

See attachement for instructions 

ANA code

The ANA Code of Ethics currently emphasizes the word “patient” instead of the word “client” in referring to nursing care recipients. Do you agree with this change? Why or why not? Review the ANA Code of Ethics for Nurses with Interpretive Statements found in Appendix B of your Butts text.

Discussion post 2 psycho

After studying Module 2: Lecture Materials & Resources, discuss the following:

  1. Define psychiatric interview and its importance to the psychiatric nurse practitioner’s role.
  2. Compare the phases and critical tasks involved in performing the initial interview.
  3. Explain the on going process of the psychiatric assessment.

Submission Instructions:

  • Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.  Your initial post is worth 8 points.
  • You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 
  • All replies must be constructive and use literature where possible.
  • Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
  • Late work policies, expectations regarding proper citations, acceptable means of responding to peer feedback, and other expectations are at the discretion of the instructor.
  • You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.

W2.2 R see attachment

Make a follow-up of a student's weekly discussion and respond with your opinion regarding to her post

——You don't have to post this in APA format necessarily, it's just giving feedback to the student .



Alayna Polter

Hello Professor and class, 

Ethical guidelines ensure patients are safe from harm. Having someone prescribe a medication who is not properly educated on the possible side effects, directions, doses, drug interactions and many other implications is considered unethical. A huge component of prescribing ethically includes examining the patients’ needs for the current situation in which they are seeking medical help for which was not done in this case study (Duquesne University, 2020). There is also a legal implication due to providers having the responsibility to make informed medical decisions before prescribing medications due to potential side effects, drug interactions etc. If the doctor prescribes the wrong medication, inappropriate dosages, or misinforms about the possible side effects they could be held liable (Harris, 2020). This will clearly affect everyone including the practice. Practicing without a license will presume this care was negligent. If this individual was injured this could justify punitive damages. If this was ruled in favor of, compensation for the harm would be involved as well as additional penalties for “deceiving the victim” (Suszek, 2023). This would cost the practice in fines as well as diminish their reputation. A medical director is in charge of running the facility, implementing regulations, budgets and many other things. This problem will quickly become their problem when trying to sort out this situation. As for the medical assistant, I am going to discuss the punishment where I live because it can vary depending on state. In Florida this medical assistant is practicing without a license and as a first-time offense this would usually be a first-degree misdemeanor. The penalties for this can include up to one year in jail and up to $1,000 in fines (The Law Place, n.d.).

I clearly do not think this medical assistant was trying to be malicious by her actions. However, she is probably not aware of the implications behind these actions and needs to be educated about what can happen if she does not follow her scope of practice. Therefore, to ensure this does not happen again, everyone needs to be educated about their roles. This is not just directed to medical assistants, but others could be informed how to best utilize them in their practice. It was stated in the case study that this was a busy primary care practice, and management should work to improve the stressful conditions for these workers. They have a lot of different roles and should have the efficient help to get their tasks done but understand exactly what they can and cannot do (Family Medicine, 2022). I also believe something in the computer system would have to be changed. It should not be that easy for someone without the proper education to put in a prescription. I think everyone needs a pin number or password to put in medications for patients.

A leadership quality I would apply is setting ethical standards. Healthcare lacking ethics can have extremely harmful effects on patients lives. Leaders that have built a reputation around integrity can set ethical standards for their team members and influence them to do the same. Another positive change would be having accountability. We all will make mistakes and being accountable for your actions will be favorable for your team. Lastly, applying mentorship is very important, in this circumstance there were many nurse practitioners, and providers that would all be very good leaders. Mentors are able to assess and support others to acquire the necessary skills to exceed in their role (DeVry University, 2022).

 

References

Aprn’s role in Ethical Prescribing: Duquesne University. Duquesne University School of Nursing. (2020, May 20). 

https://onlinenursing.duq.edu/blog/aprns-role-responsibility-ethical-prescribing/Links to an external site.

13 key traits for leadership in Healthcare. devry.edu. (2022, February 23). https://www.devry.edu/blog/key-traits-for-leadership-in-healthcare.html#:~:text=Leading%20with%20a%20positive%20attitude,difficulties%20more%20effectively%20and%20productively.

Family Medicine researchers identify most effective practices of medical assistants in the primary care setting, as well as barriers: Family medicine: Michigan medicine. Family Medicine. (2022, June 16). https://medicine.umich.edu/dept/family-medicine/news/archive/202206/family-medicine-researchers-identify-most-effective-practices-medical-assistants-primary-care

Harris, J. R. (2020, April 8). 
Who is liable for errors involving drug prescriptions?. Harris Lowry Manton LLP. 

https://www.hlmlawfirm.com/blog/who-is-liable-for-errors-involving-drug-prescriptions/Links to an external site.

Suszek, A. (2023, August 8). 
Practicing medicine without a license: Criminal & Civil Liability. www.alllaw.com. https://www.alllaw.com/articles/nolo/medical-malpractice/practicing-without-license-criminal-civil-liability.html#:~:text=Laws%20vary%20by%20state%2C%20but,in%20addition%20to%20prison%20sentences.

What are the penalties for practicing without a license in Florida?. What are the penalties for practicing without a license in Florida? – The Law Place. (n.d.). https://www.thelawplace.com/faqs/what-are-the-penalties-for-practicing-without-a-license-in-florida/#:~:text=Fines%20and%20Imprisonment,5%20years%20in%20state%20prison.

 

Nursing Nursing Dropbox assignment APA format

HUM 1050 – Introduction to Literature

Assignment #2: Two Mediums – Evaluative Essay – Initial Submission

For this assignment, students will write an evaluative essay comparing two media. You'll use the short story “The bear came over the mountain” (Munro, 2013) and the film 
Away from Her (Egoyan et al., 2006). You will begin working on this assignment with reading, viewing, drafting.

For this essay, the short story is the source material. You are going to evaluate how well the film stands up to the short story. First, you must establish the criteria. What makes the short story successful?  You want to think about this very carefully as you read and make notes. Notice elements of plot, structure, character, and point of view. You'll write about these in the first section of your paper. 

This essay should:

· have specific criteria, using the short story as source material

· use that criterion to make judgments about the film

· support the judgment with evidence from the text and film

· be 1000 words long

· have an explicit thesis statement, with the main idea (the topic of the paper) and a controlling idea (what you, as the author, is saying about the topic)

· In this case, we're making a judgment, and that should be included in the thesis.  Remember — this judgment is not about the film or text is good or bad. It's about whether or not the film lives up to the criteria established in the short story. 

· include an integrated, direct quote from the text/film to support the thesis in each of the body paragraphs

· be written using APA formatting

· use APA guidelines for citation, both in-text and on a References page

· avoid using 1st- or 2nd-person references (focus on objective 3rd-person references instead)

· be submitted as a MS Word .docx file

 

References and Citations:

Citation: (Munro, 2013).

Add paragraph numbers with direct quotes (Munro, 2013, para. 4).

All citations should be: (Egoyan et al., 2006).

Add timestamp number with direct quotes.

Reference

Egoyan, A. Hirst, V., Iron, D. Mankoff, D. Urdl, S. Weiss, J. (Producers), & Polley, S. (Director). (2006). 
Away from her. [Motion

picture]. Canada: Foundry Film.

Munro, A. (2013, Oct 21).
 The bear came over the mountain
. The New Yorker.

https://www.newyorker.com/magazine/2013/10/21/the-bear-came-over-the-mountain-2

Criteria

Ratings

This criterion is linked to a Learning OutcomeThesis statement (20) Main idea; controlling idea; compelling CSLO 4

20 pts

Highly Proficient

Precise, succinct thesis statement with obvious main idea and controlling idea; original and compelling.

Body paragraphs (20) Unified; coherent; related to thesis; topic sentences; supporting sentences CSLO 6

20 pts

Highly Proficient

All body paragraphs are unified and coherent; each body paragraph contains one distinct point; each body paragraph has a topic sentence that is directly related to the thesis; supporting sentences all relate to the topic sentence.

Grammar, Spelling, and Mechanics (10) CSLO 6

10 pts

Highly Proficient

Minimal grammar, spelling, or mechanical errors (at most 2).

Length and Originality (10) CSLO 5

10 pts

Highly Proficient

Paper meets required word count. AND/OR Less than 10% direct quotes.

Style (20) Introductory and concluding paragraphs; sentence structure; transitional phrases; word choice; tone CSLO 6

20 pts

Highly Proficient

Introductory and concluding paragraphs are compelling and creative; sentence structure is widely varied (simple sentences, compound sentences, complex sentences), exceptional use of transitional phrases, academic/elevated/creative word choice; appropriate tone; no slang or informal language.

Formatting (20) APA formatting guidelines CSLO 6

20 pts

Highly Proficient

No errors in formatting.