LEARNING CONTRACT

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Please see attached document.

587 leadership 5w

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Points: 25  | Due Date: Week 5, Day 3 & 7 | CLO: 1 | Grade Category: Discussions

Discussion Prompt

Describe a healthcare scenario in which punitive action was implemented by a nursing leader toward a staff nurse and the impact of the action on the nurse and his or her colleagues (use fictitious names and places). Describe how you, as a nurse leader, would have managed the scenario differently and the type of outcomes you would predict for the nurse and his or her colleagues as a result of your intervention.

Expectations

Initial Post:

  • Length: 150 – 250 Words

Article statistical findings significant it has on nursing

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Identify an article that is at least five years old. Summarize the statistical findings and discuss the significant it has on nursing.

400 words and one scholarly article.

APA 7 format

Unit 9 ADHD Medications. 800w. 4 references. Due 10-26-23

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Unit 9 ADHD Medications. 800w. 4 references. Due 10-26-23

Thomas Deliver, a 36-year-old male patient, enters your office for his initial appointment.  According to the intake paperwork, Mr. Deliver is a computer programmer who is complaining of problems with concentration, completing tasks, and being terrible at listening during company meetings and even at home.  He explains that he has difficulty starting and completing work projects and trouble being on time or keeping appointments and commitments.  He has divorced 3 months ago and has joint custody of two daughters ages 6 and 10 years old.  On most days, he sleeps late and he has trouble keeping a regular schedule and getting his children to their lessons and extracurricular appointments on time. 

Mr. Deliver believes the lack of concentration and poor communication with his wife led to the divorce, and Mr. Deliver worries that his trouble with organization and attention may affect his custody agreement and prevent him from keeping his job. 

Mr. Deliver’s employer and his family and friends have suggested to him that he should get evaluated for ADHD, but he has resisted because of concerns about the stigma of a psychiatric diagnosis and the risks of taking a psychotropic medication.

Mr. Deliver is 5'11″ and his weight is 165 lb.  He takes a men’s multivitamin daily, HCTZ at 25 mg for hypertension, fish oil 1,000 mg at bedtime for hyperlipidemia, and a rescue inhaler that he keeps with him although he hasn’t had to use it for many years.

1. What screening tools can be used to affirm your initial diagnosis that Mr. Deliver meets the criteria for ADHD?

2. Further assessment determines that Mr. Deliver does meet the criteria for ADHD, inattentive type. What is the current recommendation for pharmacological treatment for Mr. Deliver?

Assume that instead of Mr. Deliver being 36-years-old, Thomas is a 13-year-old male that also meets the diagnostic criteria for ADHD, hyperactive type (Thomas is not on any medications at this age).  How will your pharmacological treatment change?

Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.

Please be sure to validate your opinions and ideas with in-text citations and corresponding references in APA format.

Please review the rubric to ensure that your response meets the criteria.

1. What screening tools can be used to affirm your initial diagnosis that Mr. Deliver

meets the criteria for ADHD?

 The first tool I would use to affirm that this patient meets the criteria for ADHD would be

the DSM-5. The DSM-5 lists the diagnostic criteria for ADHD as needing six or more of

the symptoms in either category 1 (inattention) or category 2 (hyperactivity and

impulsivity) that last for at least 6 months and to a degree that negatively impacts social,

academic or occupations activities. These symptoms also need to be present in two or

more settings, be present prior to age of 12 years and do not occur exclusively during

the course of schizophrenia or another psychotic disorder and are not better explained

by another mental disorder (American Psychiatric Association, 2013). There are also

many screening tools to use in addition to the DSM-5. Rating scales are used in

conjunction with the DSM-5 to help with diagnosis of ADHD. Rating scales specifically

designed for use in adults include: Brown Attention-Deficit Disorder Symptom

Assessment Scale for Adults (BADDS); Adult ADHD Clinical Diagnostic Scale (ACDS);

ADHD Rating Scale-IV With Adult Prompts (ADHD-RS-IV); and the Adult ADHD SelfReport Scale (ASRS) (Gualtieri & Johnson, 2005).

This study source was downloaded by 100000769192234 from CourseHero.com on 10-21-2023 15:58:26 GMT -05:00

https://www.coursehero.com/file/123197904/discussion-9docx/

2. Further assessment determines that Mr. Deliver does meet the criteria for ADHD,

inattentive type. What is the current recommendation for pharmacological

treatment for Mr. Deliver?

I would recommend either an amphetamine or methylphenidate. I am slightly

concerned about this patient’s history of hypertension and hyperlipidemia, as both

of these psychostimulant classes have been shown to raise blood pressure. Long

term studies have shown that stimulant use is not associated with increased risk of

heart attacks, cardiac death or stroke. Those with well-controlled hypertension have

been shown to manage ADHD symptoms effectively with amphetamines and

methylphenidates. This still does not negate the fact however, that the product

labels of stimulants state that “caution is indicated” when treating patients with preexisting hypertension (Fairman et al., 2018). I would also be sure to encourage this

patient to partake in behavioral therapy as well as using prescription medication.

3. Assume that instead of Mr. Deliver being 36-years-old, Thomas is a 13-year-old male

that also meets the diagnostic criteria for ADHD, hyperactive type (Thomas is not on

any medications at this age). How will your pharmacological treatment change?

For an adolescent patient the treatment plan is not a lot different than for adults

with ADHD. Stimulants are more effective than non-stimulants, but there can be a

risk for growth restriction. There are other non-stimulant medications that could be

tried first (atomoxetine, guanfacine, clonidine, bupropion, and modafinil). As with

adults with ADHD, I would also recommend concurrent behavioral therapy (Heldt,

2017).

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(5th ed.). Arlington, VA: American Psychiatric Publishing

Fairman, K. A., Davis, L. E., Peckham, A. M., & Sclar, D. A. (2018). Diagnoses of

Cardiovascular Disease or Substance Addiction/Abuse in US Adults Treated for ADHD

with Stimulants or Atomoxetine: Is Use Consistent with Product Labeling? Drugs – Real

World Outcomes, 5(1), 69–79. https://doi.org/10.1007/s40801-017-0129-2

This study source was downloaded by 100000769192234 from CourseHero.com on 10-21-2023 15:58:26 GMT -05:00

https://www.coursehero.com/file/123197904/discussion-9docx/

Gualtieri, C. T., & Johnson, L. G. (2005). ADHD: Is Objective Diagnosis Possible? Psychiatry

(Edgmont (Pa. : Township)), 2(11), 44–53.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993524/

Heldt, J. P. (2017). Memorable psychopharmacology. Createspace Independent Publishing

Platform

1.What screening tools can be used to affirm your initial diagnosis that Mr. Deliver meets the criteria for ADHD?

The DSM-5 would be the first resource I would consult to confirm if this patient satisfies the requirements for ADHD. According to the DSM-5, six or more symptoms from either group—category 1 (inattention) or category 2 (hyperactivity and impulsivity)—must be present for at least six months and have a detrimental influence on a person's ability to engage in social, academic, or occupational activities. Additionally, these symptoms must appear in two or more contexts, appear before the age of twelve, not only occasionally during the course of schizophrenia or another psychotic condition, and not be better explained by another mental illness (American Psychiatric Association, 2013).The DSM-5 is just one of several screening instruments available. The DSM-5 and rating scales are combined to assist in the diagnosis of ADHD. The Brown Attention-Deficit Disorder Symptom Assessment Scale for Adults (BADDS), the Adult ADHD Clinical Diagnostic Scale (ACDS), the ADHD Rating Scale-IV With Adult Prompts (ADHD-RS-IV), and the Adult ADHD SelfReport Scale (ASRS) are among the rating scales created expressly for use in adults (Gualtieri & Johnson, 2005).

 

 

2.Further assessment determines that Mr. Deliver does meet the criteria for ADHD, inattentive type. What is the current recommendation for pharmacological treatment for Mr. Deliver?

 

Either an amphetamine or methylphenidate is what I would advise. The patient's history of hypertension and hyperlipidemia causes me a little anxiety because it has been demonstrated that both of these kinds of psychostimulants can increase blood pressure. Studies conducted over an extended period of time have revealed no link between stimulant usage and an increased risk of heart attacks, cardiac death, or stroke. Amphetamines and methylphenidate have been demonstrated to help people with well-controlled hypertension manage their ADHD symptoms. However, this does not change the fact that while treating patients with preexisting hypertension, caution is advised on the product labels of stimulants (Fairman et al., 2018). In addition to prescription medication, I would make sure to encourage this patient to engage in behavioral treatment.

 

3.Assume that instead of Mr. Deliver being 36-years-old, Thomas is a 13-year-old male that also meets the diagnostic criteria for ADHD, hyperactive type (Thomas is not on any medications at this age). How will your pharmacological treatment change?

The treatment strategy is mostly the same for adolescents and adults with ADHD. Although stimulants are more effective than non-stimulants, there is a chance that they may limit growth. There are more non-stimulant drugs that might be tried initially (atomoxetine, guanfacine, clonidine, bupropion, and modafinil). In the same way that I would advise concurrent behavioral therapy for people with ADHD (Heldt, 2017)

Step-by-step explanation

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing

 

 Fairman, K. A., Davis, L. E., Peckham, A. M., & Sclar, D. A. (2018). Diagnoses of Cardiovascular Disease or Substance Addiction/Abuse in US Adults Treated for ADHD with Stimulants or Atomoxetine: Is Use Consistent with Product Labeling? Drugs – Real World Outcomes, 5(1), 69-79. https://doi.org/10.1007/s40801-017-0129-2

 

Gualtieri, C. T., & Johnson, L. G. (2005). ADHD: Is Objective Diagnosis Possible? Psychiatry (Edgmont (Pa. : Township)), 2(11), 44-53. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993524/ 

 

Heldt, J. P. (2017). Memorable psychopharmacology. Createspace Independent Publishing Platform. 

Week 8 discussion

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pl read the instruction, need it for today

Comparing Humanistic Existential Psychotherapy with Other Approaches

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See attached . Please ensure the there is an introduction and conclusion.  Three pages without the cover page and reference page with a minimum of five journal articles.  Assignment should be written in APA 7 format to include subtitles. 

Describe two cognitive techniques and two behavioral techniques. In what types of situations would you choose each?

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Describe two cognitive techniques and two behavioral techniques. In what types of situations would you choose each? 

The student must answer the graded discussion with a substantive reply to the graded discussion question(s)/topic(s) posted by the course instructor by Thursday, 11:59 p.m. Eastern Time. Two scholarly sources references are required unless stated otherwise by your professor. 

The student provides a substantive response to the discussion question or topic on Thursday day and posts a minimum of two additional responses to peers on another day(s). The answers to classmates must be posted by Sunday, 11:59 pm Eastern Time. We expect each student to participate in the discussion board in a respectful manner. 

Remember that a new discussion rubric was approved by the professors, committee members, and a majority of the students. Please review the rubric before posting to ensure a maximum of points. 

Here are the categories of the new discussion rubric:

Initial Post relevance to the topic of discussion, applicability, and insight. (20%)

Quality of Written Communication Appropriateness of audience and words choice is specific, purposeful, dynamic, and varied. Grammar, spelling, punctuation. (20%)

Inclusion of APNA standards essentials explored in the discussion as well as the role-specific competencies as applicable.(10%)

Rigor, currency,  and relevance of the scholarly references. (Use articles that are below 5 years). (20%)

Peer & Professor Responses. The number of responses, quality of response posts. (20%)

Timeliness of the initial post and the answers to the peers. (10%

English 101

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Assignment Guide: The Persuasive Letter

Assignment Prompt

For this assignment, you will be writing a letter compelling a friend or family member to change either a behavior or a belief with which you disagree. Choose your own topic, but for example, this letter could petition an enthusiastic neighbor to scale down his blinding Christmas decorations, an immature cousin to take a gap year between high school and college, a grandparent to vote to pass the new school district budget, a friend to stop drinking, or a spouse to reconcile with an estranged sibling. Because the letter will be written to an individual of your choosing, you must tailor your 
language and 
logic to the person to whom you are writing. 

Assignment-Specific Requirements:

Length: This assignment should be at least 750 words. 


Thesis

: Underline your 
thesis statement or the main 
claim of your letter.

Sources Needed: None required. 
Cite if used, following 
MLA guidelines. 

Page Formatting: Use 
MLA guidelines.  Also add an opening salutation (e.g. Dear Sarah, or Hello, Jon.), and a closing salutation & signature (Best regards, Tom or Sincerely, Liza)


MLA

 Requirements: See 
Formatting your Essay: MLA 8th Edition

Rhetorical Mode

The goal of 
persuasive writing is to get a 
reader (your 
audience) to agree with your 
point of view. 
Persuasive writing blends facts and emotion to convince the 
reader that the writer is right. This 
genre relies on opinion and emotion to a greater extent than argumentative writing, but in moving a 
reader, the successful persuasive letter also deploys logically sound 
argumentation and quite often researched support and fact. 

Rhetorical Considerations

Purpose:

The purpose of 
drafting a persuasive letter is to move your 
reader to agree with your 
point of view. 
Persuasion is single-minded; it is based on a conviction that a particular way of thinking or acting is the only way to go; all of the energy of the letter works toward this end. As a writer, you will present one side–your side. While an 
opposing point should be mentioned, it is only mentioned to be refuted or dismissed in the service of your position.  

Audience:

Persuasive writing is almost always written with a particular 
audience in mind.  For this piece of writing, you will direct your persuasive letter to one person. Thus, your 
audience is not imagined, but rather very real, and that person and their characteristics will inform many of the choices you make as a writer. The persuasive letter requires constant negotiation with another person’s mind. At every phase of the writing process, as you prewrite, draft, and 
revise, this assignment will ask you to imagine and anticipate how your 
reader feels, responds, and thinks.   

Form:

This piece of writing will be presented using a letter format.  Thus, while you still need an 
MLA–
style heading to format your work for submission, you will address your letter directly to your 
reader with a formal letter salutation. 

Five Features of a Persuasive Letter

1.
Rhetorical Situation: 
Persuasive Writing vs. Argumentative Writing: 
Persuasive writing, in a way, is a form of argumentative writing; however, the goal of 
persuasive writing is to get a 
reader or group of readers to agree with you/your 
point of view on a particular topic, and the goal of argumentative writing is to get the 
reader to acknowledge that your side is valid and is worth considering. 
Persuasive writing blends facts with emotion in an attempt to convince the 
reader that the writer is “right,” while in argumentative writing, the writer cites relevant reasons, credible facts, and sufficient 
evidence in order to convince the 
reader to consider a particular perspective. The nuances are subtle but important to consider. (Later in this course you will be crafting an argument and will see the differences in these genres of writing with greater clarity. The letter makes balanced use of the three rhetorical appeals to persuade a 
reader to change a behavior or belief.  The three appeals, which come to us from that consequential deceased Greek, Aristotle, are: 

1.

1.

Ethos

: a writer’s or speaker’s credibility. In your letter, therefore, 
ethos is you, sort of. It’s the “you” that your writing transmits to your 
reader, the sum total of your 
tone and 
language choices, and also the values and intelligence that your writing communicates. Therefore, be vigilant with your work because 
ethos is the appeal that’s most immediately harmed by faulty word choices, punctuation mistakes, and lapses in 
tone. 

2.

Pathos

: the appeal to a 
reader’s emotions and values. Get your 
reader to feel. Play (in a non-evil way) on their emotions–their compassion, their fears, their sense of community.   

2.

Logos

: the appeal to a 
reader’s 
logic or reason.  Ensure your 
claims are logical, free of fallacies, and backed with specific support.  

3.

Organization

: Organize using argumentative structure: an 
introduction with a 
thesis/main 
claim, body paragraphs that advance points in support of the 
thesis/main 
claim, and a 
conclusion. 

2.

Transition

s: Uses 
transitional phrases to connect your ideas and move the 
reader forward smoothly and logically between sentences. 

3.
Known 

Audience

: The letter’s appeals are personalized to the 
reader’s characteristics–their professional role and its obligations, as well as their values and emotions. 

4.
Formal or Informal Writing? The 
tone of the letter depends upon the recipient and your relationship and also upon 
subject matter. The 
tone should enhance the letter’s persuasive efforts, not undermine them. Always strive for a respectful approach.

Mini-Lesson on 

ETHOS

 – 

PATHOS

 – 

LOGOS

Plan to use these appeals heavily throughout your Persuasive Letter.


Ethos

This is an 
ethical appeal. It relies on your reliability and credibility as the author. 

· Includes 
reliable sources

· Is written from an unbiased perspective

· Shows the writer’s expertise through the presentation of careful insight and research


Pathos

This is an 
emotional appeal. It relies on the construction of careful connection between the 
claims presented and the emotions of the readers. 

· Includes the writer’s values and beliefs

· Uses stories or examples that convey emotion

· Contains broader appeal and 
focus  


Logos

This is an appeal to 
logic and reason. It relies on facts and figures that can convince the 
reader of the 
claims. 

· Relies on fact and opinion

· Focuses on reasonable 
claims and 
organization of ideas

· Only includes relevant material with a 
narrow 
focus

At some point in every construction project, efforts turn from design and the focus moves to actual construction.

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 At some point in every construction project, efforts turn from design and the focus moves to actual construction. With the vision in place and the tools secured, the blueprint can be finalized and approved. Then it is time to put on hardhats and begin work.