Discussion

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Initial Post Instructions

The Discussions in this course are set up deepen your understanding of the material as you make real world connections and employ creative thinking. To get the most from these discussions, full engagement is expected on the part of the student. Be sure to stop by the discussion section frequently, not only to post, but to read the postings of your peers and instructor. Engaging with your peers and learning together is key to this experience. For you initial post, choose one of the options below:

Option 1:

A growing concern in agricultural and food chemistry is the presence of residues in food. We use many forms of organic chemicals in agriculture and food chemistry and there is growing concern as to how safe these materials are. Choose an organic chemical used in agricultural of food chemistry and report on the functional groups contained in your compound, the uses of the compound, and the safety of that compound. This research will require one or more

Option 2:

Choose a compound that is classified as an ether, aldehyde, ketone, ester, or alcohol, or amide. Report on important applications of this compound using at least one outside source. Next, write the condensed structural formula of a simple molecule with an ether, aldehyde, ketone, ester, or alcohol functional group for your peers to name (do not give away the answer!).

Case 14

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See attached report.

Nursing assignment 1-b

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

  • Starting with the precursor substance tyrosine or tryptophan, identify and briefly describe each chemical step required to create each neurotransmitter. 

Submission Instructions:

  • The typewritten description is original work and logically organized, formatted, and cited in the current APA style, including citation of references.
  • Complete and submit the assignment by 11:59 PM ET on 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.

the components of Gordon’s functional health patterns as it applies to toddlers.

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Compare and contrast the growth and developmental patterns of two toddlers of different ages using Gordon’s functional health patterns. Describe and apply the components of Gordon’s functional health patterns as it applies to toddlers.  

500 words discusion

2 APA 7 citation  and references

Case Study 3 and 4

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Case Study 3 & 4 (10 Points) 

Students much review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle.

Case Studies will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)

Turn it in Score must be less than 25 % or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 25 %. Copy-paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.

Discussion Week 2 NR501NP

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 Nursing knowledge is classified in a variety of ways, one of which is Carper’s Patterns of Knowing (Carper, 1978). Carper’s framework offers a lens through which the nurse can reflect upon insights acquired through empirical, ethical, personal, and aesthetic knowledge (Carper, 1978). Through intentional reflection using Carper’s Patterns of Knowing, nurses can process experiential learning and knowledge acquired through practice. The purpose of this assignment is to reflect upon a specific practice situation and better understand the professional knowledge and insights obtained through that experience.

Criteria for Content

  1. Think of a surprising or challenging practice situation in which you felt underprepared, unprepared, or uncomfortable.
  2. Select an important nursing issue/topic that was inherent to the identified situation.
  3. Briefly explain the situation.
  4. Identify the nursing issue inherent in the identified situation
    1. As a method of refection, use Carper’s Patterns of Knowing to analyze the situation. In your discussion, address ONE of the following Patterns of Knowing:
      1. What do you think was the underlying reason for the situation? (Esthetics)
      2. What were your thoughts and feeling in the situation? (Personal)
      3. What was one personal belief that impacted your actions? (Ethics)
      4. What evidence in nursing literature supports the nursing importance of the identified issue? (Empirical)
  5. What new insights did you gain through this reflective practice opportunity? How will this apply to your practice as a nurse practitioner? Be sure to use scholarly literature to support your position.

Interview #2

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INTERVIEW WITH A CULTURALLY DIVERSE CLIENT:
Conduct an interview with either a client or a previous healthcare consumer (this may be a neighbor, a volunteer, or a total stranger). Please be mindful of HIPPA and provide for confidentiality. Do not identify the interviewee.
• What are the client’s origins? Where were they born? Do they speak another language? (10 Points)
• How do they access the healthcare system? What resources are used? (10 Points)
• Do they have a primary care physician/nurse practitioner? (10 Points)
• Identify any healthcare disparities associated with the client. (10 Points)
• Did their socioeconomic status influence their level of or quality of healthcare? (10 Points)
• Have they ever experienced any issues during their care while at a healthcare facility? (10 Points)
• What specific needs would they like to have addressed when visiting a healthcare practitioner/facility? (10 Points)
• Do they require assistance with community resources to improve their level of care? (5 Points)

o If yes, provide a teaching moment and document this in your interview.
o If no, provide a listing of resources for future use if needed. Refer to the following link for Monroe County:
http://monroe.floridahealth.gov/programs-and-services/clinical-and-nutrition-services/_documents/community-resource-guide.pdfLinks to an external site.

sss

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Choose one of the following to respond to in Week 1 Discussion Board;

·
Chapter 1, Exercise 1.5 or

·
Chapter 2, Exercise 2.1 or

·
Chapter 2, Exercise 2.4

Respond with a minimum of two (2) paragraphs of 4-5 sentences each.

1.
You should address each bullet point in the exercise you select.

2.
Your work should have in-text citations integrating at a minimum one scholarly article from this week's readings and course textbook.

3.
APA format should be utilized to include a reference list.

4.
Correct grammar, spelling, and APA should be adhered to when writing, work should be scholarly without personalization or first person use.

case study

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THE ASSIGNMENT: 5 PAGES

Examine 
Case Study: A Puerto Rican Woman With Comorbid Addiction. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’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.

BACKGROUND

Mrs. Maria Perez is a 53 year old Puerto Rican female who presents today due to a rather “embarrassing problem.”

SUBJECTIVE

Mrs. Perez admits that she has had “problems” with alcohol since her father died in her late teens. She reports that she has struggled with alcohol since her 20’s and has been involved with Alcoholics Anonymous “on and off” for the past 25 years. She states that for the past 2 years, she has been having more and more difficulty maintaining her sobriety since the opening of the new “Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during its grand opening at which point she was “hooked.” She states that she gets “such a high” when she is gambling. While gambling, she “enjoys a drink or two” to help calm her during high-stakes games. She states that this often gives way to more drinking and more reckless gambling. She also reports that her cigarette smoking has increased over the past 2 years and she is concerned about the negative effects of the cigarette smoking on her health.

She states that she attempts to abstain from drinking but she gets such a “high” from the act of gambling that she needs a few drinks to “even out.” She also notices that when she drinks, she doesn’t smoke “as much,” but she enjoys smoking when she is playing at the slot machines. She also reports that she has gained weight from drinking so much. She currently weights 122 lbs., which represents a 7 lb. weight gain from her usual 115 lb. weight.

Mrs. Perez is quite concerned today because she borrowed over $50,000 from her retirement account to pay off her gambling debts, and her husband does not know.

MENTAL STATUS EXAM

The client is a 53 year old Puerto Rican female who is alert and oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. Her speech is clear, coherent, and goal directed. Her eye contact is somewhat avoidant during the clinical interview. When you make eye contact with her, she looks away or looks down. She demonstrates no noteworthy mannerisms, gestures, or tics. Her self-reported mood is “sad.” Affect is appropriate to content of conversation and self-reported mood. She denies visual or auditory hallucinations, and no delusional or paranoid thought processes are readily appreciated. Insight and judgment are grossly intact; however, impulse control is impaired. She is currently denying suicidal or homicidal ideation.

Diagnosis: Gambling disorder, alcohol use disorder

Decision Point One

Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks

RESULTS OF DECISION POINT ONE

·
 Client returns to clinic in four weeks

·
 Mrs. Perez says she feels “wonderful” as she has not “touched a drop” of alcohol since receiving the injection

·
 Client reports that she has not been going to the casino, as frequently, but when she does go she “drops a bundle” (meaning, spends a lot of money gambling)

·
 Client She is also still smoking, which has her concerned. She is also reporting some problems with anxiety, which also has her concerned

Decision Point Two

Add on Valium (diazepam) 5 mg orally TID/PRN/anxiety

RESULTS OF DECISION POINT TWO

·
 Client returns to clinic in four weeks

·
 Mrs. Perez reports that when she first received the Valium, it helped her tremendously. She states “I was like a new person. This is a miracle drug!” However, she reports that she has trouble “waiting” between drug administration times and sometimes takes her Valium early

·
 She is asking today for an increase the Valium dose or frequency

Decision Point Three

Continue current dose of Vivitrol, increase Valium to 10 mg orally TID/PRN/anxiety. Refer to counseling for her ongoing gambling issue

Guidance to Student

Anxiety is a common side effect of Vivitrol. Mrs. Perez reports that she is doing well with this medication, and like other side effects, the anxiety associated with this medication may be transient. The psychiatric mental health nurse practitioner should never initiate benzodiazepines in a client who already has issues with alcohol, or other substance dependencies. Additionally, benzodiazepines are not to be used long-term. Problems associated with long-term benzodiazepine use include the need to increase the dose in order to achieve the same therapeutic effect. This is what we are seeing in Mrs. Perez’s case.

The most appropriate course of action in this case would be to continue the current dose of Vivitrol, while decreasing the Valium with the goal of discontinuation of the drug within the next two weeks. At that point, you would need to evaluate whether or not the side effect of anxiety associated with Vivitrol persists.

Increasing the dose of Valium would not be appropriate, neither would maintaining her on the current dose of Valium. Additionally, the client should be referred for counseling to help with her gambling addiction, as there are no FDA approved medications gambling disorder.

Medication should never be added treat side effect of another medication, unless that side effect is known to be transient (for instance, benzodiazepines are sometimes prescribed to overcome the initial problem of “activation” associated with initiation of SSRI, or SNRI therapy). However, in a client with multiple addictive disorders, benzodiazepines should never be used (unless they are only being used for a limited duration of therapy such as acute alcohol detoxification to prevent seizures).

Additionally, it should be noted that Mrs. Perez continues to engage in problematic gambling, at considerable personal financial cost. Mrs. Perez needs to be referred to a counselor who specializes in the treatment of gambling disorder, and should also be encouraged to establish herself with a local chapter of gamblers anonymous.

You need to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions, and to enhance her overall health.

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