Category: Nursing

Zusa Sadelars (pronouns she, her, hers), a 32-year-old Afghanistan war veteran of multiple deployments, has been experiencing PTSD symptoms for more than five years. She comes to see you because it has gotten too difficult to keep going without help.
Zusa, a White woman, tells you, “I have been trying to consistently avoid thoughts and images related to witnessing my fellow service members being hit by an IED while I was driving a combat supply truck. Over the years, I have become increasingly depressed. I’ve been drinking on a daily basis to help manage my PTSD. I’ve gotten in trouble at work ‘cuz I miss so many days. My husband says I’m ‘not there’ at home around him and the kids, even when I physically am and I guess I agree with him.”
In addition to a range of other PTSD symptoms, Zusa describes her recurring nightmare. “I’m leading a convoy and my truck breaks down. We get out, pop the hood, start working on it. I wave the second truck forward. We’re all waving and smiling. The guys in the other truck, they make fun of our broken truck and our efforts to fix it. ‘Look at that piece of junk truck! Some people will do anything to not have to work today. Good luck getting that clunker fixed!’ They pass us smiling and joking and then while we’re saying some shit back, they hit the IED in front of us. Pieces of the truck and body parts fly around, hitting us”.
“It’s not just a nightmare. It really happened. And I want to stop remembering it.”
Questions
What pharmacological treatment would you prescribe to Zusa? Please include rationale, starting dose, tapering schedule (if any), how the medication works, major drug/drug interactions, and patient education.
In your community Miami, Florida , what support resources would you provide to Zusa and her family? Provide links to those available online.
Would you refer Zusa to therapy? If so, what type? Please provide evidence for your decision.

A new patient presents to your office for treatment of bipolar disorder. In his medical history, he reports that he takes gabapentin prescribed by his primary care provider, but he is not sure what he takes it for. He states he is almost out of his gabapentin and is asking you for a refill.
Consider the following questions in your initial post:
Would you prescribe the gabapentin? Why or why not?
Should a PMHNP prescribe medications not intended for psychiatric use?
Does gabapentin have any psychiatric benefits?

Assignment Four: Problem Statement and PICOT:
Guidelines: Complete a paper to discuss your clinical problem, background, significance, PICOT, purpose statement and burning clinical question. The paper is limited to 3 pages excluding the title page and reference page. Complete in APA format.
Read applicable chapters in Melnyk and Fineout-Overholt and in Burns and Grove books to formulate your problem statement and clinical question. Include the following content for this assignment: Label the paper subheadings:
1. Introduction of the problem (one paragraph)
2. Background of the problem (one paragraph)
3. Significance of the problem (one paragraph)
4. Statement of the problem in PICOT format
5. Purpose statement
6. Burning clinical question
Please use my formulated PICOT and problem statement
In patients with schizophrenia, will the implementation of the Brief Adherence Rating Scale (BARS), as compared to current practice, increase medication adherence?
P – Schizophrenic patients
I – BARS
C – Compared to current practices (None)
O – Increased medication adherence rate
T – 12 weeks
More explaination:
From my experience in inpatient. Providers tend to use the standard approach for every patient. After stabilization in the unit, they start on pills, and send them home. With this scale we would be able to know which patient needs more attention in terms of treatment modalities relating to medication adherence, early on. (Either Long-acting meds, follow ups, or etc.) Avoiding chronic readmissions and reducing symptoms more regularly.

For this assessment, you will need to interview a health care professional such as a fellow learner, nursing colleague, administrator, business partner, or another appropriate person who could provide you with sufficient information regarding an organizational problem that he or she is experiencing or has experienced, or an area where they are seeking improvements. For this assessment, you will report on the information that you collected in your interview, analyzing the interview data and identifying a past or current issue that would benefit from an interdisciplinary approach. This could be an issue that has not been addressed by an interdisciplinary approach or one that could benefit from improvements related to the interdisciplinary approach currently being used. You will discuss the interview strategy that you used to collect information. Your interview strategy should be supported by citations from the literature.Additionally, be sure to address the following, which corresponds to the grading criteria in the scoring guide. Please study the scoring guide carefully so you understand what is needed for a distinguished score.
Summarize an interview focused on past or current issues at a health care organization.
Identify an issue from an interview for which an evidence-based interdisciplinary approach would be appropriate.
Describe potential change theories and leadership strategies that could inform an interdisciplinary solution to an organizational issue.
Describe collaboration approaches from the literature that could facilitate establishing or improving an interdisciplinary team to address an organizational issue.
Communicate with writing that is clear, logically organized, and professional, with correct grammar and spelling, and using current APA style.(atleast 3 citation needed). has to be 3 pages long

In the realm of marketing, a successful branding strategy is one of the most important contributors to organizational success. A solid branding strategy can help add visibility and credibility to a company’s products.
Similarly, nurse-scholars can build a personal brand to add visibility and credibility to their work. You can begin building your brand by developing and maintaining an academic portfolio. Such an activity can help share the results of your efforts and contribute to your success. This Week’s Discussion asks you to consider and share strategies for building your portfolio.To Prepare: Reflect on strategies that you can pursue in developing portfolios or portfolio elements that focus on academic achievements.
Review one or more samples from your own research of resources focused on portfolio development.
Post an explanation of at least two strategies for including academic activities and accomplishments into your professional development goals. Then, explain how those goals may align with the University’s emphasis on social change. Be specific and provide examples.

This week you will submit the final publish of your term paper. Your term paper should:
Discuss the technical aspects of your topic in general terms.
Discuss the public policy debates relevant to the topic you choose. This section should cover arguments that favor and oppose the use of the techniques or products.
Express your personal opinion regarding the topic’s importance and the validity of the pro and con arguments.
Your submission must include:
A title page
The body of the paper, which includes 4–6 content pages of a professionally written text
At least three references from textbooks, websites, and articles that provide adequate justification and support your claim
Subheadings (technical aspects, public policy, and personal opinion/conclusion)
Appropriate in-text citations throughout the paper
A reference list with only the sources used in the body of the paper (All sources should be less than five years old unless recent research is not available, and at least one reference must be a peer-reviewed article from a professional journal. Do not use Wikipedia or an encyclopedia as they are not considered reliable academic sources and will not be accepted.)
APA style formatting throughout your paper

Nursing is a very highly regulated profession. There are over 100 boards of nursing and national nursing associations throughout the United States and its territories. Their existence helps regulate, inform, and promote the nursing profession. With such numbers, it can be difficult to distinguish between BONs and nursing associations, and overwhelming to consider various benefits and options offered by each.
Both boards of nursing and national nursing associations have significant impacts on the nurse practitioner profession and scope of practice. Understanding these differences helps lend credence to your expertise as a professional. In this Assignment, you will practice the application of such expertise by communicating a comparison of boards of nursing and professional nurse associations. You will also share an analysis of your state board of nursing.To Prepare:
Assume that you are leading a staff development meeting on regulation for nursing practice at your healthcare organization or agency.
Review the NCSBN and ANA websites to prepare for your presentation.
The Assignment: (8- to 9-slide PowerPoint presentation)
Develop a 8- to 9-slide PowerPoint Presentation that addresses the following:
Describe the differences between a board of nursing and a professional nurse association.
Describe the board for your specific region/area.Who is on the board?
How does one become a member of the board?
Describe at least one state regulation related to general nurse scope of practice.How does this regulation influence the nurse’s role?
How does this regulation influence delivery, cost, and access to healthcare?
If a patient is from another culture, how would this regulation impact the nurse’s care/education?
Describe at least one state regulation related to Advanced Practice Registered Nurses (APRNs).How does this regulation influence the nurse’s role?
How does this regulation influence delivery, cost, and access to healthcare?
Has there been any change to the regulation within the past 5 years? Explain. Include Speaker Notes on Each Slide (except on the title page and reference page)

Evaluate the Health History and Medical Information for Mr. M., presented below.
Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.
Health History and Medical Information
Health History
Mr. M., a 70-year-old male, has been living at the assisted living facility where you work. He has no known allergies. He is a nonsmoker and does not use alcohol. Limited physical activity related to difficulty ambulating and unsteady gait. Medical history includes hypertension controlled with ACE inhibitors, hypercholesterolemia, status post appendectomy, and tibial fracture status postsurgical repair with no obvious signs of complications. Current medications include Lisinopril 20mg daily, Lipitor 40mg daily, Ambien 10mg PRN, Xanax 0.5 mg PRN, and ibuprofen 400mg PRN.
Case Scenario
Over the past 2 months, Mr. M. seems to be deteriorating quickly. He is having trouble recalling the names of his family members, remembering his room number, and even repeating what he has just read. He is becoming agitated and aggressive quickly. He appears to be afraid and fearful when he gets aggressive. He has been found wandering at night and will frequently become lost, needing help to get back to his room. Mr. M has become dependent with many ADLs, whereas a few months ago he was fully able to dress, bathe, and feed himself. The assisted living facility is concerned with his rapid decline and has decided to order testing.
Objective Data
Temperature: 37.1 degrees C
BP 123/78 HR 93 RR 22 Pox 99%
Denies pain
Height: 69.5 inches; Weight 87 kg
Laboratory Results
WBC: 19.2 (1,000/uL)
Lymphocytes 6700 (cells/uL)
CT Head shows no changes since previous scan
Urinalysis positive for moderate amount of leukocytes and cloudy
Protein: 7.1 g/dL; AST: 32 U/L; ALT 29 U/L
Critical Thinking Essay
In 750-1,000 words, critically evaluate Mr. M.’s situation. Include the following:
Describe the subjective and objective clinical manifestations present in Mr. M.
Based on the information presented in the case scenario, state what primary and secondary medical diagnoses should be considered for Mr. M. Formulate a nursing diagnosis from the medical diagnosis and explain why these should be considered and what data is provided for support.
What abnormalities would you expect to find and why when performing your nursing assessment using the identified primary and secondary medical diagnoses. Describe the physical, psychological, and emotional effects Mr. M.’s current health status may have on him. Discuss the impact it can have on his family.
Discuss what interventions can be put into place to support Mr. M. and his family.
Given Mr. M.’s current condition, discuss at least four actual or potential problems he faces. Provide a rationale for each.
You are required to cite a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.
ANSWER
**Critical Thinking Essay: Evaluation of Mr. M.’s Situation**
Mr. M., a 70-year-old male residing in an assisted living facility, presents with a complex array of clinical manifestations, including cognitive decline, changes in behavior, and altered functional abilities. To understand his situation and provide appropriate care, it is crucial to evaluate the subjective and objective clinical manifestations, consider potential medical diagnoses, perform a nursing assessment, and explore the effects on Mr. M. and his family.
**Subjective and Objective Clinical Manifestations:**
Subjective manifestations reported include difficulty recalling names, memory impairment, and agitation leading to aggression, often accompanied by fear. Mr. M.’s family has noticed these changes, indicating cognitive and behavioral alterations. Objectively, Mr. M. exhibits functional decline, particularly in activities of daily living (ADLs). His ability to dress, bathe, and feed himself has diminished significantly over the past few months. Additionally, his nighttime wandering and disorientation, as well as his dependence on others to find his room, indicate further cognitive impairment.
**Potential Medical Diagnoses:**
1. **Primary Medical Diagnosis:** Alzheimer’s Disease – The cognitive and functional decline, memory loss, and behavioral changes are indicative of Alzheimer’s disease. The rapid progression of symptoms is a significant concern.
2. **Secondary Medical Diagnosis:** Urinary Tract Infection (UTI) – The presence of leukocytes and cloudiness in the urinalysis, along with his altered mental status and agitation, suggests a possible UTI. UTIs can exacerbate cognitive decline in individuals with dementia.
**Nursing Diagnosis:**
Nursing Diagnosis: **Acute Confusion related to Alzheimer’s Disease and Urinary Tract Infection as evidenced by memory impairment, agitation, disorientation, and altered ADLs.**
Supporting Data:
– Mr. M.’s memory impairment, disorientation, and difficulty in recalling names.
– Behavioral changes, including agitation and aggression.
– Decline in ADLs, requiring assistance with dressing, bathing, and feeding.
– Positive urinalysis for leukocytes and cloudy appearance, indicating a UTI.
**Abnormalities in Nursing Assessment:**
Performing a nursing assessment for Mr. M., the following abnormalities may be expected:
1. **Cognitive deficits:** Further cognitive impairment, such as difficulties in understanding questions, confusion about time and place, and inability to follow instructions.
2. **Behavioral changes:** Agitation, restlessness, aggression, and emotional lability.
3. **Functional deficits:** An inability to perform ADLs independently, requiring assistance.
4. **Gait and motor deficits:** Unsteady gait and weakness in the left side of the body may indicate motor impairment.
**Physical, Psychological, and Emotional Effects:**
Mr. M.’s current health status can have a profound impact on him, leading to:
– **Physical effects:** Increased dependency on others for ADLs, which can be frustrating and affect his self-esteem.
– **Psychological effects:** Cognitive decline and memory loss can lead to frustration, confusion, and a sense of losing control.
– **Emotional effects:** The behavioral changes, fear, and aggression can cause emotional distress and affect his overall well-being.
The impact on Mr. M.’s family can be equally significant, causing emotional distress, caregiver burden, and a sense of helplessness.
**Interventions to Support Mr. M. and His Family:**
1. **Medical Management:** Treat the UTI promptly with antibiotics to address the acute confusion.
2. **Behavioral Interventions:** Implement non-pharmacological strategies to manage aggression and agitation, such as environmental modifications and structured routines.
3. **Cognitive Stimulation:** Engage Mr. M. in cognitive activities and memory-enhancing exercises.
4. **Family Education:** Educate the family on Alzheimer’s disease, UTIs, and strategies for coping with the behavioral changes.
5. **Support Groups:** Connect the family with Alzheimer’s caregiver support groups for emotional support.
**Actual or Potential Problems Mr. M. Faces:**
1. **Worsening Cognitive Decline:** Mr. M. faces the challenge of managing the rapid progression of Alzheimer’s disease.
2. **Increased Dependence:** The decline in ADLs can lead to decreased independence and self-esteem.
3. **Behavioral Issues:** Managing aggression and agitation can be challenging for both Mr. M. and his caregivers.
4. **Comorbid Conditions:** The presence of hypertension and hypercholesterolemia adds complexity to his care.
In conclusion, Mr. M.’s situation involves a rapid decline in cognitive and functional abilities, which raises concerns about Alzheimer’s disease and its interaction with a possible UTI. A thorough nursing assessment and interventions that address his physical, psychological, and emotional needs, along with providing support to his family, are crucial in ensuring the best possible care and quality of life for Mr. M.
References:
*Insert references here, as per your requirements.*

Develop a 2 paper, write to your organization’s leadership team, addressing your selected national healthcare issue/stressor and how it is impacting your work setting. Be sure to address the following:
* Describe the national healthcare issue/stressor you selected and its impact on your organization. Use organizational data to quantify the impact (if necessary, seek assistance from leadership or appropriate stakeholders in your organization).
*Provide a brief summary of the two articles you reviewed from outside resources on the national healthcare issue/stressor. Explain how the healthcare issue/stressor is being addressed in other organizations.
* Summarize the strategies used to address the organizational impact of national healthcare issues/stressors presented in the scholarly resources you selected. Explain how they may impact your organization both positively and negatively. Be specific and provide examples.
Palumbo, M., Rambur, B., & Hart, V. (2017). Is health care payment reform impacting nurses’ work settings, roles, and education preparation?Links to an external site. Journal of Professional Nursing, 33(6), 400–404.
Park, B., Gold, S. B., Bazemore, A., & Liaw, W. (2018). How evolving United States payment models influence primary care and its impact on the Quadruple AimLinks to an external site.. Journal of the American Board of Family Medicine, 31(4), 588–604.

Case StudyMs. Z is a 28-year-old assistant store manager who arrives at your outpatient clinic complaining of sadness after her boyfriend of 6 months ended their relationship 1 month ago. She describes a history of failed romantic relationships, and says, “I don’t do well with breakups.” Ms. Z reports that, although she has no prior psychiatric treatment, she was urged by her employer to seek therapy. Ms. Z has arrived late to work on several occasions because of oversleeping. She also has difficulty in getting out of bed stating, “It’s difficult to walk; it’s like my legs weigh a ton.” She feels fatigued during the day despite spending over 12 hours in bed and is concerned that she might be suffering from a serious medical condition. She denies any significant changes in appetite or weight since these symptoms began.Ms. Z reports that, although she has not missed workdays, she has difficulty concentrating and has become tearful in front of clients while worrying about not finding a significant other. She feels tremendous guilt over “not being good enough to get married,” and says that her close friends are concerned because she has been spending her weekends in bed and not answering their calls. Although during your evaluation Ms. Z appeared tearful, she brightened up when talking about her newborn nephew and her plans of visiting a college friend next summer. Ms. Z denied suicidal ideation.
Questions:Remember to answer these questions from your textbooks and clinical guidelines to create your evidence-based treatment plan. At all times, explain your answers. Summarize the clinical case including the significant subjective and objective data.
Generate a primary and two differential diagnoses. Use the DSM5 to support the assessment. Include the DSM5 and ICD 10 codes.
Discuss a pharmacological treatment would you prescribe? Use the clinical guidelines to support the rationale for this treatment.
Discuss non-pharmacological treatment would you prescribe? Use the clinical guidelines to support the rationale for this treatment.
Describe a health promotion intervention that would be appropriate for this patient.
Submission Instructions:
Your initial post should be at least 600 words, formatted, and cited in current APA style with support from at least 2 academic sources