Nursing

Case Study: Discuss Cardiovascular!
Case Study: Discuss Cardiovascular
Week 3: PBL Case Discussion: Cardiovascular
Setting: large rural clinic; family practice clinic that employs physicians and nurse practitioners
You open the chart to review for your next patient, and you see it is Larry M. Larry is a 60 year-old African American male with a history of hypertension. You note he is not due for a follow up at this time, so you look at the chief complaint.
CC: chest pain three days ago
You enter the room and introduce yourself. Larry M. is sitting in the chair. You ask what brings him in today. Larry M. smiles, shaking his head and says “My wife made me come, I feel fine.” Three days ago Larry M. felt short of breath, had this heavy feeling in his chest, and he got kind of nauseous and sweaty. It lasted only about 3 minutes, and it has not happened again, but he does feel a little more tired. “It could be that I have not worked out since it happened.”
PMHx: Reports general health as good. He had been feeling great since starting to work out and lost weight. Had lots of energy and felt great until this episode three days ago. Now he is a little concerned because he feels a little more tired when he works out. He has not done as much strenuous running and has not worked out since the episode.
Childhood/previous illnesses: chicken pox.
Chronic illnesses: Hypertension- lifestyle changes recommended. Elevated cholesterol, lifestyle management was initiated.
Surgeries: T and A, cholecystectomy, vasectomy
Hospitalizations: None aside from surgeries listed above
Immunizations: Does not receive the flu shot.
Allergies: NKDA
Blood transfusions: None
Enjoys a beer or a glass of whiskey and the occasional cigar when playing poker with his buddies
Current medications: None
Social History: Married for 20 years, works as an architect.
Family History: Parents are deceased. Father had lung cancer and mother died from complications of a stroke. Brother died at 44 from malignant melanoma. Other sister and brother are healthy.
PE:
Height: 5’8” weight: 220 pounds; BMI 33.5 vital signs: BP 146/90 P 70 Sao2 97%
General: African American male in NAD. Alert, oriented, and cooperative. Pain: 0/10 at present
Skin: Skin warm, dry, and intact. Skin color is light skinned brown, no cyanosis or pallor.
HEENT: Head normo-cephalic. Hair thick and distribution even throughout scalp.
Eyes: Sclera clear. Conjunctiva: white, PERRLA, EOMs intact. No AV nicking noted.
Ears: Tympanic membranes gray and intact with light reflex noted. Pinna and tragus non-tender
Nose: Nares patent without exudate. Sinuses non-tender to palpation, Right-sided Deviation
Throat: Oropharynx moist, no lesions or exudate. Teeth in poor repair, gums reddened and receding, filled cavities noted. Tongue smooth, pink, no lesions, protrudes in midline.
Neck supple. No cervical lymphadenopathy or tenderness noted. Thyroid midline, small and firm without palpable masses. Mild JVD in recumbent position
Lungs: Lungs clear to auscultation bilaterally. Respirations unlabored. No rashes or vesicles noted on chest. CV: Heart S1 and S2 noted, RRR, no murmurs, noted. No parasternal lifts, heaves, and thrills. Peripheral pulses equally bilaterally. PMI 5th ICS displaced 4cm laterally. No edema in lower extremities.
Abdomen: Abdomen round, soft, with bowel sounds noted in all four quadrants. No organomegaly noted.
Labs from 3 months ago:
Total Cholesterol: 230
Ldl 180
Hdl 38
· EKG In office TODAY: ST depression
Click here to access the EKG (Links to an external site.)Links to an external site.
Discussion Questions:
· What is your primary diagnosis causing Larry M.’s chest pain? Include ICD 10 codes (no differentials)
· List any relevant labs/diagnostic tests and link them to Larry’s specific case. Remember to include evidence-based support for any testing you order along with rationale if you feel no testing is warranted.
· What leads demonstrate the ST depression?
· What other secondary diagnoses does Larry M. have that need to be addressed?
· Include the rationale and a reference for your diagnoses
· Based on JNC 8 guidelines, is Larry M. hypertensive?
· Review the ACA 2017 Recommendations for Antihypertensive Therapy and design a plan for Larry M. Please discuss the pharmacological properties of the therapy you chose including rationale for why this is the best choice for Larry M.
· Plan for your primary diagnosis (Include referral, education and follow up) based on one current evidence-based journal article.
· Further diagnostic work-up not included above
· Medications

Assessing: Current Healthcare Delivery Models
Assessing: Current Healthcare Delivery Models
Week 1 discussion
The Value of a Master’s-Prepared Nurse
Consider the current healthcare delivery models and practice settings. Reflect on how nursing practice is transforming in response to the current demands of the healthcare system and answer one of the following questions:
What differentiates the practice of a master’s-prepared nurse compared to that of a baccalaureate-prepared nurse?
What is the value of a master’s degree in nursing?
What do you consider to be the most essential professional competency for a master’s-prepared nurse practicing in the 21st century?
Refer to AACN Essentials, NLN competencies, and CCN Nursing Conceptual Framework. Use at least one outside scholarly article to support your position. Provide an example to illustrate an application to professional practice.
Question 2
Grand Rounds
Guidelines with Scoring Rubric
Purpose
The purpose of this assignment is to enhance the student’s clinical reasoning, confidence and learning of various pediatric and women health topics through facilitated discussion.
Description
In Weeks 2 and 6, you will create a Grand Rounds presentation on the topic assigned to you by the faculty member.
Course Outcomes
Through this assignment, the student will demonstrate the ability to:
1. Describe the most commonly prescribed drugs use in primary care for the chose condition.
2. Utilize clinical guidelines, research articles or other materials to support your findings.
3. Identify any practice barriers, issues, or problems (including cultural diversity and healthcare literacy).
4. Discuss best practices for optimal outcomes.
Due Dates:
Women’s Health Grand Rounds due Week 6 (please see specific days/times below)
Total Points Possible:
Week 6 – 150 points
Requirements:
Keep in mind the following guidelines and grading criteria while taking part in this assignment:
The Grand Rounds presentation will consist of a patient scenario that is assigned to you by your faculty in week one. The presentation is a video recording in Kaltura. Recording of the presentation should be interesting, professional, and focused to the topic. Wear your lab coat and name tag/badge during the recording.
Record and upload presentation by Tuesday, 11:59 p.m. MT. Begin facilitating discussion and continue to lead it throughout the week.
Participate in ongoing interactive dialogue by responding to a minimal of two (2) of your peer’s discussion questions by Friday, 11:59 p.m. MT.
Participate in all faculty directed questions to your presentation by Sunday, 11:59 p.m. MT.
Utilize a minimal of three peer reviewed scholarly articles from Chamberlain Online Library and a minimal of 2 current (within last 5 years) evidence based clinical guidelines to support your findings.
Discuss Pathophysiology, epidemiology, risk factors, clinical physical assessment findings of the assigned topic.
List and discuss a minimal of three (3) differential diagnoses.
Discuss any diagnostic studies to confirm diagnosis of assigned topic
Discuss prevention (if not applicable, discuss why).
Discuss Treatment including nonpharmacologic management and pharmacologic management
Discuss patient and/or family education.
Discuss best practices for optimal outcomes.
By Wednesday, 11:59 p.m. MT – In addition to submitting your presentation, you will also need to lead a discussion on your topic in the discussion thread. The initial post and Kaltura presentation are both due by Wednesday 11:59 p.m. MT. NOTE: By Wednesday, you will also initiate a discussion to lead.
Discussion Lead Requirement: Develop three (3) questions on your topic you can ask to initiate the discussion and keep it going.
By Friday, 11:59 p.m. MT, respond substantively to a minimal of two (2) peers’ presentation questions **If all students have a response, then choose the student with the least responses to their posting.
By Sunday, 11:59 p.m. MT, summarize your grand rounds presentation by posting a summary reply to your initial post in the discussion thread. Summarize the discussion as well as conclusions from the collective group discussion. Include evidence based references at the bottom of the summary AND respond to ALL faculty questions regarding your presentation.
Grand Rounds Presentation Criteria
Category
Points
Description
Introduction
20
Introduction of topic that include pathophysiology, epidemiology, and risk factors.
Clinical Assessment
5
Discussed typical clinical assessment findings for chosen topic.
Differential Diagnoses
20
List AND discuss of a minimal of three (3) differential diagnoses with scholarly support.
Diagnostic Studies/Labs
10
Discuss diagnostic studies and labs that can be used to confirm diagnosis.
Prevention and Treatment Options
10
Discuss prevention and treatment options for chosen topic.
Education
10
Discuss patient and family education.
Identify Outcomes
10
Discuss best practices for optimal outcomes.
Lead Discussion
10
Facilitate discussion relevant to the presentation topic by incorporating three (3) discussion question for peers.
Interactive Dialogue with Student Peers
10
By Friday, 11:59 p.m. MT, Interactive dialogue with at least two peer’s initial presentation by responding substantively to all questions posed and citing related research to support.
Summary Requirement
10
By Sunday 11:59 p.m. MT, add summary post to own grand rounds presentation that summarizes the discussion. Include conclusions from the collective group discussion on the topic.
Evidence Based Research/Articles
10
Include minimal of three (3) evidence based research and/or Peer Reviewed articles from Chamberlain Online Library.
Evidence Based Practice Clinical Guidelines
10
Include a minimal of two (2) current (within last 5 years) EBP clinical guidelines.
Interactive Dialogue with Faculty
10
Responds to ALL faculty directed questions on initial presentation. Includes scholarly support from EBP clinical guidelines and/or peer reviewed journal articles obtained from Chamberlain Online Library.
Presentation Development
5
Overall Presentation is clear, concise, and organized; demonstrated ethical scholarship in accurate representation and attribution of sources; recorded in Kaltura. Labcoat and name badge are present.
Total
150
A quality assignment will meet or exceed all of the above requirements.

Assignment: Psychosis and Schizophrenia
Assignment: Psychosis and Schizophrenia
Week 6 assignment
Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia
Psychosis and schizophrenia greatly impact the brain’s normal processes, which interferes with the ability to think clearly. When symptoms of these disorders are uncontrolled, clients may struggle to function in daily life. However, clients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with psychosis and schizophrenia.
Learning Objectives
Students will:
Assess client factors and history to develop personalized plans of antipsychotic therapy for clients
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring antipsychotic therapy
Evaluate efficacy of treatment plans
Analyze ethical and legal implications related to prescribing antipsychotic therapy to clients across the lifespan
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
Chapter 4, “Psychosis and Schizophrenia”
Chapter 5, “Antipsychotic Agents”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.
Review the following medications:
amisulpride
aripiprazole
asenapine
chlorpromazine
clozapine
flupenthixol
fluphenazine
haloperidol
iloperidone
loxapine
lurasidone
olanzapine
paliperidone
perphenazine
quetiapine
risperidone
sulpiride
thioridazine
thiothixene
trifluoperazine
ziprasidone
Naber, D., & Lambert, M. (2009). The CATIE and CUtLASS studies in schizophrenia: Results and implications for clinicians. CNS Drugs, 23(8), 649-659. doi:10.2165/00023210-200923080-00002
Note: Retrieved from Walden Library databases.
Document: Midterm Exam Study Guide (PDF)
Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261-276.
Note: Retrieved from Walden Library databases.
Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine. Retrieved from https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf
Walden University. (2016). ASC success strategies: Studying for and taking a test. Retrieved from http://academicguides.waldenu.edu/ASCsuccess/ASCtesting
Required Media
Laureate Education. (2016j). Case study: Pakistani woman with delusional thought processes [Interactive media file]. Baltimore, MD: Author
Note: This case study will serve as the foundation for this week’s Assignment.
Optional Resources
Chakos, M., Patel, J. K., Rosenheck, R., Glick, I. D., Hammer, M. B., Tapp, A., & … Miller, D. (2011). Concomitant psychotropic medication use during treatment of schizophrenia patients: Longitudinal results from the CATIE study. Clinical Schizophrenia & Related Psychoses, 5(3), 124-134. doi:10.3371/CSRP.5.3.2
Fangfang, S., Stock, E. M., Copeland, L. A., Zeber, J. E., Ahmedani, B. K., & Morissette, S. B. (2014). Polypharmacy with antipsychotic drugs in patients with schizophrenia: Trends in multiple health care systems. American Journal of Health-System Pharmacy, 71(9), 728-738. doi:10.2146/ajhp130471
Lin, L. A., Rosenheck, R., Sugar, C., & Zbrozek, A. (2015). Comparing antipsychotic treatments for schizophrenia: A health state approach. The Psychiatric Quarterly, 86(1), 107-121. doi:10.1007/s11126-014-9326-2
To prepare for this Assignment:
Review this week’s Learning Resources. Consider how to assess and treat clients requiring anxiolytic therapy.

Understanding Philosophy of Nursing.
Understanding Philosophy of Nursing.
Module 04 Written Assignment – Developing a Philosophy of Nursing
In one page, describe your philosophy of nursing.
The definition of a philosophy is having a personal and specific outlook and approach you can use to make decisions and take action. Your philosophy of nursing should include your beliefs and attitudes about nursing, being a nurse, your approach to caring for others. It can also include your attitudes about working in healthcare facilities, working as part of a team, or even how you feel about people in general.
Save a copy of your philosophy as you will want to refer to it during your Program.
Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates
Module 05 Project Assignment – How Am I Doing?
Part 2: How Am I Doing?
Balancing School and Life – My Quality of Life Self-Care Plan. The purpose of developing this Plan is to set a framework and a plan to maintain wellness and to stay motivated and engaged throughout your Program. Doing this will help you achieve success during your coursework and as a professional nurse.
The goal of the Project is to help you become self-aware and reflective as a means of identifying personal self-care strategies that will increase your energy and help you manage your stress. The Project will give you a chance to learn how this is accomplished as you will be doing similar work with clients during the Program and as a professional nurse to assist them in the same way.
Share in a 2 – 3 page paper, the following:
Re-look at your Quality of Life Self-Care Wheel scores. Have they changed? If so, in what ways.
Think about your current levels of tension and stress. On a scale of 1-10 with 10 being the highest level, what is your score? Now think about the strategies you identified. Describe how well you have put them into action. If you have not been able to implement them, identify why and what you can do to overcome this.
Identify any new strategies that you think will “fit” better and describe why.
Minimum length 2-3 pages not including cover or referencing. APA formatting
Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates.
Module 07 Written Assignment – Researching for Evidence
For this written assignment, select one recent (within the last two years) evidence-based article from a peer reviewed nursing journal that describes a “best practice” in an area of nursing you are interested in. For example, if you would like to be a pediatric nurse, select an article that discusses a best practice in pediatric care.
Cite the article and provide a brief overview of how the results or findings were obtained. Then describe the “best practice.” Conclude your discussion by explaining whether you thought the research findings supported the conclusions and the best practice.
This assignment must be no more than 3 pages long. It should include all of the required elements. Use APA Editorial format and attach a copy of the article.
Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates
Module 08 Written Assignment – The Case of Mrs. G.: Client Centered Communication and Collaboration
In this written assignment, you have the opportunity to share your thoughts about how to deliver client-centered culturally competent care and work collaboratively with others.
The Case of Mrs. G.
Mrs. G. is a 75 year old Hispanic woman who has been relatively well all of her life. She had been married for 50 years and had five children. Her children are grown with families of their own. All but one of her children live in other states. Mrs. G.’s husband passed away last year, which was devastating for her. She had been very close to him and relied upon him for everything. He was “the life of the party” she always said and was a loving and caring man. Since his passing, Mrs. G. has continued to live in the house they shared for 35 years. In the last month, Mrs. G. has fallen twice sustaining injuries, though minimal. Her home health nurse comes weekly to check in on her. Mrs. G. likes her very much and wishes she could come more often. Mrs. G.’s daughter who lives in the next town over, has been worried and decided with the urging of her siblings and the doctor to start looking for an assisted living facility for her mother. She found one last week and talked with the Director who said she would be happy to help in whatever way was best. The daughter decided to tell her mother that it was time for her to move, so she can be cared for and be safe. When she told her mother, Mrs. G. cried and said, “This will not happen ever. I plan to stay in this house of loving memories for the remainder of my life.”
In 3 – 4 pages answer the following questions:
How would you best describe Mrs. G.’s feelings about her life, her family, her traditions, and her future?
Did Mrs. G.’s response to her daughter surprise you? Please explain your answer.
In what way do you believe her culture might be influencing her decision?
If you were Mrs. G.’s daughter what would you say to her that shows you are caring and have compassion for her situation? What nonverbal communication would support that level of communication?
Suppose Mrs. G. stands firm about not leaving her house. What resources and collaborations might be available and helpful so the daughter and other healthcare providers can keep her mother safe and make the most effective decision?
Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates

Assignment: How to Improve General Health
Assignment: How to Improve General Health
Week 1 discussion
DQ1 A 26-year-old female who has a history of obesity wants to begin an exercise program and is seeking information about how to improve her general health.
a. How would you approach the concept of the physiology metabolism as an energy source?
b. What is the best way to explain the body’s physiologic energy needs as it relates to exercise
The Course Objective the guides your learning outcome is Course Objective 1 (CO1): Define cell/tissue function and general mechanisms of disease.
DQ2 A 12-year-old adolescent boy has hemophilia A. His father and mother have requested a meeting, as they really do not understand how their son could have this disorder as neither one of them have the disease.
a. What concepts of gene disorders should be discussed?
b. What teaching would be necessary for the long term and short term?
The Course Objective the guides your learning outcome is CO 2: Differentiate pathophysiology of genetic disorders.
Question 2
Module 09 Written Assignment – Seizures
An older client was recently discharged from the hospital for evaluation of seizure activity. His history reveals that he has late-stage Alzheimer’s disease, Parkinson’s disease, hypertension, and type II diabetes mellitus, which is controlled by diet. He lives at home, where his wife and daughter take care of him. His discharge medications include phenytoin (Dilantin), 100 mg BID; hydrochlorothiazide (HydroDIURIL), 50 mg QD; levodopa (Sinemet), 25/100 TID; and haloperidol (Haldol), 1 mg before bed. The client has been referred for home care nursing follow-up.
Questions:
On the initial home visit by the nurse, what assessments should be made?
The wife and daughter need teaching about his antiepileptic medication. What teaching should be included?
During the initial home visit, the client experiences a generalized seizure. What action should the nurse take?
Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates.

Assignment: Adolescent Risk Behaviors
Assignment: Adolescent Risk Behaviors
Week 10 discussion
Discussion: Case Study – Adolescent Risk Behaviors
This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered. For this assignment, make sure you post your initial response to the Discussion Area by Saturday, September 30, 2017.
To support your work, use your course textbook readings and the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.
Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates’ initial postings. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite sources in your responses to other classmates. Complete your participation for this assignment by Wednesday, October 4, 2017.
For this assignment, you will complete an case study based on the course objectives and weekly content. cases emphasize core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, you will use the case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.
The assignments are highly interactive and a dynamic way to enhance your learning. Material from the cases may be present in the quizzes, the midterm exam, and the final exam.
Here you can view information on how to access and navigate .
This week, complete the case titled “Angela Cotez VE”.
Apply information from the Case Study to answer the following questions:
Describe the evaluation tool and explain why this tool is essential in the care of the adolescent patient population.
Apply the findings of the scholarly research articles to the use of this evaluation tool and describe its validity and reliability.
Apply this evaluation tool to a patient situation and summarize your opinion of the results.
Describe a plan of care for the patient, depending upon the results.

Assignment: Master’s-Prepared Nurse
Assignment: Master’s-Prepared Nurse
Nursing Theory
Identify your specialty area of professional practice. Select a nursing theory from the list of specialty track specific theories provided in the lesson plan or one of your own findings. Address the following: (1) briefly identify concepts of the nursing metaparadigm (remember the selected theory may not include all four concepts); (2) provide an example how the theory could be used to improve or evaluate the quality of practice in your specific setting.
Question 2
The Value of a Master’s-Prepared Nurse
Consider the current healthcare delivery models and practice settings. Reflect on how nursing practice is transforming in response to the current demands of the healthcare system and answer one of the following questions:
What differentiates the practice of a master’s-prepared nurse compared to that of a baccalaureate-prepared nurse?
What is the value of a master’s degree in nursing?
What do you consider to be the most essential professional competency for a master’s-prepared nurse practicing in the 21st century?
Refer to AACN Essentials, NLN competencies, and CCN Nursing Conceptual Framework. Use at least one outside scholarly article to support your position. Provide an example to illustrate an application to professional practice.
Week 2 discussion
Caring Concepts in Nursing
This week’s topic is centered on the concept of caring in contemporary nursing practice. In your initial response, provide a definition of caring that aligns with your perspective on the concept of caring. Identify your selected program of study specialty track (Executive, Education, FNP, Healthcare Policy, or Nursing Informatics). Describe how you will apply the principles of caring and holistic nursing in your future professional practice. Use at least one outside scholarly article to support your position. Provide an example to illustrate an application to professional practice.
Week 3 discussion
Knowing Self
Reflect the concepts addressed in this week’s lesson plan and required reading. Recall a challenging experience in either your personal or professional life. In the initial response, start with an introduction that includes a brief description of two core values that influence your nursing practice and interaction with others. Provide a concise description of the challenging experience. What core values were challenged in this experience? What lessons were learned from this experience? How did the experience inform future professional behaviors, decisions, and actions? Provide a specific example on how lessons learned from the challenging experience were applied in your professional practice. Use at least one outside scholarly reference to support your position.
Week 4 discussion
Leadership: Establishing Relationships and Influencing Change
This week’s focus is on developing foundational interpersonal skills that will prepare you for professional practice as a leader and change agent. As a leader, how will you influence change in your professional specialty area? Identify two strengths you have that will promote strong leadership. Identify two areas of improvement to your skill in leading and influencing change. What are two priority strategies you will implement to improve and/or enhance your leadership skills?
Week 5 discussion
Evidence-Based Practice
Discuss the EBP process and importance to nursing practice. Identify your selected specialty track. Provide a rationale on why you selected the specific professional track. Identify a concept or topic you have a passion about or an area of interest related to your future specialty advanced practice area. Provide an example, using the best evidence available, substantiating the significance of your selected area of interest as it relates to your specific specialty track.
Week 6 discussion
Systems-Structure and Function
Many of you have experience in complex adaptive systems whether you realize it or not. Thinking about your future practice specialty area, identify an issue or concern common to your future practice setting. (Note: This can be the same practice issue identified in Week 5.) In your initial response, please identify your specialty track, as well as the issue or concern. Discuss how this issue or concern impacts the system at the micro, meso, and macro levels. How will you address this issue or concern at the microsystem level? What is the expected impact of your solution on the meso- and macrosystems? Remember you can use an information technology-based solution to address the issue or concern.
Week 7 discussion
Healthful Environments
Reflect on an experience in which you were directly involved or witnessed incivility in the workplace. Provide a brief synopsis of the situation. How did this make you feel? How did you respond? What were the consequences of this situation? Provide an example of how this negatively affected the work environment and outcomes. How could the situation have been prevented? Discuss strategies that would support a healthy work environment.
Week 8 discussion
What Did You Learn
Reflecting on this course, consider and answer the following questions: How do you envision using the AACN essentials and information learned in this course to identify, guide, and evaluate your MSN project? How do you envision using the concepts learned in this course in your future nursing practice?

Case Study: Down Syndrome
Case Study: Down Syndrome
Module 6 discussion
Discussions A/B
Complete the discussion in Group A or B as assigned by the instructor and then respond to the alternate group. All students are required to review all posts for general knowledge. Keep in mind that you will earn points for your initial discussion posts, as well as your responses. If you do not posts responses, you cannot earn full credit. Refer to the Discussion Rubric on how points are earned.
DISCUSSION A
Robert and Jenna Smith’s 2nd child has Down Syndrome. Philip is 14 years old. He has a sibling that is older and one younger. 15 year old sister, Lucy and a little brother Danny who is 10 years old. As all 14 year olds he is becoming more interested in his sexuality and expressing that with curiosity. He has been known to have some overt aggression toward his sister and some classmates in his public school.
Discuss how you could help this family cope and guide Philip to learn appropriate behavior.
Group B Response
Will this behavior interfere with his interest in being in the local Boy Scout troop? His troop leader is his father.
DISCUSSION B
Toddlers have some very unique behavioral characteristics as they move from infancy to childhood. Identify these behavioral changes. Include the challenges that parents may face with these characteristics including identifying temperament, nutritional barriers, hygiene, activity, and sleep.
Group A Response
Can you help parents learn to deal with these behaviors and provide them some insight and guidance that will ease this transition for the child and parent?
You work in the pediatrician’s office.
Assessments and education are the focus of your work.
Toddlers have some very unique behavioral characteristics as they move from infancy to childhood. Identify these behavioral changes. Include the challenges that parents may face with these characteristics including identifying temperament, nutritional barriers, hygiene, activity, and sleep.

Treating Pediatric Clients Study
Treating Pediatric Clients Study
Week 2 assignment
Assignment: Assessing and Treating Pediatric Clients With Mood Disorders
When pediatric clients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult clients with the same disorders, but they also metabolize medications much differently. As a result, psychiatric mental health nurse practitioners must exercise caution when prescribing psychotropic medications to these clients. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting with mood disorders.
Note: This Assignment is the first of 10 assignments that are based on interactive client case studies. For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients.
Learning Objectives
Students will:
Assess client factors and history to develop personalized plans of antidepressant therapy for pediatric clients
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in pediatric clients requiring antidepressant therapy
Evaluate efficacy of treatment plans
Analyze ethical and legal implications related to prescribing antidepressant therapy to pediatric clients
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
Chapter 6, “Mood Disorders”
Chapter 7, “Antidepressants”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
Review the following medications:
amitriptyline
bupropion
citalopram
clomipramine
desipramine
desvenlafaxine
doxepin
duloxetine
escitalopram
fluoxetine
fluvoxamine
imipramine
ketamine
mirtazapine
nortriptyline
paroxetine
selegiline
sertraline
trazodone
venlafaxine
vilazodone
vortioxetine
Magellan Health, Inc. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. Retrieved from http://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdf
Rao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787–791. doi:10.1002/da.22171
Note: Retrieved from Walden Library databases.
Vitiello, B. (2012). Principles in using psychotropic medication in children and adolescents. In J. M. Rey (Ed.), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from http://iacapap.org/wp-content/uploads/A.7-PSYCHOPHARMACOLOGY-072012.pdf
Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.
Note: Retrieved from Walden Library databases.
Required Media
Laureate Education (2016e). Case study: An African American child suffering from depression [Interactive media file]. Baltimore, MD: Author.
Note: This case study will serve as the foundation for this week’s Assignment.
Optional Resources
El Marroun, H., White, T., Verhulst, F., & Tiemeier, H. (2014). Maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes: A systematic review. European Child & Adolescent Psychiatry, 23(10), 973–992. doi:10.1007/s00787-014-0558-3
Gordon, M. S., & Melvin, G. A. (2014). Do antidepressants make children and adolescents suicidal? Journal of Pediatrics and Child Health, 50(11), 847–854. doi:10.1111/jpc.12655
Seedat, S. (2014). Controversies in the use of antidepressants in children and adolescents: A decade since the storm and where do we stand now? Journal of Child & Adolescent Mental Health, 26(2), iii–v. doi:10.2989/17280583.2014.938497
To prepare for this Assignment:
Review this week’s Learning Resources. Consider how to assess and treat pediatric clients requiring antidepressant therapy.
The Assignment
Examine Case Study: An African American Child Suffering From Depression. 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 stop to complete the following:
Decision #1
Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients.

Assignment: Assessing Anxiety Disorders
Assignment: Assessing Anxiety Disorders
Week 5 assignment
Assignment: Assessing and Treating Clients With Anxiety Disorders
Common symptoms of anxiety disorders include chest pains, shortness of breath, and other physical symptoms that may be mistaken for a heart attack or other physical ailment. These manifestations often prompt clients to seek care from their primary care providers or emergency departments. Once it is determined that there is no organic basis for these symptoms, clients are typically referred to a psychiatric mental health practitioner for anxiolytic therapy. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with anxiety disorders.
Learning Objectives
Students will:
Assess client factors and history to develop personalized plans of anxiolytic therapy for clients
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring anxiolytic therapy
Evaluate efficacy of treatment plans
Analyze ethical and legal implications related to prescribing anxiolytic therapy to clients across the lifespan
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
Chapter 9, “Anxiety Disorder and Anxiolytics”
Stahl, S. M., & Grady, M. (2010). Stahl’s illustrated anxiety, stress, and PTSD. New York, NY: Cambridge University Press.
To access the following chapters, click on the Illustrated Guides tab and then the Anxiety, Stress, and PTSD tab.
Chapter 4, “First-Line Medications for PTSD”
Chapter 5, “Second-Line, Adjunct, and Investigational Medications for PTSD”
Strawn, J. R., Wehry, A. M., DelBello, M. P., Rynn, M. A., & Strakowski, S. (2012). Establishing the neurobiologic basis of treatment in children and adolescents with generalized anxiety disorder. Depression and Anxiety, 29(4), 328–-339. doi:10.1002/da.21913
Note: Retrieved from Walden Library databases.
Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0
Note: Retrieved from Walden Library databases.
Required Media
Laureate Education. (2016b). Case study: A middle-aged Caucasian man with anxiety [Interactive media file]. Baltimore, MD: Author.
Note: This case study will serve as the foundation for this week’s Assignment.
Optional Resources
Lupi, M., Martinotti, G., Acciavatti, T., Pettorruso, M., Brunetti, M., Santacroce, R., & … Di Giannantonio, M. (2014). Pharmacological treatments in gambling disorder: A qualitative review. Biomed Research International, 2014. doi:10.1155/2014/537306
To prepare for this Assignment:
Review this week’s Learning Resources. Consider how to assess and treat clients requiring anxiolytic therapy.
The Assignment
Examine Case Study: A Middle-Aged Caucasian Man With Anxiety. 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 stop to complete the following:
Decision #1
Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients.