Nursing

Assignment: Care PlanPatient Whose HIV Status is Unknown
Assignment: Care PlanPatient Whose HIV Status is Unknown
Question 1
When the nurse is caring for a patient whose HIV status in unknown, which of these patient exposures is most likely to require postexposure prophylaxis?
Question 2
Which information will the nurse include when teaching range-of-motion exercises to a patient with an exacerbation of rheumatoid arthritis?
Question 3
The nurse obtains the following information about a patient before administration of metformin (Glucophage). Which finding indicates a need to contact the health care provider before giving the metformin?
Question 4
A patient is admitted with diabetic ketoacidosis (DKA) and has a serum potassium level of 2.9 mEq/L. Which action prescribed by the health care provider should the nurse take first?
Question 5
A patient hospitalized with an acute exacerbation of ulcerative colitis is having 14 to 16 bloody stools a day and crampy abdominal pain associated with the diarrhea. The nurse will plan to
Question 6
Which nursing action will the nurse include in the plan of care when admitting a patient with an exacerbation of inflammatory bowel disease (IBD)?
Question 7
A pregnant woman with a history of early chronic HIV infection is seen at the clinic. Which information will the nurse include when teaching the patient?
Question 8
Which of these laboratory values, noted by the nurse when reviewing the chart of a hospitalized diabetic patient, indicates the need for rapid assessment of the patient?
Question 9
A 24-year-old woman who uses injectable illegal drugs asks the nurse about preventing AIDS. The nurse informs the patient that the best way to reduce the risk of HIV infection from drug use is to
Question 10
Prednisone (Deltasone) is prescribed for a patient with an acute exacerbation of rheumatoid arthritis. Which laboratory result will the nurse monitor to determine whether the medication has been effective?
1280 × 920

Case #1: A young girl with difficulties in school
Case #1: A young girl with difficulties in school
BACKGROUND
In psychopharmacology you met Katie, an 8-year-old Caucasian female, who was brought to your office by her mother (age 47) and father (age 49). You worked through the case by recommending possible ADHD medications. As you progress in your PMHNP program, the cases will involve more information for you to sort through.
For this case, you see Katie and her parents again. The parents have reported that the medication given to Katie does not seem to be helping. This has prompted you to reconsider the diagnosis of ADHD. You will consider other differential diagnoses and determine what information you need to accurately assess the DSM-5 criteria to make the diagnosis of ADHD or another disorder with similar diagnostic features.
When parents bring their child to your office, they may have read symptoms on the internet or they may have been told by the school “your child has ADHD”. Your diagnosis will either confirm or refute that diagnosis.
Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine a differential diagnosis and to begin medication, if indicated. The PMHNP makes this diagnostic decision based on interviews and observations of the child, her parents, and the assessment of the parents and teacher.
To start, consider what assessment tools you might need to evaluate Katie.
Child Behavior Check List
Conners’ Teacher Rating Scale
The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised” (Available at: ). This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, makes careless mistakes in her schoolwork, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. She has difficulty interacting with peers in the classroom and likes to play by herself at recess.
When interviewing Katie’s parents, you ask about pre- and post-natal history and you note that Katie is the first born with parents who were close to 40 years old when she was born. She had a low 5 minute Apgar score. The parents say that she met normal developmental milestones and possibly had some difficulty with sleep during the pre-school years. They notice that Katie has difficulty socializing with peers, she is quiet at home and spends a lot of time watching TV.
SUBJECTIVE
You observe Katie in the office and she is not able to sit still during the interview. She is constantly interrupting both you and her parents. Katie reports that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds some subjects boring or too difficult, and sometimes hard because she feels “lost”. She admits that her mind does wander during class. “Sometimes” Katie reports “I will just be thinking about something else and not looking at the teacher or other students in the class.”
Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. She offers no other concerns at this time.
Katie’s parents appear somewhat anxious about their daughter’s problems. You notice the mother is fidgeting with her rings and watch while you are talking. The father is tapping his foot. Other than that, they seem attentive and straight forward in the interview process.
MENTAL STATUS EXAM
The client is an 8-year-old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. Affect is neutral. Katie says that she doesn’t hear any ‘voices’ in her head but does admit to having an imaginary friend, ‘Audrey’. No reports of delusional or paranoid thought processes. Attention and concentration are somewhat limited based on Katie’s short answers to your questions.
Decision Point One: Case #1: A young girl with difficulties in school
BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHAT IS YOUR DIAGNOSIS FOR KATIE?
In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.
299.00 Autism Spectrum Disorder (ASD), mild and co-occurring; 300.23 Social Anxiety Disorder
315.0 Specific Learning Disorder with Impairment in Reading and 315.1 Impairment in Mathematics
314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation
Decision Point One
299.00 Autism Spectrum Disorder (ASD), mild and co-occurring; 300.23 Social Anxiety Disorder
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
You have selected Autism Spectrum Disorder along with co-occurring Social Anxiety Disorder. Based on this choice, outline the remainder of the diagnostic evaluation that you will conduct on this child and their parents. Be sure to include standardized assessment instruments that you would administer
Decision Point One
315.0 Specific Learning Disorder with Impairment in Reading and 315.1 Impairment in Mathematics
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
You have selected 315.0 Specific Learning Disorder with Impairment in Reading and 315.1 Impairment in Mathematics. Based on this choice, outline the remainder of the diagnostic evaluation that you will conduct on this child and their parents. Be sure to include standardized assessment instruments that you would administer.
Comprehensive Integrated Psychiatric Assessment
The comprehensive integrated psychiatric assessment of a child or adolescent consists of gathering information from not only the child but from several sources, most notably the family members, caregivers, and the child’s teacher or school counselor. Because of this, the diagnostic assessment becomes more complicated. Issues of confidentiality, privacy, and consent must be addressed. Also, the PMHNP must take into consideration the impact of culture on the child.
In this Discussion, you review and critique the techniques and methods of a mental health professional as he or she completes a comprehensive integrated psychiatric assessment of an adolescent.
Learning Objectives
Students will:
Evaluate comprehensive integrated psychiatric assessment techniques
Recommend assessment questions
To Prepare for the Discussion:
Review the Learning Resources concerning the comprehensive integrated psychiatric assessment.
Watch the Mental Status Examination video.
Watch the two YMH Bostonvideos.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts and cannot post anonymously. Please check your post carefully before clicking Submit!
By Day 3
Based on the YMH Boston Vignette 4 video, post answers to the following questions:
What did the practitioner do well?
In what areas can the practitioner improve?
At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
What would be your next question, and why?
Discussion: Parent Guide
Note: You and your group will use the wiki function to develop three Parent Guides (one in Week 3, one in Week 7, and one in Week 10). A wiki is a site that allows collaborative editing by all users. Each group will have its own place to communicate and collaborate on the assignments. Once your group has completed each assignment, one member should transfer the information to its final format and submit it through the group submission link in the Discussion. Do not delete the assignment from the wiki format, as your Instructor will review this area to determine each member’s participation.
Collaboration is essential to accurate diagnosis of the conditions under consideration in this week. For this week’s Discussion, you practice collaboration by working in a group on developing a “Parent Guide,” which will serve as a teaching tool for parents with children who have been diagnosed with a specific mental health disorder.
It is recommended that you make your project as attractive as possible and consider using the finished product as teaching tools for families that you will work with in your own practices.
Learning Objectives
Students will:
Analyze signs and symptoms of neurodevelopmental disorders
Analyze the pathophysiology of neurodevelopmental disorders
Analyze diagnosis and treatment methods for neurodevelopmental disorders
Evaluate Parent Guides
To Prepare for this Discussion:
Your Instructor will assign you to a group and a disorder by Day 1 of Week 2.
Review the resources concerning your assigned disorder.
Review the Blackboard Help website concerning wikis.
Use your group’s Discussion Board to design and develop the Parent Guide before posting to the group wiki. For further guidance, refer to the Accessing Group Discussionsinstructions below.
Using evidence-based research, design and develop a Parent Guide for your assigned disorder including:
Signs and symptoms
Pathophysiology
How the disorder is diagnosed
Treatment options
Provide a minimum of three academic references.
Assignment 1: Practicum: Decision Tree
For this Assignment, you examine the client case study in this week’s Learning Resources. Consider how you might assess and treat pediatric clients presenting with symptoms noted in the case.
Note: This Assignment is the first of three 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:
Evaluate clients for treatment of mental health disorders
Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders
The Assignment:
Examine Case 1. You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.
At each Decision Point, stop to complete the following:
Decision #1: Differential Diagnosis
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: Treatment Plan for Psychotherapy
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: Treatment Plan for Psychopharmacology
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 and their families.
Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.
CASE NUMBER 1

Assignment: Clinical Judgment Skills
Assignment: Clinical Judgment Skills
Clinical Judgment is the process of integrating evidence-based practice, critical-thought, the Nursing Process, knowledge, skills, and attitudes, as well as application of theory to practice in order to promote safe, quality care to clients in all settings.
Keeping that in mind, answer the following scenario:
You are the Charge Nurse in a large Urban Emergency Department (ED). You nursing staff include:
RN with 12 years of Trauma ED experience
New RN with 6 months ED experience
RN from the Medical Surgical floor with 8 years of experience
The following patients are in the ED, which patient will you give to each of the nurses and why?
A 76-year-old client who was involved in a motor vehicle accident and has hematuria.
A 38-year-old client with kidney stones complaining of severe pain.
A 24-year-old diabetic client with an acute urinary tract infection who will require discharge teaching.
An 80-year-old client that has not had a bowel movement for 4 days.
Please make an initial post by midweek, and respond to at least two other student’s posts with substantial details that demonstrate an understanding of the concepts, and critical thinking. Remember that your posts must exhibit appropriate writing mechanics including using proper language, cordiality, and proper grammar and punctuation. If you refer to any outside sources or reference materials be sure to provide proper attribution and/or citation.
Module 2 discussion
Patient with Hyperkalemia
Mr. Sweet, 38 years old, is brought to the Emergency Department unresponsive. He has a history of Type 1 diabetes and has been sick for the last 3 days. On admission his Blood sugar is 532, Potassium is 7.2 and ABG results include pH 7.08, Bicarb 12, and CO2 28. His VS are HR 116, BP 107/64, RR 36 Deep and rapid, and Temp 101.5. Answer the following questions:
What interventions do expect to be ordered for Mr. Sweet? Why?
What type of acid-base disturbance does he have?
What do you think is Mr. Sweet’s Medical Diagnosis?
Please make an initial post by midweek, and respond to at least two other student’s posts with substantial details that demonstrate an understanding of the concepts, and critical thinking. Remember that your posts must exhibit appropriate writing mechanics including using proper language, cordiality, and proper grammar and punctuation. If you refer to any outside sources or reference materials be sure to provide proper attribution and/or citation
Module 3 discussion
Case Scenario: Tuberculosis
Wilson is a 36-year-old migrant worker. He was admitted to the Hospital with a cough, unintended weight loss, and night sweats. He is staying with 6 friends in a one bedroom apartment near the strawberry field where he works. The ED physician suspects Tuberculosis (TB).
What diagnostic testing will the Provider order to confirm a diagnosis of TB?
What Isolation precautions do you expect to be put in place and why?
Describe the recommended treatment regimen for TB, including the rationale for combination drug therapy.
Identify the reason compliance to medication therapy is often a concern in the patient with TB.
What should be done for Wilson’s 6 roommates?
Please make an initial post by midweek, and respond to at least two other student’s posts with substantial details that demonstrate an understanding of the concepts, and critical thinking. Remember that your posts must exhibit appropriate writing mechanics including using proper language, cordiality, and proper grammar and punctuation. If you refer to any outside sources or reference materials be sure to provide proper attribution and/or citation.
Module 4 discussion
I-SBAR-R Reporting
Think of a situation from clinical when the Provider needed to be informed of a change in patient condition. Using ISBARR write what you would report to the Provider. You can use the ISBARR form for guidance.
Please make an initial post by midweek, and respond to at least two other student’s posts with substantial details that demonstrate an understanding of the concepts, and critical thinking. Remember that your posts must exhibit appropriate writing mechanics including using proper language, cordiality, and proper grammar and punctuation. If you refer to any outside sources or reference materials be sure to provide proper attribution and/or citation.
Module 5 discussion
Patient Teaching: Anticoagulants
Sandra is a 27-year-old female admitted with a possible Deep Vein Thrombosis (DVT). She smokes one pack per day and is on birth control. She has a history of hypertension and obesity. She is admitted to the hospital and placed on bedrest. Heparin drip is started per protocol. The Provider is anticipating on sending her home with Coumadin.
Can Sandra be placed on Coumadin and Heparin at the same time? Explain your answer.
Develop 3 teaching points important for Sandra to know about her medications regimen.
Teach Back is a great way to find out about patient teaching effectiveness. Watch the following video for an example of Teach Back
What questions would you ask Sandra to verify that she understand the 3 teaching points?
Please make an initial post by midweek, and respond to at least two other student’s posts with substantial details that demonstrate an understanding of the concepts, and critical thinking. Remember that your posts must exhibit appropriate writing mechanics including using proper language, cordiality, and proper grammar and punctuation. If you refer to any outside sources or reference materials be sure to provide proper attribution and/or citation.
Module 7 discussion
Type 1 vs. Type 2 and Patient Education
Compare and contrast risk factors, age of onset, pathophysiology and clinical manifestations of Type 1 and Type 2 Diabetes. What do you think is the most important topic that must be taught to the diabetic patient and why?
Please make an initial post by midweek, and respond to at least two other student’s posts with substantial details that demonstrate an understanding of the concepts, and critical thinking. Remember that your posts must exhibit appropriate writing mechanics including using proper language, cordiality, and proper grammar and punctuation. If you refer to any outside sources or reference materials be sure to provide proper attribution and/or citation.
Module 8 discussion
The Older Adult
A nurse at the local Senior Center made the following notation about a client: A 74-year-old female client wearing eyeglasses with bifocal lenses and hearing aid in her left ear. Walks with a shuffling gait, using a cane for support. Wearing house slippers and housedress. States, “My other doctor says I should have my eyes looked at by an expert. It’s been a while, and my eyes seem to be acting up lately. I can’t see so good anymore.” The client states that she takes medication for “sugar” and her blood pressure and has worn glasses for years with the last prescription changed about 3 years ago. “I was a seamstress for many years and quit when I couldn’t see to thread the needles anymore-just in time too. These new materials are too hard to work with!” Denies using any eye drops. Describes vision changes as difficulty seeing well at night, especially if trying to read. Uses a magnifying glass to help when reading. No eye pain or discharge, although eyes sometimes feel “dry and scratchy,” with the left eye being worse than the right. Admits to rubbing eyes but without relief.
Develop a Plan of Care for this patient that includes:
2 Nursing Diagnosis
2 goals for each Nursing Diagnosis
Interventions with rationales
Please make an initial post by midweek, and respond to at least two other student’s posts with substantial details that demonstrate an understanding of the concepts, and critical thinking. Remember that your posts must exhibit appropriate writing mechanics including using proper language, cordiality, and proper grammar and punctuation. If you refer to any outside sources or reference materials be sure to provide proper attribution and/or citation.
Module 10 discussion
Bariatric Surgery Patient
EJ is a 28-year-old female. She is being admitted for Gastric Bypass Surgery. She is 5’6” and 265 pounds. She has a history of Diabetes and hypertension, she is not on medications at the time.
What client education topics are important to reinforce for this client?
How will this client’s diet be advanced?
What complications can occur after this surgery?
What is Dumping Syndrome and what are some interventions to help prevent its development?
Please make an initial post by midweek, and respond to at least two other student’s posts with substantial details that demonstrate an understanding of the concepts, and critical thinking. Remember that your posts must exhibit appropriate writing mechanics including using proper language, cordiality, and proper grammar and punctuation. If you refer to any outside sources or reference materials be sure to provide proper attribution and/or citation.
Assignment: Clinical Judgment Skills

NRS 451 Topic 5: Reengineering Health Care Tasks
Topic 5: Reengineering Health Care Tasks
NRS 451 Assignment: Health Organization Evaluation
Research a health care organization or network that spans several states with in the United States (United Healthcare, Vanguard, Banner Health, etc.). Assess the readiness of the health care organization or network you chose in regard to meeting the health care needs of citizens in the next decade.
Prepare a 1,000-1,250 word paper that presents your assessment and proposes a strategic plan to ensure readiness. Include the following:
Describe the health care organization or network.
Describe the organization’s overall readiness based on your findings.
Prepare a strategic plan to address issues pertaining to network growth, nurse staffing, resource management, and patient satisfaction.
Identify any current or potential issues within the organizational culture and discuss how these issues may affect aspects of the strategic plan.
Propose a theory or model that could be used to support implementation of the strategic plan for this organization. Explain why this theory or model is best.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. Refer to the for assistance.
Course Code Class Code Assignment Title Total Points
NRS-451VN NRS-451VN-O501 Health Organization Evaluation 180.0
Criteria Percentage Unsatisfactory (0.00%) Less Than Satisfactory (65.00%) Satisfactory (75.00%) Good (85.00%) Excellent (100.00%)
Content 80.0%
Health Care Organization or Network 15.0% Health care organization or network is not described. Health care organization or network is partially presented. There are significant omissions and inaccuracies. Health care organization or network is summarized. Some information is needed. There are minor inaccuracies related to the representation of the organization or network. Health care organization or network is described. Some detail is needed for clarity. Health care organization or network is clearly and accurately described.
Assessment of Overall Organizational Readiness 15.0% Assessment of overall organizational readiness is omitted. Assessment of overall organizational readiness is partially presented. There are significant omissions. Degree of organizational readiness is not established. Assessment of overall organizational readiness is summarized. Degree of organizational readiness is partially established. More information, rationale, and support are needed. Assessment of overall organizational readiness is described. Degree of organizational readiness is generally established. Some evidence or rationale is needed for support. Assessment of overall organizational readiness is described in detail. Degree of organizational readiness is established. Strong evidence and rationale support the assessment.
Strategic Plan 20.0% Strategic plan is omitted. Strategic plan is partially presented. Plan contains major omissions. The plan fails to address issues outlined in the assignment criteria. The strategic plan generally addresses network growth, nurse staffing, resource management, and patient satisfaction. More information, rationale, and support are needed. The strategic plan addresses network growth, nurse staffing, resource management, and patient satisfaction. Some evidence or rationale is needed for support. The strategic plan is well developed. Network growth, nurse staffing, resource management, and patient satisfaction are addressed in detail. The plan is supported with strong evidence and rationale. Topic 5: Reengineering Health Care Tasks
Identification of Current or Potential Issues in Organizational Culture and Impact of These to Strategic Plan 15.0% Current or potential issues in the organizational culture and the impact of these to strategic plan are omitted. Current or potential issues in the organizational culture are partially summarized. The potential impact of these on the strategic plan is unclear. There are omissions and inaccuracies throughout. Current or potential issues in the organizational culture are generally discussed. The impact of these on the strategic plan is summarized. Evidence and rationale are needed to support claims. Current or potential issues in the organizational culture and the potential impact of these on the strategic plan are discussed. Some evidence or rationale is needed. Current or potential issues in the organizational culture are clearly identified. The potential impact of these on the strategic plan is thoroughly described and supported with evidence and rationale.
Theory or Model to Support Implementation of Strategic Plan 15.0% Theory or model to support strategic plan implementation is omitted. Theory or model to support strategic plan implementation is partially described. It is unclear how the theory or model would support implementation of strategic plan for the organization. Theory or model to support strategic plan implementation is proposed. The theory or model demonstrates some support for implementation of the strategic plan for the organization. It is unclear why this theory or model is the best choice. More information is needed. Theory or model to support strategic plan implementation is proposed. The theory or model demonstrates support for implementation of the strategic plan for the organization. General rationale is provided for why the theory or model is the best choice. Theory or model to support strategic plan implementation is proposed. The theory or model demonstrates strong support for implementation of the strategic plan for the organization. Compelling rationale supports why the theory or model is the best choice. Topic 5: Reengineering Health Care Tasks
Organization, Effectiveness, and Format 20.0%
Thesis Development and Purpose 5.0% Paper lacks any discernible overall purpose or organizing claim. Thesis is insufficiently developed or vague. Purpose is not clear. Thesis is apparent and appropriate to purpose. Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose. Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.
Argument Logic and Construction 5.0% Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources. Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility. Argument is orderly but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative. Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative. Topic 5: Reengineering Health Care Tasks
Mechanics of Writing (includes spelling, punctuation, grammar, language use) 5.0% Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied. Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed. Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech. Writer is clearly in command of standard, written, academic English.
Paper Format (use of appropriate style for the major and assignment) 2.0% Template is not used appropriately, or documentation format is rarely followed correctly. Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent. Appropriate template is used. Formatting is correct, although some minor errors may be present. Appropriate template is fully used. There are virtually no errors in formatting style. All format elements are correct.
Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style) 3.0% Sources are not documented. Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors. Sources are documented, as appropriate to assignment and style, although some formatting errors may be present. Sources are documented, as appropriate to assignment and style, and format is mostly correct. Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

NURS 6660 Week 1: Comprehensive Integrated Psychiatric Assessment
The comprehensive integrated psychiatric assessment of a child or adolescent consists of gathering information from not only the child but from several sources, most notably the family members, caregivers, and the child’s teacher or school counselor. Because of this, the diagnostic assessment becomes more complicated. Issues of confidentiality, privacy, and consent must be addressed. Also, the PMHNP must take into consideration the impact of culture on the child.
In this Discussion, you review and critique the techniques and methods of a mental health professional as he or she completes a comprehensive integrated psychiatric assessment of an adolescent.
To Prepare for the Assignment:
Review the Learning Resources concerning the comprehensive integrated psychiatric assessment.
Watch the?Mental Status Examination?video.
Watch the two YMH Bostonvideos.
Assignment
Based on the YMH Boston?Vignette 4?video, post answers to the following questions:
What did the practitioner do well?
In what areas can the practitioner improve?
At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
What would be your?next?question, and why?
PLEASE, INCLUDE INTRODUCTION, CONCLUSION,?3 OR MORE REFERENCES LESS THAN 5 YEARS OLD, AND ANSWER ALL THE QUESTIONS AS INSTRUCTED
Learning Resources
Required Readings
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).?Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry?(11th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 5, “Examination and ?????Diagnosis of the Psychiatric Patient” (pp. 192–289)
Chapter 31, “Child Psychiatry” (pp. 1082–1107)
American Psychiatric Association. (2013).?Diagnostic and statistical manual of mental disorders?(5th ed.). Washington, DC: Author.
Kaplan, C. (2017). Ethical dilemmas.?Advanced Healthcare Network.?Retrieved from http://nurse-practitioners-and-physician-assistants.advanceweb.com/Article/Ethical-Dilemmas-2.aspx
Pumariega, A. J., Rothe, E., Mian, A., Carlisle, L., Toppelberg, C., Harris, T., . . . ?Smith, J. (2013). Practice parameter for cultural competence in child and adolescent psychiatric practice.?Journal of the American Academy of Child HYPERLINK “http://pumariega, a. j., rothe, e., mian, a., carlisle, l., toppelberg, c., harris, t., . . . ?smith, j. (2013). practice parameter for cultural competence in child and adolescent psychiatric practice.?journal of the american academy of child & adolescent psychiatry,?52(10), 1101–1115. retrieved from http://www.jaacap.com/article/S0890-8567(13)00479-6/pdf”&HYPERLINK “http://pumariega, a. j., rothe, e., mian, a., carlisle, l., toppelberg, c., harris, t., . . . ?smith, j. (2013). practice parameter for cultural competence in child and adolescent psychiatric practice.?journal of the american academy of child & adolescent psychiatry,?52(10), 1101–1115. retrieved from http://www.jaacap.com/article/S0890-8567(13)00479-6/pdf” Adolescent Psychiatry,?52(10), 1101–1115. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00479-6/pdf
American Academy of Child HYPERLINK “http://american academy of child & adolescent psychiatry (aacap). (2012a). practice parameter for psychodynamic psychotherapy with children.?journal of the american academy of child & adolescent psychiatry,?51(5), 541–557. retrieved from http://www.jaacap.com/article/S0890-8567(12)00141-4/pdf”&HYPERLINK “http://american academy of child & adolescent psychiatry (aacap). (2012a). practice parameter for psychodynamic psychotherapy with children.?journal of the american academy of child & adolescent psychiatry,?51(5), 541–557. retrieved from http://www.jaacap.com/article/S0890-8567(12)00141-4/pdf” Adolescent Psychiatry (AACAP). (2012a). Practice parameter for psychodynamic psychotherapy with children.?Journal of the American Academy of Child HYPERLINK “http://american academy of child & adolescent psychiatry (aacap). (2012a). practice parameter for psychodynamic psychotherapy with children.?journal of the american academy of child & adolescent psychiatry,?51(5), 541–557. retrieved from http://www.jaacap.com/article/S0890-8567(12)00141-4/pdf”&HYPERLINK “http://american academy of child & adolescent psychiatry (aacap). (2012a). practice parameter for psychodynamic psychotherapy with children.?journal of the american academy of child & adolescent psychiatry,?51(5), 541–557. retrieved from http://www.jaacap.com/article/S0890-8567(12)00141-4/pdf” Adolescent Psychiatry,?51(5), 541–557. Retrieved from http://www.jaacap.com/article/S0890-8567(12)00141-4/pdf
American Psychological Association. (2017).?Code of Ethics. Retrieved from http://www.apa.org/ethics/code/
Required Media
Gajbhare, P. (2014, March 8).?Mental status examination?[Video file].?Retrieved from https://www.youtube.com/watch?v=VjWVYgf2UcU
YMH Boston. (2013a, May 22).?Vignette 1 – Introduction to a preventive services visit?[Video file].?Retrieved from https://www.youtube.com/watch?v=pQy-jwiu7gM
YMH Boston. (2013c, May 22).?Vignette 4 – Introduction to a mental health assessment?[Video file].?Retrieved from https://www.youtube.com/watch?v=JCJOXQa9wcE
SEE SAMPLE ANSWER BELOW
NURS 6000N:?PMH Nurse Practitioner Role I: Child and Adolescent
WEEK 1 INITIAL DISCUSSION POST
The YMH Boston?Vignette 4?video,?described a 16 year adolescent client who came into an outpatient clinic for a mental health assessment.? He was referred there by his mother and he reported he had no idea why he was there.? In the video, it was evident the client did not want to be at the appointment.? The provider used many techniques to engage the adolescent client.? Some techniques displayed in the vignette were helpful and some techniques should have been avoided.? The following post will answer four questions provided from the discussion board in relationship to the video.
What did the practitioner do well?
At the beginning of the session the provider informed the client about confidentiality.? Confidentiality is a cornerstone of healthy therapeutic relationships and effective treatment and is based upon the ethical principles of autonomy and fidelity (Wheeler, 2014).? Another positive is that the provider engaged the client by asking him about his views.? That indirectly communicates that the provider believes the client has his own thoughts and feelings. The client has a positive response to the engagement as he becomes more verbal and makes better eye contact. ?Sadock, Sadock, and Ruiz (2014) reported once rapport has been established, many adolescents appreciate the opportunity to tell their side of the story (p. 1109). ?Lastly, the provider asks about other people in the client’s life.? In doing this, the provider finds out that the client is more comfortable relating to his girlfriend and his coach. The client feels more comfortable talking about those relationships and becomes more genuine when talking about other relationships.
In what areas can the practitioner improve?
There were a few areas the provider could improve on.? When the patient states his mother thinks he has an “anger management” problem, the provider challenges him, saying that his mother must have a reason for thinking this. The provider’s tone of voice and facial expressions indicate that he is having some negative feelings about this patient. By taking the approach that challenges the client it alienates him.? In the vignette the client withdraws and looked down with his hands in his lap when the provider expressed that.??Learning to read a teen’s body language is an important skill.? A teen who is avoiding eye contact, mumbling words, or giving one word answers may be struggling with something, and providers can often help teens open up by acknowledging this discomfort (Tomescu and Ginsburg, 2012).
At this point in the clinical interview, any compelling concerns? If so, what are they?
At this point in the interview there are a few compelling concerns.? One being the provider doesn’t elicit strategies for the patient to communicate with his mother more effectively.? The patient says he doesn’t like it when his mother “keeps nagging him” to talk about his feelings. This can be viewed as a developmental issue as well as a family issue, as adolescent boys do not generally want to talk to their mothers about their feelings (Sadock, Sadock, and Ruiz, 2014). Although development does not occur in a linear stage, familiarity with the primary developmental themes and transitions of each age period provides an important context from which to view current symptoms (Sadock, Sadock, and Ruiz, 2014).? The provider should also recognize that the patient is saying that talking about his feelings is hard for him and he feels angry when he is pushed to try. The provider reflects and normalizes the patient’s aversion to talking to his mother by using humor. This resonates with the patient and helps him become more connected.
What would be your?next?question, and why?
The provider identified the client’s positive attributes, but the “at risk” behavior was not addressed. ?I would assess substance use, abuse, and addiction.? I would start with a question from the CRAFFT screening tool “have you ever ridden in a CAR driven by someone (including yourself) who was “high” or had been using alcohol or drugs?”? Substance abuse or dependence can have a significant impact on psychiatric symptoms and treatment course (Sadock, Sadock, and Ruiz, 2014).? Substance use contributes sharply to the mortality related to injuries and violence, and to the morbidities of school failure, depression, and sexually transmitted disease acquisitions (Pollack, 2006).
References
Pollack, W. (2006). The “war” for boys: Hearing “real boys” voices, healing their pain.Professional Psychology-Research and Practice,?37(2), 190-195. Retrieved from Walden Library databases
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).?Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry?(11th ed.). Philadelphia, PA: Wolters Kluwer.
Tomescu, O. & Ginsburg, K. R. (2012). Interviewing the adolescent: strategies that promote communication and foster resilience. In?Emans, Laufer, Goldstein’s Pediatric and Adolescent
Wheeler, K. (Eds.). (2014).?Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice?(2nd ed.). New York, NY: Springer Publishing Company.
YMH Boston. (2013c, May 22).?Vignette 4 – Introduction to a mental health assessment?[Video file].?Retrieved from?https://www.youtube.com/watch?v=JCJOXQa9wcE
Assignment 1: Practicum: Decision Tree
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 symptoms of a mental health disorder.
Learning Objectives
Students will:
Evaluate clients for treatment of mental health disorders
Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders
The Assignment:
Examine Case 2: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.
At each Decision Point, stop to complete the following:
Decision #1: Differential Diagnosis
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: Treatment Plan for Psychotherapy
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: Treatment Plan for Psychopharmacology
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 and their families.
BACKGROUND
Tyrel is an 8-year-old black male who is brought in by his mother for a variety of psychiatric complaints. Shaquana, Tyrel’s mother, reports that Tyrel has been exhibiting a lot of worry and “nervousness” over the past 2 months. She states that she notices that he has been quite “keyed up” and spends a great deal of time worrying about “germs.” She states that he is constantly washing his hands because he feels as though he is going to get sick like he did a few weeks ago, which kept him both out of school and off the playground. He was also not able to see his father for two weekends because of being sick. Shaquana explains that although she and her ex-husband Desmond divorced about 2 years ago, their divorce was amicable and they both endeavor to see that Tyrel is well cared for.
Shaquana reports that Tyrel is irritable at times and has also had some sleep disturbances (which she reports as “trouble staying asleep”). She reports that he has been more and more difficult to get to school as he has become nervous around his classmates. He has missed about 8 days over the course of the last 3 weeks. He has also stopped playing with his best friend from across the street.
His mother reports that she feels “responsible” for his current symptoms. She explains that after he was sick with strep throat a few weeks ago, she encouraged him to be more careful about washing his hands after playing with other children, handling things that did not belong to him, and especially before eating. She continues by saying “maybe if I didn’t make such a big deal about it, he would not be obsessed with germs.”
Per Shaquana, her pregnancy with Tyrel was uncomplicated, and Tyrel has met all developmental milestones on time. He has had an uneventful medical history and is current on all immunizations.
OBJECTIVE
During your assessment of Tyrel, he seems cautious being around you. He warms a bit as you discuss school, his friends at school, and what he likes to do. He admits that he has been feeling “nervous” lately, but when you question him as to why, he simply shrugs his shoulders.
When you discuss his handwashing with him, he tells you that “handwashing is the best way to keep from getting sick.” When you question him how many times a day he washes his hands, he again shrugs his shoulders. You can see that his bilateral hands are dry. Throughout your assessment, Tyrel reveals that he has been thinking of how dirty his hands are; and no matter how hard he tries to stop thinking about his “dirty” hands, he is unable to do so. He reports that he gets “really nervous” and “scared” that he will get sick, and that the only way to make himself feel better is to wash his hands. He reports that it does work for a while and that he feels “better” after he washes his hands, but then a little while later, he will begin thinking “did I wash my hands well enough? What if I missed an area?” He reports that he can feel himself getting more and more “scared” until he washes his hands again.
MENTAL STATUS EXAM
Tyrel is alert and oriented to all spheres. Eye contact varies throughout the clinical interview. He reports his mood as “good,” admits to anxiety. Affect consistent to self-reported mood. He denies visual/auditory hallucinations. No overt delusional or paranoid thought processes were apparent. He denies suicidal ideation.
Lab studies obtained from Tyrel’s pediatric nurse practitioner were all within normal parameters. An antistreptolysin O antibody titer was obtained for reasons you are unclear of, and this titer was shown to be above normal parameters.
Decision Point One
BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PMHNP GIVE TO TYREL?
In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.
Decision Point One
Obsessive Compulsive Disorder
Decision Point Two
https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6660/05/mm/decision_tree/img/pill-blue.pngBegin Fluvoxamine immediate release 25 mg orally at bedtime
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Upon return to the clinic, Tyrel’s mother reported that he has had some decrease in his symptoms. She states that the frequency of the handwashing has decreased, and Tyrel seems a bit more “relaxed” overall.
She also reports that Tyrel has not fully embraced returning to school, but that his attendance has improved. She reported that over this past weekend, Tyrel went outside to play with his friend from across the street, which he has not done in a while.
Decision Point Three
https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6660/05/mm/decision_tree/img/pill-red.pngIncrease Fluvoxamine to 50 mg orally at bedtime
Guidance to Student
In terms of an actual diagnosis, the child’s main symptoms are most consistent with obsessive-compulsive disorder. There may also be an element of social phobia developing, but at this point, the PMHNP has not assessed the nature of the school avoidance—that is, why is the child avoiding school. Notice that nothing in the scenario tells us that the PMHNP has assessed this.
Fluvoxamine immediate release is FDA-approved for the treatment of OCD in children aged 8 years and older. Fluvoxamine’s sigma-1 antagonist properties may cause sedation and as such, it should be dosed in the evening/bedtime.
At this point, it would be appropriate to consider increasing the bedtime dose, especially since the child is responding to the medication and there are no negative side effects.
Atypical antipsychotics are typically not used in the treatment of OCD. There is also nothing to tell us that an atypical antipsychotic would be necessary (e.g., no psychotic symptoms). Additionally, the child seems to be responding to the medication, so there is no rationale as to why an atypical antipsychotic would be added to the current regimen.
Cognitive behavioral therapy is the psychotherapy of choice for treating OCD. The PMHNP should augment medication therapy with CBT. If further assessment determines that Tyrel has social anxiety disorder, CBT is effective in treating this condition as well.
NURS 660 Week 4: Trauma and Stressor-Related Disorders in Childhood
“He was drunk again, so I should have known better. I should have stayed away from the house, but that would have made him madder. He has done this before, but not nearly this bad. He broke my wrist as I was protecting my mom. The neighbor heard the screaming and called the cops. They hauled him away, but I know he will be back. She always lets him come back.”
Avery, age 14
In August of 2005, thousands of children lost their homes in Hurricane Katrina. On December 14, 2012, the students at Sandy Hook Elementary School experienced the death of 20 of their classmates and six of their teachers. Every day, children experience physical and sexual abuse and neglect by their parents or caregivers. These types of trauma have a lifelong impact on the children involved and those witnessing the events. As much as we try to prevent unwanted childhood trauma and stressors, the phenomena are present in our culture. Childhood trauma is a significant contributor to both physical and mental health problems in children and adults.
This week, you examine several cases of child abuse and neglect, and you recommend strategies for assessing for abuse. You analyze influences of media and social media on mental health and evaluate the need for mandatory reporting of abuse. You also submit your Practicum Journal and Assignments.
Photo Credit: StaffordStudios / Getty Images
Learning Resources
Required Readings
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 31, “Child Psychiatry” (pp. 1216–1226)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
“Trauma- and Stressor-related Disorders”
Note: You will access this book from the Walden Library databases.
Pfefferbaum, B., & Shaw, J. A. (2013). Practice parameter on disaster preparedness. Journal of the American Academy of Child & Adolescent Psychiatry, 52(11), 1224–1238. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00550-9/pdf
American Psychiatric Nurses Association. (2017). Childhood and adolescent trauma. Retrieved from http://www.apna.org/i4a/pages/index.cfm?pageID=4545
Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.
Optional Resources
Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell.
Chapter 50, “Provision of Intensive Treatment: Intensive Outreach, Day Units, and In-Patient Units” (pp. 648–664)
Chapter 58, “Disorders of Attachment and Social Engagement Related to Deprivation” (pp. 795–805)
Chapter 59, “Post Traumatic Stress Disorder” (pp. 806–821)
Chapter 64, “Suicidal Behavior and Self-Harm” (pp. 893–912)
Discussion: Treating Childhood Abuse
In 2012, statistics in the United States indicated that state CPS agencies received 3.4 million referrals for child abuse and neglect. Of these, nearly 700,000 children were found to be victims of maltreatment: 18% were victims of physical abuse and 78% were victims of neglect (CDC, 2014). Child sexual abuse makes up roughly 10% of child maltreatment cases in the United States (CDC, 2014). The CDC considers sexual abuse at any age a form of violence. Child abuse of any kind can lead to an increased state of inflammatory markers in adulthood, as well as multiple physical illnesses and high-risk behavior such as alcoholism and drug abuse. If a PMHNP identifies child abuse, there may be a need to report the abuse to authorities. Once able to provide treatment, the PMHNP can be instrumental in reducing the long-term effects of child abuse.
In this Discussion, you recommend strategies for assessing for abuse and analyze influences of media and social media on mental health. You also evaluate the need for mandatory reporting of abuse.
Learning Objectives
Students will:
Recommend strategies for assessing for abuse
Analyze influences of media and social media on mental health
Evaluate the need for mandatory reporting of abuse
To Prepare for this Discussion:
Read the Learning Resources concerning treating childhood abuse.
Read the Child Abuse Case Study in the Learning Resources. See Child Abuse Case Study
Assignment Question to be addressed
What strategies would you employ to assess the patient for abuse? Explain why you selected these strategies.
How might exposure to the media and/or social media affect the patient?
What type of mandatory reporting (if any) is required in this case? Why?

Assignment: Effect of Frequent Urination
Assignment: Effect of Frequent Urination
Question 1
Jeannie is a 24-year-old pregnant woman who asks you if her frequent urination is normal Which of the following hormones is most likely responsible for this?
TSH
HCG
Oxytocin
Estradiol
Question 2
Marion presents to your office with back pain associated with constipation and urinary retention Which of the following is most likely?
Sciatica
Epidural abscess
Cauda equine
Idiopathic low back pain
Question 3
Which is true of examination of the olfactory nerve?
It is not tested unless patient reports a change in smell
The smell must not be identified to declare a normal response
Abnormal responses may be seen in otherwise normal elderly patients
Allergies are unrelated to testing of this nerve
Question 4
A woman in her 24th week of pregnancy notices she feels faint when lying down for a period What would you suspect as the cause for this?
Adrenal insufficiency
Orthostatic hypotension
Supine hypotensive syndrome
Hypoglycemia
Question 5
What is the most effective pattern of palpation for breast cancer?
Beginning at the nipple, make an ever-enlarging spiral
Divide the breast into quadrants and inspect each systematically
Examine in lines resembling the back and forth pattern of mowing the lawn
Inspect the breast in a circular motion
Question 6
You are assessing a patient with diffuse joint pains and want to make sure that it is only the joints that are the problem, and that the pain is not related to other diseases Which of the following is a systemic cause of joint pain?
Gout
Osteoarathritis
Tendonitis
Spondylosis
Question 7
You are examining a child with severe cerebral palsy When you suddenly move his foot dorsally, a sustained “beating” of the foot against your hand ensues What does this represent?
A focal seizure
Clonus
Kernig’s sign
Brudzinski’s sign
Question 8
A young woman comes in experiencing brief, rapid, jerky, irregular movements They can occur at rest or during other intentional movements They mostly involve her face, head, lower arms, and hands How would you describe these movements?
Tics
Dystonia
Athetosis
Chorea
Question 9
An infant presents with a heart rate of 180, a respiratory rate of 68, and an enlarged liver What diagnosis does this suggest?
Pneumonia
Heart failure
Sepsis
Necrotizing enterocolitis
Question 10
You are assessing a patient with joint pain and are trying to decide whether it is inflammatory or non-inflammatory in nature Which one of the following symptoms is consistent with an inflammatory process?
Stiffness
Cool temperature
Ecchymosis
Deformity
Question 11
Which is true of women who have had unilateral mastectomy?
Examination of the remaining breast only
Lymohedema of the ipsilateral arm usually suggests recurrence of breast cancer
Breast reconstruction over the mastectomy site no longer requires examination
Examination starts at the nipple, making an ever-enlarging spiral
Question 12
Which is true of prostate cancer?
It is commonly lethal
It is one of the less common forms of cancer
Family history does not appear to be a risk factor
Ethnicity is a risk factor
Question 13
Which of the following will help to optimize yield from a pediatric examination?
Take advantage of quiet periods for auscultation
Perform a head to toe exam
Use firmness, as needed to make it through your examination
Encourage Mom to hold the child’s hand

Epidemiology Paper Part One: Descriptive Method
Epidemiology Paper Part One: Descriptive Method DNP 825
The Epidemiology Paper is a practice immersion assignment designed to be completed in three sections, this is part one of the assignment. Learners are required discuss the role of descriptive epidemiology in nursing science and apply descriptive epidemiology in nursing science.
General Guidelines: Epidemiology Paper Part One: Descriptive Method
Use the following information to ensure successful completion of the assignment:
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
This assignment requires that support your position by referencing at least six to eight scholarly resources. At least three of your supporting references must be from scholarly sources other than the assigned readings.
You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center. Epidemiology Paper Part One: Descriptive Method DNP 825
Epidemiology Paper Part One: Descriptive Method Directions:
Write a 1,250–1,500 word paper discussing the role of descriptive epidemiology in nursing science. Include the following:
Define descriptive epidemiology and describe its relationship and role in nursing science today.
Provide a contemporary example of how descriptive epidemiology is applied in public health nursing.
Identify the epidemiology components used to analyze at-risk populations.
Epidemiology Paper Part One: Descriptive Method Portfolio Practice Hours:
Practice immersion assignments are based on your current course objectives, and are intended to be application-based learning using your real-world practice setting. These assignments earn practice immersion hours, and are indicated in the assignment by a Portfolio Practice Hours statement that reminds you, the learner, to enter a corresponding case log in Typhon. Actual clock hours are entered, but the average hours associated with each practice immersion assignment is 10.
You are required to complete your assignment using real-world application. Real-world application requires the use of evidence-based data, contemporary theories, and concepts presented in the course. The culmination of your assignment must present a viable application in a current practice setting. For more information on parameters for practice immersion hours, please refer to DNP resources in the DC Network.
To earn portfolio practice hours, enter the following after the references section of your paper:
Practice Hours Completion Statement DNP-825
I, (INSERT NAME), verify that I have completed (NUMBER OF) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.
Epidemiology Paper Part One: Descriptive Method Rubric
Course Code Class Code Assignment Title Total Points
DNP-825 DNP-825-O500 Epidemiology Paper Part One: Descriptive Method 200.0
Criteria Percentage Unsatisfactory (0.00%) Less Than Satisfactory (74.00%) Satisfactory (79.00%) Good (87.00%) Excellent (100.00%)
Content 70.0%
Demonstrates an Understanding of Descriptive Epidemiology and Its Relationship to Nursing Science and Public Health Nursing 20.0% Paper does not demonstrate an understanding of descriptive epidemiology or its relationship to nursing science and public health nursing. Paper shows a vague understanding of descriptive epidemiology, but does not demonstrate an understanding of the relationship to nursing science and public health nursing. Paper illustrates a general understanding of descriptive epidemiology, and shows a general relationship to nursing science and public health nursing, but lacks a clear understanding of data collection, conditions, or distribution and determinants in relationship to disease in populations. Paper illustrates a theoretical understanding of descriptive epidemiology through an accurate discussion of distribution and disease determinants in populations. Paper demonstrates the functional relationship between descriptive epidemiology and nursing science and public health nursing. Paper illustrates a theoretical and conceptual understanding of descriptive epidemiology and offers insight into using specific conditions (outcomes of exposure, person, place, etc.) to identify specific patterns. Paper shows the significant relationship between descriptive epidemiology and contemporary nursing science and public health nursing. Epidemiology Paper Part One: Descriptive Method DNP 825
Uses Contemporary Theories, Concepts, and Examples That Demonstrate an Ability to Identify, Analyze, and Apply Descriptive Epidemiology 20.0% Paper does not use contemporary theories, concepts, or examples as support or in the analysis of the paper. Paper uses some aspects of contemporary theories and concepts throughout the paper, but no relevant examples are used. Overall, the concepts and theories used are incomplete or inaccurate and do not support the analysis or application of descriptive epidemiology. Paper uses contemporary theories and concepts throughout the paper, and general examples are used for support. Overall, the concepts and theories used are very general and offer only minor support of the analysis or application of descriptive epidemiology presented in the paper. Paper uses contemporary theories and concepts throughout the paper. Accurate and strong examples are used for support. Overall, the concepts and theories provide support of the analysis and application of descriptive epidemiology presented in the paper. Paper uses contemporary theories and concepts throughout the paper. Accurate and strong examples are used for support. Overall, the concepts and theories provide support of the analysis and application of descriptive epidemiology presented in the paper.
Demonstrates Knowledge of Health Disparities and the Variables Contributing to Health Disparity or At-Risk Populations 20.0% Paper does not demonstrate knowledge of health disparities, or of the variables contributing to health disparity or at-risk populations. Paper demonstrates a rudimentary knowledge of the concept of health disparities, but does not demonstrate knowledge of the dimensions of disparity in a realistic setting, or of the variables contributing to the disparity or at-risk populations. Paper demonstrates general knowledge of the dimensions of health disparities that occur in a realistic setting and identifies some general variables contributing to the disparity and the at-risk populations. Paper demonstrates knowledge of the dimensions of health disparities that occur in a realistic setting and identifies specific variables contributing to health disparities and at-risk populations. Paper demonstrates keen knowledge and unbiased insight pertaining to the dimensions of health disparities that occur in a realistic setting. Paper identifies significant variables from a broad spectrum that contribute to health disparities and at-risk populations. Epidemiology Paper Part One: Descriptive Method
Six to Eight Additional Scholarly Research Sources With In-Text Citations 10.0% None of the required elements (minimum of six topic-related scholarly research sources and six in-text citations) are present. Not all required elements are present. One or more elements are missing and/or included sources are not scholarly research or topic-related. All required elements are present. Scholarly research sources are topic-related, but the source and quality of one or more references is questionable. All required elements are present. Scholarly research sources are topic-related and obtained from reputable, professional sources. All required elements are present. Scholarly research sources are topic-related, and obtained from highly respected, professional, original sources.
Organization and Effectiveness 20.0%
Thesis Development and Purpose 7.0% Paper lacks any discernible overall purpose or organizing claim. Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear. Thesis and/or main claim are apparent and appropriate to purpose. Thesis and/or main claim are clear and forecast the development of the paper. It is descriptive and reflective of the arguments and appropriate to the purpose. Thesis and/or main claim are comprehensive. The essence of the paper is contained within the thesis. Thesis statement makes the purpose of the paper clear.
Argument Logic and Construction 8.0% Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources. Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility. Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative. Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.
Mechanics of Writing (includes spelling, punctuation, grammar, language use) 5.0% Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) and/or word choice are present. Sentence structure is correct but not varied. Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed. Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech. Writer is clearly in command of standard, written, academic English.
Format 10.0%
Paper Format (use of appropriate style for the major and assignment) 5.0% Template is not used appropriately or documentation format is rarely followed correctly. Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent. Appropriate template is used. Formatting is correct, although some minor errors may be present. Appropriate template is fully used. There are virtually no errors in formatting style. All format elements are correct.
Research Citations (in-text citations for paraphrasing and direct quotes, and reference page listing and formatting, as appropriate to assignment and style) 5.0% No reference page is included. No citations are used. Reference page is present. Citations are inconsistently used. Reference page is included and lists sources used in the paper. Sources are appropriately documented, although some errors may be present. Reference page is present and fully inclusive of all cited sources. Documentation is appropriate and citation style is usually correct. In-text citations and a reference page are complete and correct. The documentation of cited sources is free of error.

Assignment: Redesign Of Healthcare Systems
Assignment: Redesign Of Healthcare Systems
In 2008, Donald Berwick and colleagues provided a framework for the delivery of high value care in the USA, the Triple Aim, that is centered around three overarching goals: improving the individual experience of care; improving the health of populations; and reducing the per capita cost of healthcare. 1 The intent is that the Triple Aim will guide the redesign of healthcare systems and the transition to population health.
FULL ARTICLE ATTACHED FOR ASSISTANCE
Reflect on how Evidenced Based Practice might impact (or not impact) the Quadruple Aim in healthcare.
Consider the impact that Evidenced Based Practice may have on factors impacting these quadruple aim elements, such as preventable medical errors or healthcare delivery.
Permalink:
To Complete:
Write a brief analysis of the connection between Evidenced Based Practice and the Quadruple Aim.
Your analysis should address how Evidenced Based Practice might (or might not) help reach the Quadruple Aim, including each of the four measures of:
1. Patient experience
2. Population health
3. Costs
4. Work life of healthcare providers
(2 pages only no longer than 2 pages)
APA FORMAT WITH REFERENCES & IN-TEXT CITATIONS
In 2008, Donald Berwick and colleagues provided a framework for the delivery of high value care in the USA, the Triple Aim, that is centered around three overarching goals: improving the individual experience of care; improving the health of populations; and reducing the per capita cost of healthcare. 1 The intent is that the Triple Aim will guide the redesign of healthcare systems and the transition to population health.
FULL ARTICLE ATTACHED FOR ASSISTANCE
Reflect on how Evidenced Based Practice might impact (or not impact) the Quadruple Aim in healthcare.
Consider the impact that Evidenced Based Practice may have on factors impacting these quadruple aim elements, such as preventable medical errors or healthcare delivery.
To Complete:
Write a brief analysis of the connection between Evidenced Based Practice and the Quadruple Aim.
Your analysis should address how Evidenced Based Practice might (or might not) help reach the Quadruple Aim, including each of the four measures of:
1. Patient experience
2. Population health
3. Costs
4. Work life of healthcare providers
(2 pages only no longer than 2 pages)
APA FORMAT WITH REFERENCES & IN-TEXT CITATIONS

Assignment: Election in Healthcare Setup
Assignment: Election in Healthcare Setup
Week 4 Preparation of Presentation to Elected Official
Purpose
The purpose of this assignment is to prepare for the professional presentation to an elected official of the selected healthcare concern and the proposed solution. This includes the identification of communication strategies as well as development of presentation content.
Course Outcomes
This assignment enables the student to meet the following course outcomes:
CO 2. Communicate with decision-makers to advocate for effective policies that impact nurses and nursing, consumers, or the healthcare system. (PO 2)
CO 3. Demonstrate professional and personal growth regarding the advocacy role of the advance practice nurse in healthcare policy for diverse healthcare settings. (PO 3)
CO 5. Advocate for institutional, local, national, and international policies that influence person-centered healthcare, consumers, and nursing practice. (PO 5)
Due Date Sunday 11:59 p.m. MT at the end of Week 4
Total Points: 200 points
Requirements
Description of the Assignment
For this assignment, the focus is preparation for the presentation to the selected elected official regarding the healthcare concern and the proposed resolution. A video presentation of the healthcare concern and its proposed resolution will be prepared and presented. Following completion of this, a written self-evaluation is required.
Criteria for Content
Video Presentation:
Content: The video presentation is to include the following elements:
Introduction of self
Presentation of healthcare policy concern
Presentation of student identified solution to the healthcare policy concern
Summary
Evaluation of video presentation includes the following elements:
Content:
Introduction of self
Presentation of healthcare policy concern
Presentation of student identified solution to the healthcare policy concern
Summary
Information is relevant to healthcare concern and its solution
Method of Delivery:
Effective opening
Stayed connected to audience
Grammar was correct
Style of Delivery:
Eye contact
Voice clarity
Gestures
Appearance
Paper Content:
Overview of the healthcare policy concern and solution: This section provides a concise but comprehensive overview of the healthcare policy as well as the solution. Required content includes:
Identification of the healthcare policy
Identification of the student identified solution
Relevance to the community or population group
Identification of communication techniques: This section requires the delineation of communication techniques useful to the upcoming presentation to the selected elected official. Required content includes:
Identification of the selected elected official and position
Rationale for the selection
Identification of 4 (four) beneficial communication/presentation techniques
Providing scholarly resources that support the use of the identified communication techniques
Self-evaluation of video presentation: This section provides an opportunity for self-evaluation of the video recording. The student must self-evaluate oneself in each major content area by identifying one positive and one area to improve (i.e. content, method of delivery, and style of delivery):
Content:
Introduction of self
Presentation of healthcare policy concern
Presentation of student identified solution to the healthcare policy concern
Summary
Information is relevant to healthcare concern and its solution
Method of Delivery:
Effective opening
Stayed connected to audience
Grammar was correct
Style of Delivery:
Eye contact
Voice clarity
Gestures
Appearance
Conclusion: This section requires a summary of the key points from the video and paper assignment.
Preparing the Assignment
Criteria for Format and Special Instructions:
The video presentation will be recorded via the use of Voice Thread located within the course on the initial page in the left column.
The video presentation will last a minimum of 3 minutes and no longer than 5 minutes.
The paper (excluding the title page and reference page) should be at least 2, but no more than 4 pages. Points will be lost for not meeting these length requirements.
Title page, running head, body of paper, and reference page must follow APA guidelines as found in the 6th edition of the manual. This includes the use of headings for each section of the paper except for the introduction where no heading is used.
A minimum of 4 (four) appropriate research-based scholarly references must be used.
Required textbook for this course, dictionary and Chamberlain College of Nursing lesson information may NOT be used as scholarly references for this assignment. For additional assistance regarding scholarly nursing references, please see “What is a scholarly source” located in the Course Resources tab. Be aware that information from .com websites may be incorrect and should be avoided. References are current – within a 5-year time frame unless a valid rationale is provided and the instructor has approved them prior to submission of the assignment.
Ideas and information from scholarly, peer reviewed, nursing sources must be cited and referenced correctly.
Rules of grammar, spelling, word usage, and punctuation are followed and consistent with formal, scientific writing.

Assignment: Capella FPX4000 assessment
Assignment: Capella FPX4000 assessment
Develop a solution to a specific ethical dilemma faced by a health care professional by applying ethical principles. Describe the issues and a possible solution in a 3-5-page paper.
Introduction
Whether you are a nurse, a public health professional, a health care administrator, or in another role in the health care field, you must base your decisions on a set of ethical principles and values. Your decisions must be fair, equitable, and defensible. Each discipline has established a professional code of ethics to guide ethical behavior. In this assessment, you will practice working through an ethical dilemma as described in a case study. Your practice will help you develop a method for formulating ethical decisions.
Demonstration of Proficiency
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
Competency 1: Apply information literacy and library research skills to obtain scholarly information in the field of health care.
Apply academic peer-reviewed journal articles relevant to an ethical problem or issue as evidence to support an analysis of the case.
Competency 3: Apply ethical principles and academic standards to the study of health care.
Summarize the facts in a case study and use the three components of an ethical decision-making model to analyze an ethical problem or issue and the factors that contributed to it.
Discuss the effectiveness of the communication approaches present in a case study.
Discuss the effectiveness of the approach used by a professional to deal with problems or issues involving ethical practice in a case study.
Apply ethical principles to a possible solution to an ethical problem or issue described in a case study.
Competency 4: Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others, and that is consistent with expectations for health care professionals.
Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.
Write following APA style for in-text citations, quotes, and references.
Instructions
Note: The requirements outlined below correspond to the grading criteria in the scoring guide. At a minimum, be sure to address each point. In addition, you are encouraged to review the performance level descriptions for each criterion to see how your work will be assessed.
For this assessment, you will develop a solution to a specific ethical dilemma faced by a health care professional. In your assessment:
Access the Ethical Case Studies | Transcript media piece to review the case studies you may use for this assessment.
Select the case most closely related to your area of interest and use it to complete the assessment.
Note: The case study may not supply all of the information you need. In such cases, you should consider a variety of possibilities and infer potential conclusions. However, please be sure to identify any assumptions or speculations you make.
Identify which case study you selected and briefly summarize the facts surrounding it. Identify the problem or issue that presents an ethical dilemma or challenge and describe that dilemma or challenge.
Access the Ethical Decision-Making Model | Transcript media piece and use the three components of the ethical decision-making model (moral awareness, moral judgment, and ethical behavior) to analyze the ethical issues.
Analyze the factors that contributed to the problem or issue.
Identify who is involved or affected by the problem or issue.
Describe the factors that contributed to the problem or issue and explain how they contributed.
In addition to the readings provided, use the Capella library to locate at least one academic peer-reviewed journal article relevant to the problem or issue that you can use to support your analysis of the situation.
Cite and apply the journal article as evidence to support your critical thinking and analysis of the case.
Assess the credibility of the information source.
Assess the relevance of the information source.
Discuss the effectiveness of the communication approaches present in the case study.
Describe how the health care professional communicated with others.
Describe the communication and communication strategies that were applied, both in creating and in resolving the problems or issues presented.
Assess instances where the professional communicated effectively or ineffectively.
Discuss the effectiveness of the approach used by the professional related to any problems or issues involving ethical practice in the case.
Describe the actions taken in response to the ethical dilemma or challenge presented in the case study.
Summarize how well the professional managed professional responsibilities and priorities to resolve the problem or issue in the case.
Discuss the key lessons this case provides for health care professionals.
Apply ethical principles to a possible solution to the proposed problem or issue from the case study.
Describe the proposed solution.
Discuss how the approach makes this professional more effective or less effective in building relationships across disciplines within his or her organization.
Discuss how likely it is the proposed solution will foster professional collaboration.
Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.
Determine the proper application of the rules of grammar and mechanics.
Write using APA style for in-text citations, quotes, and references.
Determine the proper application of APA formatting requirements and scholarly writing standards.
Apply the principles of effective composition.
Integrate information from outside sources into academic writing by appropriately quoting, paraphrasing, and summarizing, following APA style.
Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:
Assessment 1 Example [PDF].
Additional Requirements
Length: At least 3–5 typed, double-spaced pages, not including the title page and reference page.
Font and font size: Times New Roman, 12 point.
APA Template: Use the APA Style Paper Template [DOCX] as the paper format and use the APA Style Paper Tutorial [DOCX] for guidance.
Written communication: Use correct spelling, grammar, and punctuation.
References: Integrate information from outside sources to include at least two references (the case study and an academic peer-reviewed journal article) and three in-text citations within the paper.
APA format: Follow current APA guidelines for in-text citation of outside sources in the body of your paper and also on the reference page.
Note: Read the Applying Ethical Principles Scoring Guide to fully understand how your paper will be graded.
If you would like assistance in organizing your assessment, or if you simply have a question about your assessment, do not hesitate to ask faculty or the teaching assistants in the NHS Learner Success Lab for guidance and suggestions.
Note:Your instructor may also use the Writing Feedback Tool to provide feedback on your writing. In the tool, click the linked resources for helpful writing information.