All posts by : chebby

Nurses are often portrayed in films and television. From Nurse Ratched in One Flew over the Cuckoo’s Nest, to Julia Baker in Julia, and Gaylord “Greg” Focker in Meet the Parents, nurses have been portrayed showing various traits. Some are positive, while others are less than caring. For each, the five elements of emotional intelligence, 1) self-awareness, 2) self-regulation, 3) motivation, 4) empathy, and 5) social skills, are expressed at different levels. Select a nurse archetype portrayed in films or on television and consider the following.

· What features of emotional intelligence does your selected nurse portray? What features are they lacking? Provide an example to support your rationale.

· If you were the nurse’s leader, how would use your change agent characteristics to support that individual’s growth? Provide specific examples using scenarios from the setting from which the nurse is portrayed.

· How does complexity theory or chaos theory influence the organization in which the nurse is portrayed? Provide specific examples to support your rationale.

Reading:

Hanrahan, K., Wagner, M., Matthews, G., Stewart, S., Dawson, C., Greiner, J., & Williamson, A. (2015). Sacred cow gone to pasture: A systematic evaluation and integration of evidence-based practice (Links to an external site.). Worldviews on Evidence-Based Nursing, 12(1), 3-11. https://doi.org/10.1111/wvn.12072 (Links to an external site.)

Kawar, L. N., Dunbar, G., & Scruth, E. A. (2017). Creating a credible and ethical curriculum vitae (Links to an external site.). Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 31(6), 298. https://doi.org/10.1097/NUR.0000000000000327 (Links to an external site.) 

Marshall, E. S. & Broome, M.E. (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd ed.). Springer Publishing Company.

· Chapter 1: Expert Clinician to Transformational Leader in a Complex Health Care Organization: Foundations

o Table 1.2 Examples of Situational and Constituent Interaction Theories for Leadership, Emotional Leadership,” p. 10

· Chapter 2: Understanding Contexts for Transformational Leadership: Complexity, Change, and Strategic Planning

o Theory of Complex Adaptive Systems, P. 40-41

o Nurse Leaders Within Complex Health Care Systems, P. 41-44

Instructions:

This is a Doctorate level paper. APA format (7th edition). At least 2 references (must be within 5 years)

Absolutely plagiarism free.

Read the following case study and submit a 1500 – 2000 word paper that addresses the case study and the questions at the end of the case study. 

Mr. B. is an 83 year old male referred to home health services following a hospital admission for congestive heart failure. His payor source is Medicare (traditional). He lives alone and indicates he does not have sufficient financial resources to afford private-pay in home supportive care. His daughter, who lives in the neighboring county about 30 miles away, has offered her father to move in with her – he has refused and she is not “forcing the issue”. Mr. B. is also not open to discussing moving to an assisted living environment.

This is his third hospital admission for the same problem over the last 12 months and his second admission to a home health agency. He was discharged from the previous home health agency 6 weeks ago. Physician orders are for the home health agency to provide skilled nursing for assessment of his cardiac condition and to teach him about his care and medication regime. Physical therapy has been ordered to establish a home exercise program. Home health aide services have been ordered 3 times a week to assist Mr. B. with his personal care needs.

By the end of the third week of service, it is clear to the RN Case Manager that Mr. B. is not making progress to the established goals. She reports during case conference that he is not a good candidate for teaching because of intermittent confusion and forgetfulness. According to the nurse, no matter what she has tried to teach him and regardless of the aids she has used, Mr. B. continues to take is medication incorrectly. She states, “I know he needs services, but I am not sure that he is in the right environment. I am concerned about Mr. B. – I am not sure why his daughter won’t just step up and put her foot down.”

The physical therapist reports at case conference that the “client lacks motivation”. The home exercise program has been established with Mr. B.; however, he does not complete the exercises between therapy visits.

An improvement in his personal hygiene has been noted with the Home Health Aide (HHA) services. The HHA has also been successful in decluttering his living space. The HHA reports that she is concerned that he is not eating regular meals.

This situation offers an ethical challenge to the professional caregivers and to the agency for which they work. 

Discuss how you would handle this ethical dilemma. Address the following questions as a part of your response:

1. What are your concerns about this case?
2. How does the RN Case Manager meet her ethical responsibilities to the patient and to the organization?
3. What is the best plan of action to ensure the client’s safety and well-being?
4. What are realistic outcomes and goals for this client?
5. Who will provide the ongoing care needs required by this client?

By the due date assigned, write a 1-page paper addressing the sections below of the research proposal.

Methodology

•  Data Analysis Plans
•  Describe plan for data analysis for demographic variables (descriptive statistical tests). Describe plan for data analysis of study variables (descriptive and inferential  statistical tests)

COMMUNITY: WHEELING COMMUNITY, ILLINOIS

AGREGATE: OBESE POPULATION

need two case studies 

apa format

references must be less than 5 years 

please provide proof of turnitin.com 

no plagiarism

providing two templates you can use.

#1 Anxiety (differential diagnosis 1) Cardiac disease 2) Substance abuse 3) hyperthyroidism)

#2 Trichomoniasis (differential diagnosis 1) gonorrhea 2) chlamydia 3) vaginal cancer)

please provide 3 differential diagnosis as you will see what I’m referring to when you open my supporting files.

video and answer 

You will take on the role of a clinician who is building a health history:

CASE #2

Chief Complaint: “I have pain during intercourse and urination”

History of Present Illness (HPI): A 19-year-old female reports to you that she has “sores” on and in her vagina for the last three months.

Drug Hx: She tries to practice safe sex but has a steady boyfriend and figures she doesn’t need to be so careful since she is on the birth control pill

Subjective: states “I have sores and bumps on the inner creases of my thighs and pelvic area”. “There is yellowish discharge from the sores that comes and goes”

Objective Data: VS temperature: 100.2°F; pulse 92; respirations 18; BP 122/78; weight 156 lbs, 25 lbs overweight; height 5′3″

 General: patient appears to have good hygiene; minimal makeup, pierced ears, no tattoos; well nourished (slightly overweight); no obvious distress noted

HEENT: Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, nasopharynx clear, good dentition. Piercing in her right nostril and lower lip.

Lungs: within normal limits, appropriate lung sounds auscultated, clear and equal bilaterally

Card: S1S2 without rub or gallop

Breast: • INSPECTION: no dimpling or abnormalities noted upon inspection
• PALPATION: Left breast no abnormalities noted. Right breast: denies tenderness, pain, no abnormalities noted.

Lymph: Inguinal Lymph nodes: tenderness bilaterally, numerous, 1 cm in size

Abd: tender during palpation; the left lower quadrant was very tender during palpation; patient denies nausea or vomiting

GU: labia major and minor: numerous ulcerations, too many to count; some ulcerations enter the vaginal introitus; no ulcerations in the vagina mucosa; cervix is clear, some greenish discharge; bimanual exam reveals tenderness in left lower quadrant; able to palpate the left ovary; unable to palpate the right ovary; no tenderness; uterus is normal in size, slight tenderness with cervical mobility

MS: Muscles are smooth, firm, symmetrical. Full ROM. No pain or tenderness on palpation.

Neuro: No obvious deficits and CN grossly intact II-XII

THEN, answer the following questions:

1. What other subjective data would you obtain?
2. What other objective findings would you look for?
3. What diagnostic exams do you want to order?
4. Name 3 differential diagnoses based on this patient presenting symptoms?
5. Give rationales for your each differential diagnosis.
6. What teachings will you provide?

*Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources

Describe one innovative health care delivery model that incorporates an interdisciplinary care delivery team. Explain how this model is advantageous to patient outcomes.

Due Date Thursday 3

 Assignment: 

Respond to at least two of your colleagues who argued the opposite side as you by countering their argument with evidence. Identify at least two consequences to support your position.

Support your responses with evidence-based literature with at least two references in each colleague’s response with proper citation in APA Format. 

Response Post #1

Against Diagnosing Pediatric Patients with Bipolar Disorder

           Bipolar disorder is genetic, and 60 to 90 percent of studies on twins indicates that it is passed down from generation to generation. Studies indicate that changes in the prefrontal cortex and subcortical area of the brain are associated with bipolar disorder (Sadock & Ruiz 2014).   Bipolar Disorder is a persistent mental health disorder that occurs with severe and single mood swings, either high with a lot of energy or low with a feeling of depression, according to the National Institute of Mental Health (2018).   The genetic aspect of Bipolar Disorder causes signs to be seen in pediatric patients and in the DSM-5 manual without meeting the diagnostic criteria.

           According to the DSM-5 manual, hypomanic or manic episodes (talkative, a flight of thoughts, diminished need for sleep, distractibility, high-energy agitation, and outburst) are the diagnostic criteria for Bipolar Disorder (APA, 2013).  This diagnosis criterion is close to the Attention-Deficit / Hyperactive Disorder criteria. ADHD requirements include (flight of thoughts, concentration difficulty, non-stop conversation, higher energy, etc.) (APA, 2013).  Therefore, an ADHD child with Bipolar Disorder is extremely likely to be misdiagnosed.

           The American Association of Psychology recognized children’s irritability, rage, and mood swings and agreed to add another diagnosis; Destructive Mood Dysregulation Disorder  (APA, 2013). Chronic irritability in between periods of rage or temper tantrums seen in the Bipolar Disorder criteria is the main characteristic of DMDD.  Diagnosis of DMDD is a child-specific symptom that aids in the proper care and removes the controversies in children around Bipolar Disorder.  There is a need to be particular when diagnosing children.  Developmental and hormonal changes in children have their psychological effects and may be temporary.  Therefore, other treatment options should be explored before rushing to diagnose a child with Bipolar Disorder. 

Response Post #2

Against

Pediatric Bipolar Depression Disorder Debate

           Pediatric Bipolar Depression Disorder (PBDD) has been a controversial subject for decades. The concept of PBDD came about by United States researchers in the middle of the 1990s (Duffy, Carlson, Dubicka, & Hillegers, 2020). The following will provide information that supports that PBDD is not an appropriate diagnosis for children.

Against the Diagnosis

According to the diagnostic criteria form the DSM-5, pediatric diagnosis of Bipolar Depression Disorder can be made with irritability rather than depression, sleep disturbances, psychomotor agitation, inappropriate guilt, problems concentrating, fatigue, and/or thoughts of death. The question I present is: How does a provider determine if those symptoms are due to trauma, ADHD, or other mental health concerns? Another question is: Why is the United States the one country who embraces the diagnosis of PBDD?

A case review highlighted by the NCTSN showed that a 12 year old child who had been subjected to extreme neglect, sexual abuse, domestic violence, and parental substance use was diagnosed with Oppositional Defiant Disorder and Pediatric Bipolar Disorder (2019). Further screening and assessment by a trauma-informed clinician found that the symptoms she was presenting was linked to complex trauma. Perry and Levin (2012) highlighted that not only trauma, but ADHD, can lead to the presentation of symptoms that are congruent with the diagnosis of PBDD.

In the facility I work, we provide trauma-informed care. Many of the children we care for are diagnosed with ADHD, anxiety, ODD, and Bipolar Disorder. We are finding that once we have switched to trauma informed care, children are leaving our care with LESS diagnoses. Duffy et al. (2020) highlights that the determination of PBDD does not take into account the environmental factors, social factors, and adverse childhood factors that may be contributing to the presenting symptoms.

Conclusion

           The controversy of over medicating children and causing significant long-term harm has been an issue that all providers need to be aware of. What if a child is diagnosed with PBDD and treated with medications that are not warranted? What if a trauma-informed approach could decrease or even eliminate the symptoms? Are you willing to make a lifelong diagnosis, treat the child with medications that may be unnecessary and harmful, and not take into account the possibility of a childhood disorder or trauma?  I know I am not.

Health history and discussing Testicular self exam or Breast self exam. Template provided to know what questions to ask. Just needs filled in and then a 2 page reflection.