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ZERO PLAGIARISM

The adolescent population is often referred to as “young adults,” but in some ways, this is a misrepresentation. Adolescents are not children, but they are not yet adults either. This transition from childhood to adulthood often poses many unique challenges to working with adolescent clients, particularly in terms of disruptive behavior. In your role, you must overcome these behaviors to effectively counsel clients. For this Discussion, as you examine the Disruptive Behaviors media in this week’s Learning Resources, consider how you might assess and treat adolescent clients presenting with disruptive behavior.

Learning Objectives

Students will:

• Assess clients presenting with disruptive behavior 
• Analyze therapeutic approaches for treating clients presenting with disruptive behavior 
• Evaluate outcomes for clients presenting with disruptive behavior 

To prepare:

• Review this week’s Learning Resources and reflect on the insights they provide.
• View the media, Disruptive Behaviors. Select one of the four case studies and assess the client. 
• For guidance on assessing the client, refer to pages 137-142 of the Wheeler text in this week’s Learning Resources. 

Note: To complete this Discussion, you must assess the client, but you are not required to submit a formal Comprehensive Client Assessment.

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

Post an explanation of your observations of the client in the case study you selected, including behaviors that align to the criteria in DSM-5. Then, explain therapeutic approaches you might use with this client, including psychotropic medications if appropriate. Finally, explain expected outcomes for the client based on these therapeutic approaches. Support your approach with evidence-based literature.

Henderson believed nurses have the responsibility to assess the needs of the individual patient, help individuals meet their health needs, and provide an environment in which the individual can perform activities unaided. What is an opportunity in your nursing practice that would benefit from application of Henderson’s theory?  How does this align with the ANA’s definition of nursing? Provide at least one evidenced-based research article to support this recommendation.

OM

 Learning Resources

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Chapter 1, “The History and Interviewing Process”This chapter explains the process of developing relationships with patients in order to build an effective health history. The authors offer suggestions for adapting the creation of a health history according to age, gender, and disability.

Chapter 5, “Recording Information”This chapter provides rationale and methods for maintaining clear and accurate records. The authors also explore the legal aspects of patient records.

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
Chapter 2, “The Comprehensive History and Physical Exam” (pp. 19–29)

Deckx, L., van den Akker, M., Daniels, L., De Jonge, E. T., Bulens, P., Tjan-Heijnen, V. C. G., … Buntinx, F. (2015). Geriatric screening tools are of limited value to predict decline in functional status and quality of life: Results of a cohort study. BMC Family Practice, 16, 1–12.  https://doi-org.ezp.waldenulibrary.org/10.1186/s12875-015-0241- x 

Wu, R. R., & Orlando, L. A. (2015). Implementation of health risk assessments with family health history: Barriers and benefits. Postgraduate Medical Journal, (1079), 508–513. 

Lushniak, B. D. (2015). Surgeon general’s perspectives: Family health history: Using the past to improve future health. Public Health Reports, (1), 3. 

Jardim, T. V., Sousa, A. L. L., Povoa, T. I. R., Barroso, W. K. S., Chinem, B., Jardim, L., … Jardim, P. C. B. V. (2015). The natural history of cardiovascular risk factors in health professionals: 20-year follow-up. BMC Public Health, 15(1111), 1–7. https://doi-org.ezp.waldenulibrary.org/10.1186/s12889-015-2477-8 

Shadow Health Support and Orientation Resources

Use the following resources to guide you through your Shadow Health orientation as well as other support resources:

Frey, C. [Chris Frey]. (2015, September 4). Student orientation [Video file]. Retrieved from https://www.youtube.com/watch?v=Rfd_8pTJBkY

Shadow Health. (n.d.). Shadow Health help desk. Retrieved from https://support.shadowhealth.com/hc/en-us 

Document: Shadow Health. (2014). Useful tips and tricks (Version 2) (PDF)

Document: Sh

With the information presented in Chapter 1 of Ball et al. in mind, consider the following:

• By Day 1 of this week, you will be assigned a new patient profile by your Instructor for this Discussion. Note: Please see the “Course Announcements” section of the classroom for your new patient profile assignment.
• How would your communication and interview techniques for building a health history differ with each patient?
• How might you target your questions for building a health history based on the patient’s social determinants of health?
• What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?
• Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.
• Select one of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the Seidel’s Guide to Physical Examination text, or another tool with which you are familiar, related to your selected patient.
• Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.

Post a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.

Response

• Share additional interview and communication techniques that could be effective with your colleague’s selected patient.
• Suggest additional health-related risks that might be considered.
• Validate an idea with your own experience and additional research.

 Respond to this post. At least 2 citations. APA format. 7th edition

Building a Health History

My assigned patient for this week’s discussion is a 14-year old biracial male living with his grandmother in a high-density public housing complex.  As clinicians, it is very important to gather as much pertinent information as you possible can. This will help with building health history and identify potential issues or concerns. Building health history and gathering pertinent information also give clinicians the opportunity to customize care to a patient’s individual needs. This will also help with forming diagnosis and implementing plan of care.

Interview and Communication Techniques

When conducting an interview with an adolescent, it is imperative that you develop a rapport with the patient, parents, or guardian. Developing a rapport will make the adolescent comfortable and easier to communicate with. I would provide privacy so that the patient and I are away from his family. This will allow the patient to share information with me that he may not disclose if his family was present. I would first find out about his interests, hobbies, and other things he enjoys doing. I would inform him that the environment is a safe space, and he should express himself as he sees fit. I would then begin my head to toe assessment, informing the patient of what I am doing while doing it. While doing my head to toe assessment, I would allow the teen to talk about any concerns he may currently have. I would also use the opportunity to enquire about school, nutrition, health, activities with friends and his homelife. After completing my assessment, I would invite his guardian to rejoin us and give her the opportunity to express any concerns or issues she may have. I would advocate for my patient as I see fit and I would educate all parties involved on any abnormal findings and the best plan of care. When communicating, I would use simple words that are easily understood, to prevent any miscommunication or misunderstanding.   

Risk Assessment Instrument

I chose the HEADSS interview tool for my adolescent patient. This is a screening tool that is used to facilitate communication and to create a sympathetic, confidential, and respectful environment where youths may be able to attain adequate healthcare (BC Children’s Hospital, n.d.).

Home: Who lives with the adolescent? Does he have roommates? What are the relationships like with the other persons living in his household?

Education and Employment: Which school is he attending? How are his grades? What is his favorite subject? Does he like going to school? How is his relationship with his teachers and classmates? What are his future goals?

Activities: Sports activities, hobbies, favorite music/movies, and exercise regimen.

Drugs: Any tobacco use, illicit drug, or alcohol use?

Sexuality: Sexual orientation, any physical or sexual abuse, ask if patient is sexually active, knowledge of STD, and use of condoms.

Suicide/Depression: Enquire about suicidal or homicidal ideation (past or present), mood swings, emotional outburst, and feelings of depression.

Substance abuse is an identified risk factor among adolescents. According to the World Health Organization (2018), harmful drinking among adolescents is a major concern because it is an underlying cause of injuries, violence and premature deaths.

Five Targeted Questions

My five target questions are:

• Have you ever had any thoughts of harming yourself or anybody else?

• Are you sexually active and if so, are you using condoms?

• Have you ever used alcohol, or illicit drugs?

• Do you feel comfortable at home or at school?

• Tell me about how you feel at home. Are you comfortable, do you think you are being treated

   fairly?

References

BC Children’s Hospital (n.d.). H.E.A.D.S.S.- A Psychosocial Interview for Adolescents.

 http://www.bcchildrens.ca/youth-health-clinic-

site/documents/headss20assessment20guide1.pdf 

World Health Organization (2018). Adolescents: health risks and solutions.

 https://www.who.int/news-room/fact-sheets/detail/adolescents-health-risks-and-

solutions#:~:text=prevent%20these%20deaths.-

,Mental%20health,of%20developing%20mental%20health%20problems.

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What are your thoughts? Reply to this discussion question.

Per our infection control nurse, one area in which my hospital lacks is with patients diagnosed with sepsis. I have yet to get ahold of the numbers which I will have later this week, but per Melissa, these numbers are not great and could be improved. She believes and even from working as a bedside nurse in the Intensive Care Unit (ICU), I agree with her that we are lacking in the department of handoff communication between nurses. Report from the emergency room to the floors, or from the floors to a higher level of care (I.e. ICU’s, Cardiac ICU’s, ICU step downs or telemetry), there is a lack of effective communication between nurses. 

We all are aware of a sepsis bundle as it was drilled into our minds during our nursing programs and very well followed us into our careers. Whether you work medical-surgical, telemetry, critical care, mother/baby, labor and deivery, pediatrics, etc., we will always have patients of all ages who can have sepsis. Although the sepsis bundle is quite straightforward, communicating that is not always easy. Many times, nurses are not thorough in their reports of interventions and cares already provided, fail to notify the receiving nurse of sepsis protocol interventions that were canceled by physicians although this is not allowed in my facility or miss handing off important parts of report. By discontinuing interventions I am talking about a physician saying it is not necessary to achieve repeat lactates, administer fluid boluses, more than one sets of blood cultures, etc. Main things you would do during a sepsis bundle. It is now the nurses responsibility, per protocol, to reorder any interventions that a physician has canceled despite the discontinuation.  

Our hospital is beginning to implement a paper form, strictly for nursing to complete and then hand into our quality department for review. We are calling this the “Sepsis Handoff Tool”. It is a form that has the nurse fill out the time and date of when severe sepsis was recognized and what systemic inflammatory response syndromes (SIRS) were identified. It also requires the hospitalist notified three sets of vital signs to be noted. The form also has two boxes, one with a three hour sepsis bundle power plan and the other with a six hour sepsis bundle power plan; all which much be checked off with no exceptions. Then registered nurse and physician both must sign the paper and send to the quality department. With this new implemenation, infection control will then perform a study on whether this new tool increased patient outcomes or not. 

As nurses, there are many implications to our job. WIth sepsis and nursing in general, we are expected to be on top of our patients, their cares and interventions. We are responsible for making sure our patients are receiving all of the treatments they have ordered and that they are appropriate. WIth sepsis, a patients condition can rapidly deteriorate. We are a part of the team that attempts to prevent this from occuring, which means implementing our protocols and policies to the fullest extent. This handoff tool has the potential for nurse to nurse and nurse to phyisicians to both be on the same page and aware of patient care. The second implication for nurses would be that we are here to help our patients. As nurses, we do what we do to help those who are sick. Accurately implementing interventions that have been proven to decrease morbidity related to sepsis when performed together are interventions that we should be doing. Having a form that helps nurses reduce time wasted in determining what has and has not been done is very beneficial as we can go right ahead to implement appropriate interventions that are left. 

As a nurse in a healthcare organization, it has become evident that patient outcome data have been consistently declining in some patient care settings. Some of the outcomes under inspection include patient Hospital acquired pressure injury (HAPI), (4 % increase in the last 6 months) .

You have investigated contributing factors to the declining outcomes and participated with a team approach to developing an evidence-based practice project. After reading this article Aiken Article titled “The effects of nurse staffing and nurse education on patent deaths in hospital with different nurse work environment”, PICO: In a healthcare setting, what is the effect of nursing staffing in reducing patient outcomes in HAPI cases? Was developed.

Complete the following categories for an EBP project (based on the case scenario above). Use the clinical question that was developed based on the PICO format. Include minimum of 10 articles reviews. For this assignment address the following areas:

• Title Page
• Abstract
• Introduction
• Background
• Problem Statement
• Purpose of the Project
• Clinical Question(s)
• Review of the Literature

Minimum of 350 words with at least 2 peer review reference in 7th edition apa style

Clinicians traditionally incorporate history taking and physical examination as an integral component in the evaluation, assessment, diagnosis, planning, and implementation of care. With the advent of ever-more sophisticated diagnostic tools, some individuals propose that these new tools and innovations ultimately can replace the history and examination. Is that a good idea? Why or why not? Support your position with a minimum of two references.

Attached is my discussion and assignment with their rubrics. please follow the rubric and 7th edition APA format

What’s your Disease factor

Chapter 7: Posttraumatic Stress Disorder

1. There are different treatments used for the diagnosis of PTSD. The textbook mentions several. Please, select one of them and discuss it. Explain why you selected that particular treatment.

Eplain the role of Florence Nightingale has or had in the evolution of healthcare. 

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