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Planning is the key to successful completion of this course and program-related objectives. The Individual Success Plan (ISP) assignment requires early collaboration with the course faculty and your course preceptor. Students must establish a plan for successful completion of

1. The required 50 community direct clinical practice experience hours, 50 leadership direct clinical practice hours, and 25 indirect clinical experience hours.
2. Completion of work associated with program competencies.
3. Work associated with completion of the student’s capstone project change proposal.

Students will use the “Individual Success Plan” to develop an individual plan for completing practice hours and course objectives. As a part of this process, students will identify the number of hours set aside to meet course goals.

Student expectations and instructions for completing the ISP document are provided in the “NRS-493 Individual Success Plan” resource, located in the Study Materials and in the assignment instructions.

Students should apply concepts from prior courses to critically examine and improve their current practice. Students are expected to integrate scholarly readings to develop case reports that demonstrate increasingly complex and proficient practice.

After the ISP has been developed by the student and approved by the course faculty, students will initiate a preconference with the faculty and preceptor to review the ISP.

You are not required to submit this assignment to LopesWrite.

An understanding of the factors surrounding women’s and men’s health, infections, and hematologic disorders can be critically important to disease diagnosis and treatment in these areas. This importance is magnified by the fact that some diseases and disorders manifest differently based on the sex of the patient.  Effective disease analysis often requires an understanding that goes beyond the human systems involved. The impact of patient characteristics, as well as racial and ethnic variables, can also have an important impact. An understanding of the symptoms of alterations in systems based on these characteristics is a critical step in diagnosis and treatment of many diseases. For APRNs, this understanding can also help educate patients and guide them through their treatment plans.

In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health. 

Assignment (2-page case study analysis)

In your Case Study Analysis related to the scenario provided, explain the following:

· Anemia and the different kinds of anemia (i.e., micro and macrocytic).

You may also want to briefly explain:

· The factors that affect fertility (STDs).

· Why inflammatory markers rise in STD/PID.

· Why prostatitis and infection happens. Also explain the causes of systemic reaction.

· Why a patient would need a splenectomy after a diagnosis of ITP.

Case Study: 

67-year-old female presents with chief complaint of shortness of breath, fatigue, weakness, unintentional weight loss, and mild numbness in her feet. She states she feels unsteady when she walks. PMH includes hypothyroidism well controlled on Synthroid 100 mcg/day. No hx of HTN or CHF.

Vital signs: Temp 98.7 F, pulse 118, Respirations 22, BP 108/64, PaO2 95% on room air.

Physical exam revealed pale, anxious female appearing older than stated years.

HEENT- pale conjunctiva of eyes and pale palate. Tongue beefy red and slightly swollen with loss of normal rugae. Turbinates pale but no swelling. Thyroid palpable but no nodules felt. No lymph nodes palpated.

Cardiac-regular rate and rhythm with soft II/VI systolic murmur. Respiratory- lungs clear with no adventitious breath sounds. Abdomen-soft, non-tender with positive bowel sounds. Liver edge palpated two finger breadths below right costal margin. Lab data- hgb, hct, reticulocyte count, serum B12 levels low, mean corpuscle volume, plasma iron, and ferritin levels high, folate, TIBC are normal.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. 

Minimum of 250 words with at least one peer review reference in 7th edition apa style

 Often times we can find credible sources of information that are not found in a formal literature search through a library database. These sources are considered grey literature. You may see this type literature in your systematic reviews. When conducting research, you should consider the following sources as a way to supplement your more formal reviews. More than likely, they are more up-to-date than a traditional article, which takes longer to get published. You can find grey literature by conducting a Google Scholar search. It is important to vet the information once you locate it. You can read more about grey literature by clicking the link in the reference.  

What is grey literature review pros and con

PICOT question for your capstone project change proposal. A PICOT question starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention used to address the problem must be a nursing practice intervention. Include a comparison of the nursing intervention to a patient population not currently receiving the nursing intervention, and specify the timeframe needed to implement the change process.  Formulate a PICOT question using the PICOT format (provided in the assigned readings) that addresses the clinical nursing problem.

The PICOT question will provide a framework for your capstone project change proposal.

In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.

Describe the problem in the PICOT question as it relates to the following:

1. Evidence-based solution
2. Nursing intervention
3. Patient care
4. Health care agency
5. Nursing practice

Prepare this assignment according to the guidelines found in the APA Style Guide

Follow guidelines

4 replies 

 Discuss the tenets of nursing’s metaparadigm. Identify personal philosophy of nursing. 

Your paper should include the following:

– Discuss personal philosophy of nursing.
– Articulate changes in personal philosophy over time.
– Discuss factors that impacted change in personal philosophy of nursing.

Submission Instructions:

• The paper is to be clear and concise and students will lose points for improper grammar, punctuation and misspelling.
• The paper should be formatted per current APA and 3-5 pages in length, excluding the title, abstract and references page. Incorporate a minimum of 3 current (published within last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work.

Case Study 

A 32-year-old African American mother of three toddlers who is 28 weeks pregnant is admitted to the high-risk pregnancy unit with regular contractions. She is concerned because the plans for her family are not finalized. She has many comfort needs, diagrammed in Table 33.1. When nurses assess for comfort needs in patients, they use the taxonomic structure, or comfort grid, to identify and organize all known needs. Using the comfort grid (see Fig. 33.1) as a mental guide, nurses design interrelated comforting interventions that can be implemented in one or two nurse–patient–family interactions. For this case, some suggestions to individualize the types of comfort interventions that might be considered are presented in 

Everything is in the document 

Respond to your colleague by providing at least two ways that their strategies may be expanded or improved.  

NOTE: Positive comment

                                                         Main Post

Treating Childhood Abuse

Psychiatric  Nurse Practitioners who work with children are mandatory reporters  (Child Welfare Information Gateway, 2019). Each state enacts specific  statutes that will clarify the guidelines/requirements about reporting  suspected child abuse, and it is the obligation of the PMH-NP to know  the law in his/her praciting state (Child Welfare Information Gateway,  2019).

Assessing for Abuse

Sadock,  Sadock & Ruiz (2014) identify certain vulnerability factors for  PTSD, including the presence of childhood trauma, inadequate support,  genetic predisposition to psychiatric illnesses, and recent stressful  life changes, all of which the patient in the case study displays. I  would keep those facts in mind as I assess any patient for the  possibility of abuse/trauma.

First  and foremost, establishing a therapeutic alliance is paramount; there  can be no self-disclosure without trust (Wheeler, 2014). I’m not sure if  this is a “strategy,” per se, but it is the foundation of any  relationship between the PMH-NP and her clients. 

As  I researched this topic, and I researched for hours because of the  gravitas of this topic, I found little conclusive evidence for specific  strategies. What I did find was a study from the WHO’s Mental Health Gap  Action Programme (2015) that concluded with, 

“Evidence  supporting the efficacy of strategies for detecting maltreatment of  children and youth within the context of mental health and developmental  assessment is sparse and inconclusive. No studies have evaluated the  performance of measures in predicting referrals and health outcomes.  However, it is generally agreed that it is important for health care  providers to detect child maltreatment. It is recognised that assessment  of child maltreatment requires a clinician who is competent enough to  ask the right questions and to respond appropriately’ (p. 17). 

While  this is disheartening, it is also a call to action. Not only do we need  to be attentive and alert with our younger patients, it is also clear  that we can and should be doing more to establish evidence-based  protocols for these situations. 

With  this particular case, considering this is a nineteen year old adult  presenting with a history of abuse versus current abuse (at least that  has been disclosed thus far), establishing trust and normalizing the  feelings of the client will be my priority. Also, I think it’s  imperative that we know our limits as clinicians and, while I might feel  competent to prescribe medications for this client, I am well aware  that bad therapy can worsen trauma for those with PTSD. I used to work  closely with our Trauma Stress Center at work and they consistently  drove home the importance of shoring up coping skills for these patients  before ever delving into the trauma, itself. I think too often some  clinicians overestimate their ability to help without taking into  consideration the possibility of doing harm.

Exposure to Social Media

As  with most things in life, exposure to social media has both pros and  cons, particularly when it comes to mental health/awareness/illness. On  the one hand, good information and resources are readily available;  however, there is also a glut of bad information. While there does seem  to be some evidence that social media can increase depression and/or  loneliness (Healthline, 2018) due to the tendency to compare oneself to  others, there are other studies which have not reached that same  conclusion. Instead, a study by Berryman, Ferguson & Negy (2018)  seem to suggest that the way social media is utilized is more important  than the mere use of social media. Certainly, at times social media can  increase connection with others.

Mandatory Reporting

As  previously referenced, the mandatory reporting requirements vary from  state to state (Child Welfare Information Gateway, 2019); however, in  the particular case, the client is nineteen years old. In the case of  adults, unless this is a elderly adult or adult with disabilities  (National Adult Protective Services Association, 2020). If Morgan is not  being currently abused and does not have a disability, mandatory  reporting is not required.

As  a side note, per the ANCC IQ practice questions for certification  (American Nurses Association, 2020), even if you suspect that an elderly  patient is being abused, if that patient is competent, you must respect  his/her wishes if they explicitly forbid you from reporting the abuse  to anyone. That surprised me but the rationale states, “The patient is  an adult. He has the right to make decisions for himself. Not all states  have mandatory elder abuse statutes or mandatory domestic abuse  statutes” (https://learning.ana-nursingknowledge.org/

d2l/le/content/8482/viewContent/40740/View, 2020). I would obviously double-check with state statutes to clarify state law. 

                                                                   References

American Nurses Association. (2020). Psychiatric Mental Health Nurse Practitioner 

Certification Practice IQ. Retrieved from https://learning.ana-nursingknowledge.org/d2l

home/8482

Berryman, C., Ferguson, C.J. & Negy, C.  (2018). Social Media Use and Mental Health 

Among Young Adults. The Psychiatric Quarterly 89(2), 307–14. doi:10.1007/s11126-017-9535-6.

Child Welfare Information Gateway. (2019). Mandatory reporters of child abuse and 

neglect. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau.

Healthline. (2018). The FOMO is Real: How Social Media Increases Depression and Loneliness.

Retrieved from https://www.healthline.com/health-news/social-media-use-increases-

depression-and-loneliness

National Adult Protective Services Association. (2020). What is Adult Protective Services?

Retrieved from https://www.napsa-now.org/get-help/how-aps-

helps/#:~:text=In%20most%20states%20in%20the,professionals%20to%20report%20their%20concerns.

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.

Wheeler, M. (Ed.) (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to

guide for evidence-based practice. New York, NY: Springer.

World Health Organization (WHO). (2015). Effective strategies for detecting maltreatment of 

Children and youth within the context of mental health and developmental assessment.

Retrieved from https://www.who.int/mental_health/mhgap/evidence/resource/child_q15.pdf

 Short answer

Less than 10 % similarity

References APA

Please note: i was born in Cuba. please do the work from Cuban Culture. thanks 

Chapter 10: Cultural Competence: Awareness, Sensitivity, and Respect

Think for a while about cultural practices and how they affect health or illness in your own family. They may be difficult to identify as such at first, but they do exist. What ideas about illness prevention does your family adhere to? What do you do when someone gets sick? What rituals does your family practice when someone dies?