All posts by : chebby

A patient has been coming into a clinic for the last 5 years. His medical history includes DM type II, hypertension, and obesity.  Previously his blood sugars and blood pressures were well controlled with diet, exercise, and antihypertensive.  However in the last 2 years, the patient has had uncontrolled blood sugars, and his blood pressure is consistently in the severe range, regardless of how medications are prescribed.  You are assigned to this patient, and on entry to the clinic the patient looks to be sad, and disheveled. 

While taking the patient’s vital signs, the patient shares with the nurse that “this medical stuff is just too hard, my wife use to take care of it for me, but she died two years ago, and now I just don’t understand it all.”  As a nurse, you use your therapeutic communication with the patient and find that he has not been taking his medications as ordered, and has not been reading food labels on how to eat a healthy diet.  The patient states again,  “Well my wife always did all that stuff for me, she took care of the bills, and all of the documents, and all that stuff, and now I just don’t know what to do anymore.” After further questioning, you find that the patient is not able to read more than just a few words, and had been “non-compliant” because he hasn’t been able to read his medication labels and by extension doesn’t know how to read nutrition labels.  

What can you do for this patient?  What types of patient teaching would be useful for this patient? What resources could you use in his care? Write a nursing diagnosis for this patient, and create a teaching plan for this patient, including expected learning outcomes for this patient. 

I NEED A RESPONSE TO THIS ASSIGNMENT
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ZERO PLAGIARISM

I believe this patient to have Oppositional Defiant Disorder.  This patient is within the guidelines of the DSM-5 criteria.  According to Criteria A, the patent must display a pattern of an angry or irritable mood, a behavior that displays defiance or argumentativeness, as well as vindictiveness (American Psychiatric Association, 2013). Criterion B states this disturbance is in correlation with the individual’s distress or that it impacts the person negatively (American Psychiatric Association, 2013). Lastly, Criterion C states these behaviors cannot be contributed to a psychotic episode, or other disorder (American Psychiatric Association, 2013).  

            This patient displays anger and irritability and verbalizes being resentful of being there.  She is defiant and is argumentative with the provider who is typically viewed as an authoritative figure. She also refuses to comply with treatment and the rules.  She displays vindictiveness in the form of withholding information from the therapist.  Her symptoms are moderate in that they are present in at least two different settings.

Therapeutic Approaches

 Through combined approaches, this disorder can be addressed with parenting modifications, social-emotional skills training, and if needed, psychiatric medication (Treatments for Oppositional Defiant Disorder in Children, 2020). Parenting modifications include fostering a healthy and loving relationship between the parent and child; creating healthy boundaries and rules; being consistent in ignoring annoying behaviors while praising good behaviors (Treatments for Oppositional Defiant Disorder in Children, 2020). The Social-emotional skills training includes implementing skills for the identification and management of feelings, and strategies for decision making that are not based on emotions (Treatments for Oppositional Defiant Disorder in Children, 2020).

            Lastly, if necessary, I would trial a psychiatric medication for the patient.  There are not medications for ODD specifically, but the symptoms are treated (Treatments for Oppositional Defiant Disorder in Children, 2020). There are stimulants such as methylphenidate or dextroamphetamine for ADHD (Treatments for Oppositional Defiant Disorder in Children, 2020). There are also escitalopram or fluoxetine for depression and anxiety (Treatments for Oppositional Defiant Disorder in Children, 2020). Other medications that can aid with disruptive behaviors include guanfacine, clonidine, or aripiprazole (Treatments for Oppositional Defiant Disorder in Children, 2020). Medication should not be used as a standalone treatment (Treatments for Oppositional Defiant Disorder in Children, 2020).

            For this patient specifically, I would implement the first two interventions prior to adding in a psych medication.  I would like to gauge the family dynamic and the patient’s emotional skills prior to adding a medication.  But, if at the second appointment she still had such aggressive symptoms, I would begin the patient on escitalopram 5mg, PO daily for three days then titrate to 10mg PO daily.  I would then recheck the patient in two weeks to make sure she wasn’t having any significant side effects.  

Expected Outcomes

The expected outcomes for this patient would benefit the entire family.  The family may benefit from stronger stability and healthier boundaries, less chaos, or a more caring environment. This can be seen or reflected in children’s behaviors.  I would also expect that with proper tools, social factors such as disagreements with other children, would also be overcome for the benefit of the patient (ODD, 2020).  It was once believed that a child could “outgrown” ODD , however this has been unfounded and symptoms can occur up to an individual’s later years (ODD, 2020). If the patient needs to have medication on board to help, I would expect at least a partial remission if not a full remission of symptoms. 

Reference

American Psychiatric Association. (2013).  Diagnostic and statistical manual of mental    disorders (5th ed.). Washington, DC: Author.

ODD (2020). Retrieved 23 October 2020, from             https://www.aacap.org/App_Themes/AACAP/docs/resource_centers/odd/odd_resource_c            enter_odd_guide.pdf

Treatments for Oppositional Defiant Disorder in Children | Boston Children’s Hospital. (2020).    Retrieved 23 October 2020, from https://www.childrenshospital.org/conditions-and-            treatments/conditions/o/oppositional-defiant-disorder/treatments

1.In one-two paragraphs, summarize at least one healthcare policy that was adopted and implemented at the organizational level. (Please refrain from  discussions on HIPAA regulations in this forum). 

2. create a potential scenario where the policy you selected can benefit a population or healthcare institution. Your scenario should be applicable to one of the policies we learned this week or in other scholarly readings.

Direct Practice Improvement (DPI) Project Proposal Chapter 3 – Methodology

TOPIC: Improving Medication Adherence in Diabetic Patients in Home Health Care Settings

Chapter 3 of the Direct Practice Improvement (DPI) Project, titled “Methodology,” will expand upon the content and concepts presented in the “10 Strategic Points Final Draft” (Appendix A) document you completed in its final iteration in Topic 1.

General Requirements:

Use the following information to ensure successful completion of the assignment:

SAMPLE CHAPTER 3 METHODOLOGY (ATTACHED)

· Locate the “DPI Proposal Template” in the PI Workspace of the DC Network. ATTACHED

· Locate the 10 Strategic Points Final Draft assignment completed earlier in this course. ATTACHED

· Doctoral learners are required to use APA style for their writing assignments.

· You are required to submit this assignment to LopesWrite.

Directions:

Use the “DPI Proposal Template” and the “10 Strategic Points Final Draft” document, to develop a draft of (Chapter 3) Methodology that describes the methodology you are utilizing in your DPI Project Proposal. Sections in Chapter 3 include:

1. Chapter 3 Methodology

2. Introduction and Statement of the Problem

3. Clinical Question(s)

4. Project Methodology

5. Project Design

6. Population and Sample Selection

7. Instrumentation

8. Validity

9. Reliability

10. Data Collection Procedures

11. Data Analysis Procedures

12. Ethical Considerations

13. Limitations

14. Summary

Most patients with mental health disorders are not aggressive. However, it is important for nurses to be able to know the signs and symptoms associated with the five phases of aggression, and to appropriately apply nursing interventions to assist in treating aggressive patients. Please read the case study below and answer the four questions related to it.

Aggression Case Study

Christopher, who is 14 years of age, was recently admitted to the hospital for schizophrenia. He has a history of aggressive behavior and states that the devil is telling him to kill all adults because they want to hurt him. Christopher has a history of recidivism and noncompliance with his medications. One day on the unit, the nurse observes Christopher displaying hypervigilant behaviors, pacing back and forth down the hallway, and speaking to himself under his breath. As the nurse runs over to Christopher to talk, he sees that his bedroom door is open and runs into his room and shuts the door. The nurse responds by attempting to open the door, but Christopher keeps pulling the door shut and tells the nurse that if the nurse comes in the room he will choke the nurse. The nurse responds by calling other staff to assist with the situation.

1. What phase of the aggression cycle is Christopher in at the beginning of this scenario? What phase is he in at the end the scenario? (State the evidence that supports your answers).

2. What interventions could have been implemented to prevent Christopher from escalating at the beginning of the scenario?

3. What interventions should the nurse take to deescalate the situation when Christopher is refusing to open his door?

4. If a restrictive intervention (restraint/seclusion) is used, what are some important steps for the nurse to remember?

SCHOLAR NURSING ARTICLE>>>APA FORMAT>>>

Setting:    

You have been given some startling news! Upon entering your office as the new assistant director of the Food and Agricultural Organization (FAO), you are confronted with the following headline:

“Global citrus crop devastated by lack of bee pollination!!”

(That’s okay by me, I don’t eat honey anyway…you might think.)

The crops immediately affected are the following:

Lemon          Lime              Orange                  Grapefruit

You are faced with a serious problem! Using your brain, whit, and possibly charm, find out what other alternative crops will be used to supply the global vitamin C need.

1.  List four alternative crops that provide an equivalent amount of vitamin C, fiber, and carbohydrates as the citrus listed above.

2.  Describe how these sources will be produced and distributed. If they don’t exist, or not in sufficient numbers, then tell me how you intend to solve that problem too!

1. List the nutrient content of the four food sources you choose and compare them to the ones listed above.

Post a summary of the psychotherapy that you selected and explain why it resonates with you the most at this time. Then compare the psychotherapy you selected with existential-humanistic therapy. What are the strengths and challenges of each type of psychotherapy? Describe a fictional client that you think would be best suited for the therapy you selected and one fictional client you think would be best suited for existential-humanistic therapy. Explain why.

More details to come. Will send 2 classmates posts to respond to (due 10/24) 

Please watch the video and answer the following questions:

• Did this video change your opinion on suicide?
• What did the video teach you about suicide?
• When completing an initial assessment for a client with suicidal ideation, what are the most important pieces of information that should be captured?

VIDEO LINK>>>>>  https://youtu.be/WcSUs9iZv-g

use apa format with scholarly nursing article

summarise the attached article on one page.