Your presentation must include the following components:

• Your Preferred/desired specialty (nurse PractitionerNurse)
• Description of the specialty
• The education required for the specialty
• Professional organizations that are available in your specialty
• The target population for the specialty, their needs, and comorbidities
• The availability of your specialty in your community and the mission of the organizations (I live in Minnesota)
• Describe and discuss culturally competent care and/or developmental competence within the client population
• Explain how each of the QSEN competencies (patient-centered care, teamwork and collaboration, evidence-based practice, informatics, quality improvement, and safety) are utilized throughout your specialty or with the target population
• Create a scenario within your specialty, include 2-3 questions for the class to answer
• Create a SMART goal related to your specialty’s main  goal

include APA reference citation as indicated

my specialty of interest is Nurse Practitioner, and live in Minnesota 

Read and watch the lecture resources & materials below early in the week to help you respond to the discussion questions and to complete your assignment(s).

Read

• Meiner, S.E., Yeager, J.J. (2019).
  • Chapter 9
    Chapter_009.pptx
  • Chapter 10
    Chapter_010.pptx
  • Chapter 11
    Chapter_011.pptx
  • Chapter 12
    Chapter_012.pptx
  • Chapter 13
    Chapter_013.pptx
  • Chapter 14
    Chapter_014.pptx

Watch

None.

Supplemental Materials & Resources

• The Power of One (Links to an external site.)
  Parker, F. (2007). Ethics: The power of one. The Online Journal of Issues in Nursing, 13(1). http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Columns/Ethics/Power.html

• Visit the CINAHL Complete under the A-to-Z Databases on the University Library’s website and locate the article(s) below:
  1. Parks, E. J. (2012). An integrated ethical decision-making model for nurses. Nursing Ethics, 19(1), 139-159.

After studying Module 3: Lecture Materials & Resources, discuss the following:

• Describe and discuss the pathological conditions that might affect the sexual responses in older adults.
• How and why do you think Nutritional factors, psychological factors, drugs and complementary and alternative medications affect the immune system in older adults.

Submission Instructions:

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

When you decide to purchase a new car, you first decide what is important to you. If mileage and dependability are the important factors, you will search for data focused more on these factors and less on color options and sound systems.

The same holds true when searching for research evidence to guide your clinical inquiry and professional decisions. Developing a formula for an answerable, researchable question that addresses your need will make the search process much more effective. One such formula is the PICO(T) format.

In this Discussion, you will transform a clinical inquiry into a searchable question in PICO(T) format, so you can search the electronic databases more effectively and efficiently. You will share this PICO(T) question and examine strategies you might use to increase the rigor and effectiveness of a database search on your PICO(T) question.

To Prepare:

• Review the materials offering guidance on using databases, performing keyword searches, and developing PICO(T) questions provided in the Resources.
• Review the Resources for guidance and develop a PICO(T) question of interest to you for further study.

Antipsychotic Therapy Case Study 

Psychosis is a mental health condition that manifests in the case of patients experiencing episodes of hallucinations as described by Saha, et al. (2016). Patients with the psychotic conditions may hear or see things that do not exist in real life. Psychosis may result from bipolar condition, the schizophrenia or personality disorder condition besides occurring even in the absence of these conditions. The pharmacological treatment of the psychosis is through the use of the antipsychotic medications (Opler, Yavorsky, & Daniel, 2017). Antipsychotic drugs are used to treat several types of mental health disorders such as the dementia, major depression condition schizophrenia and schizoaffective disorder. The process of developing suitable features that would be associated with the increase in the quality of healthcare. antipsychotics occur in two types; first generation antipsychotics and second generation antipsychotics. Second generation antipsychotics were introduced to the market after the 1990s and are known to have less side effects as compared to the first generation types as agreed by Opler, Yavorsky, and Daniel, (2017). This paper discusses the choice of antipsychotic treatment for managing the presented case study. The rationale for selecting the medication and the expected impact of the medication is also discussed in this case. 

Decision #1

Start Invega Sustenna 234 mg intramuscular X1 followed by 156 mg intramuscular on day four and monthly thereafter.

Rationale for Choice

The patient differential diagnosis is schizophrenia paranoid type. The presented antipsychotic medication options are all second generation antipsychotics (Saha, et al. 2016). All the conditions could be considered to have similar effectiveness in the management of the patient condition. The patient is middle aged adult and thus the limitation due to the elderly sides effects do not apply in all the presented options. The patient is presented to have stopped the use of the Risperdal and thus indicating the signs of non-adhering to medication instructions. Thus the most appropriate choice would be to have an intravenous medication. From the provided options, the other two are orally administered while Invega Sustenna is intravenous. 

Expected Outcome

The patient condition is expected to respond positively the PANSS positive score is expected to increase by at least 30% after the four weeks’ period. The PANSS negative score is also expected to reduce by the at least 25% while the composite scale score is expected to improve by at least 25% (Opler, Yavorsky, & Daniel, 2017). The episodes of hallucination are also expected to have reduced significantly over the period as a response to the medication. The frequency of the signs of paranoid condition will also be expected to have reduced. Considering the positive responses to the treatment, the patient would also be expected to be tolerant to the medication. 

Variation Between Actual Outcome and the Expected Outcome

After the four weeks, the patient returns to office for the appointment. The patient presented a 25% reduction in the negative PANSS score. The patient is also observed to be tolerate to the medication considering that she managed to turn up for the injection appointment. The PANSS positive score had not improved by the expected 30% and the composite score had also not improved by the expected 25%. The patient had gained 2 pounds within the four weeks and this was also not expected. This could be attributed to the side effects of using the medication as explained by Spertus, et al. (2018) The other unexpected patient experience was the pain at the injection site that made the patient to stay without the sitting for hours. 

Decision #2

Continue Invega Sustenna. Begin injections into the deltoid and add on Abilify Maintena 300 mg intramuscular monthly with oral Abilify 10 mg in the MORNING for 2 weeks 

Rationale for Choice

The patient has proved to be positively responsive to the medication as the has been a 25% reduction in the PANSS negative score. Thus in order to obtain continuously positive responses, the patient should continue with the medication. The patient has also proved to be tolerant to the medication and thus making it a suitable option (Keks, Schwartz, & Hope, 2019). One of the side effects of using the Invega Sustenna is that it may cause weight gain and thus explains the 2 pound gained by the patient within the short period. The additional Abilify Maintena 300 mg intramuscular monthly with oral Abilify 10 mg orally every morning is aimed at increasing the rate of response. Since this is reversible, the patient should not be bothered. In order to address the issue of the pain at the injection site, the injection will be done on the deltoid. Deltoid injection would not deny the patient to sit down despite the pain. 

Expected Outcome

 Continuous use of Invega Sustenna is expected to further improve the condition of the patient. The PANSS negative score is also expected to reduce by 50% within the next four weeks. The PANSS positive score is also expected to increase by at least 50% before the next appointment. The hallucination symptoms are expected to continuously increase due to the additional Abilify Maintena. Since the deltoid injection will be adopted, the patient is not likely to complain of the pain that affected her sitting down for several hours after the injection (Saha, et al. 2016). One of the side effects that will be expected is the weight gain of an additional 1 to 2 pounds by the next visit. 

Variation Between Obtained outcome and the Expected Outcome

 After the next four weeks the patient was punctual to honor the appointment and thus indicating a high level of compliance. The PANSS negative score had reduced by 50% just as it had been anticipated. The patient condition had indicated high rate of responsiveness and this was encouraging. The frequency of hallucinations had reduced significantly as well as the paranoid nature. The aspect of weight gain increased beyond the expected outcome. The patient had gained 2.6 pounds over the four weeks. The other unexpected conditions that developed as was that the patient had developed salivary gland disorder besides the stiffening of feet. The patient had failed to complied to the oral medication instructions. 

Decision #3

Discontinue Abilify. Continue with the Invega Sustenna

Rationale for Decision

The discontinuation of the Abilify medication is due to the fact that the patient experienced more side effects from using this drug. The continuation with the use of Invega Sustenna based on the fact that the patient had consistently responded positively at the initial stage (Keks, Schwartz, & Hope, 2019). The patient had also experienced limited side effects since the only side effect was weight gain. Patient education on the approach to cope to normal life will also be made to accompany the injection. 

Expected Patient Outcome

 With the last four weeks of treatment period, the patient negative PANSS score would be expected to have reduced by 80%. The patient is also expected to be 100% tolerant to the medication as at this time, she will have adopted to the medication. The patient is expected to experience at most two episodes of hallucinations (Saha, et al. 2016). The patient is also expected to gain up to 4 pounds within the period of four weeks. The patient is also expected to further honor appointments with the assistance of the husband has they have been in the past appointments. The salivary gland disorder is also expected to stop after the four weeks. 

Variation Between Obtained outcome and the Expected Outcome

 The PANSS negative score had reduced by 75% contrary to the expected 80% reduction. The salivary glands had reduced by 75% while the patient had also gained 1.5 pounds within the four weeks. The patient was 100% compliant to the treatment and thus patient education was also provided at the period. The patient education will be targeted to improve further adherence to the medication instructions. 

Impact of Ethical Consideration on the Treatment Approach

 The treatment of psychotic health conditions should be considerate of the ethical factors for the improvement of the patient condition as elaborated by Hunt-Grubbe, (2020). The decisions made by the PMHNP should align to the ethical requirements. The aspect of the informed consent was strongly adhered to in the process of providing treatment to the patient. With the consideration of the patient religion, the hallucination of being Prophet Mohamed was also handled with adherence to the required ethics. The aspect of being paranoid was also addressed with ethical caution in order to avoid victimization of the husband. The false stigma due to her religion and ethnicity was also handled with consideration of ethics as the patient demonstrated possibility of false stigmatization. 

Summary

Antipsychotic treatments could be considered to be the most critical procedure that should be adhered to steadily. Critical thinking should also be applied when selecting the antipsychotic medication during the treatment plan. Response to treatment should be monitored at every appointment so as to determine whether to change the treatment approach. Ethical consideration should also be adhered to so as to maintain autonomy throughout the treatment process. Informed consent on the choice of antipsychotics is also important throughout the process. In the situation where the patient is from a different religious and cultural background, the PMHNP should always focus to maintain a suitable relationship with the patient. 

References

Hunt-Grubbe, H. (2020). Ethical Issues Arising from the Prescription of Antipsychotic Medication in Clinical Forensic Settings. In Ethical Issues in Clinical Forensic Psychiatry (pp. 99-114). Springer, Cham.

Keks, N., Schwartz, D., & Hope, J. (2019). Stopping and switching antipsychotic drugs. Australian Prescriber, 42(5), 152.

Opler, M., Yavorsky, C., & Daniel, D. G. (2017). Positive and Negative Syndrome Scale (PANSS) Training: Challenges, Solutions, and Future Directions. Innovations in clinical neuroscience, 14(11-12), 77–81.

Saha, K. B., Bo, L., Zhao, S., Xia, J., Sampson, S., & Zaman, R. U. (2016). Chlorpromazine versus atypical antipsychotic drugs for schizophrenia. Cochrane Database of Systematic Reviews, (4). 

Spertus, J., Horvitz-Lennon, M., Abing, H., & Normand, S. L. (2018). Risk of weight gain for specific antipsychotic drugs: a meta-analysis. NPJ schizophrenia, 4(1), 1-7.

 Respond to  your colleagues by constructively critiquing their interview format and providing feedback. 

                                                    Main Post

Interview Format

         The attached interview format is a combination of components from  interview formats used at current and previous practicum sites, as well  as a few additional elements that are important to consider.  For older  clients with diminished capacity, it is may be more appropriate to  obtain some information from caregivers or spouses accompanying the  client.  Additionally, older clients will require a functional  assessment of ADLs through questions and observations (American  Psychological Association, 2008).  Furthermore, clients that are  difficult to assess due to being too symptomatic may require information  gathering from family or others involved in the client’s care.  For  example, during a previous practicum experience, a client was very  disorganized and psychotic.  He verbally agreed to have information  discussed with his family, who was in the waiting room, and they  provided important background information for the interview.  

Interview Format Used by Preceptor

         The interview used by the current preceptor generally follows the  same format with some additional information.  The current practicum  site is at a VA facility.  Thus, part of the initial interview involves  gathering information regarding clients’ military histories, including  years of service, job title, type of discharge, and whether they were  deployed to combat zones.  Another important component of an interview  with veterans is whether they were victims of military sexual trauma  (MST) (Military Sexual Trauma, n.d.).  Additionally, these  clients are evaluated in the emergency room to determine whether they  require inpatient treatment.  Each client undergoes a physical exam and  requires medical clearance from the emergency room physician.  Another  piece of information included at the beginning of the evaluation  specifies whether the client is admitted under voluntary or involuntary  status.

Most Helpful Element of the Interview Format 

         All of the interview format elements are essential to developing a  case formulation and appropriate treatment plan.  The most important  aspect of an initial interview is how the PMHNP approaches the client.   The PMHNP should approach clients directly and calmly and allow clients  to tell their stories to help build rapport (Sadock et al., 2014,  Chapter 5.1).  Positive client-practitioner interactions, especially  upon meeting, can significantly impact the amount of information  disclosed from clients needed to conduct thorough evaluations and create  treatment plans.

Initial Interview Format .pdf 

References

American Psychological Association. (2008). Assessment of older adults with diminished capacity. https://doi.org/https://www.apa.org/pi/aging/programs/assessment/capacity-psychologist-handbook.pdf

Military sexual trauma. (n.d.). U.S. Department of Veterans Affairs. Retrieved November 29, 2020, from https://www.mentalhealth.va.gov/msthome/index.asp

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Wolters Kluwer.

Anyone can do this for $20

In this assignment, you will review the interactive Endocrine Thyroid Case Study patient scenario and analyze the data to determine the health status of the patient. You will need a minimum of two evidence-based practice articles to include clinical practice guidelines, as well as the course textbook.

• Use the NU641 Endocrine Thyroid Case Study Questions (Word) document to complete the case study assignment.
• Follow the requirements posted in the rubric.
• This case study should be three to five pages, excluding title and references pages.

All papers must conform to the most recent APA standards.

RUBRIC

Clinical Case Study Rubric

Note: Scholarly resources are defined as evidence-based practice, peer-reviewed journals; textbook (do not rely solely on your textbook as a reference); and National Standard Guidelines. Review assignment instructions, as this will provide any additional requirements that are not specifically listed on the rubric.

Clinical Case Study Rubric – 100 PointsCriteriaExemplary
Exceeds ExpectationsAdvanced
Meets ExpectationsIntermediate
Needs ImprovementNovice
InadequateTotal PointsContent of Clinical Case StudyThe writer demonstrates a well-articulated understanding of the case study subject matter in a clear, complex, and informative manner. The case study content and theories are well developed and linked to the course content, assignment requirements, and practical experience. The case study includes relevant material that fulfills all objectives of the assignment.

Cites three or more references, using at least one new scholarly resource that was not provided in the course materials.

all instruction requirements noted

30 pointsThe writer demonstrates an understanding of the subject matter, and the components of the case study are accurately represented with evidence-based practice, ethics, theory, and/or role content. Course materials and scholarly resources are present to support required concepts. The paper includes relevant material that fulfills all objectives of the case study.

Cites two references.

Most instruction requirements are noted.

26 pointsThe writer demonstrates a moderate understanding of the subject matter. as evidenced by components of the case study and use of evidence-based practice, theory, or role-development. Course content is present but missing depth and or development.

Cites one reference.

23 pointsAbsent application to evidence-based practice, theory, or role development.

Demonstrates incomplete understanding of content and/or inadequate preparation.

Significant content of case study is vague, inaccurately portrayed, or missing.

No references cited.

Submits assignment late.

20 points30Analysis and Synthesis of Case Study Content and Meaning with Content Related to Preventative GuidelinesThrough critical analysis, the submitted case study provides an accurate, clear, concise, and complete summary of the scenario.

Information from scholarly resources is synthesized, providing new information or insight related to the context of the assignment by providing both supportive and alternative information or viewpoints

Includes all major and minor relevant risk factors based on standard preventative guidelines for age and gender and treatment/follow-up plans.

all instruction requirements noted.

30 pointsCase study is complete, providing evidence of further synthesis of course content via scholarly resources.

Information is synthesized to help fulfill the case study requirements. The content supports at least one viewpoint.

Submission provides clarification of the assignment by correctly answering all posed questions within the instructions.

Includes all major risk factors and most minor relevant risk factors based on standard preventative guidelines for age and gender (i.e.’ to two minor risk factors are missing and/or one incorrect treatment plan).

Most instruction requirements are noted.

26 pointsLacks clarification or new information. Scholarly reference supports the content without adding any new information or insight. Case study content may be confusing or unclear, and the summary may be incomplete.

Risk factors are partially complete (i.e., missing one to two major risk factors or three to four minor risk factors, or two incorrect treatment plans).

Missing some instruction requirements.

23 pointsSubmission is primarily a summation of the assignment without further synthesis of course content or analysis of the scenario.

Demonstrates incomplete understanding of content and/or inadequate preparation.

Multiple risk factors missing (e.g., three major risk or five to six minor risk factors or three incorrect treatment plans, or four or more major risk factors or seven or more minor risk factors or four or more incorrect treatment plans).

Scholarly reference(s) are incorrect or inappropriate for the topic case.

Missing several instruction requirements.

Submits assignment late.

20 points30Application of Knowledge To Clinical Aspect of Patient EncounterThe summary of the case study provides validated information via scholarly resources that offer a multidisciplinary approach to the scenario provided.

The student’s application in practice is accurate and plausible, and additional scholarly resources supporting the application are provided.

all questions posed within the assignment are answered correctly in a well-developed manner, applying knowledge with citations for validation.

Includes all relevant subjective and objective data; diagnostic testing; routine care to be provided; patient education; anticipatory guidance; review of previous diagnostics; and follow-up of acute concern and chronic health issues, etc.—based on assignment instructions.

all instruction requirements noted.

30 pointsA summary of the study, findings, and knowledge gained from the assignment is presented.

Student indicates how the information will be used within their professional practice.

all questions posed by the study are answered correctly.

Includes most of the routine content (subjective and objective data; diagnostic testing; routine care to be provided; education; anticipatory guidance; review of previous diagnostics; and follow-up) (is missing two minor details or one major detail).

Most instruction requirements are noted.

26 pointsComponents of the case study are summarized with minimal application to evidence-based practice, theory, or role development, thus presenting a more superficial analysis of content between the assignment and the broader course content. Synthesis of course content is present but missing depth and or development.

Student’s explanation of how the information will be used within their professional practice is vague or incomplete.

One of the questions posed is not answered and/or one of the questions is answered incorrectly.

Includes some of the routine content (subjective and objective data; diagnostic testing; routine care to be provided; education; anticipatory guidance; review of previous diagnostics; and follow-up) (is missing three minor details or two major details).

Cited one reference.

Missing some instruction requirements.

23 pointsAbsent application to evidence-based practice, theory, or role development. Synthesis of course content is superficial.

Demonstrates incomplete understanding of content and/or inadequate preparation.

Content of case study is inaccurately portrayed or missing.

Student’s explanation of how the information will be used within their professional practice is not feasible or appropriate, or student fails to explain how the information will be used within their personal practice.

Omits routine content (subjective and objective data; diagnostic testing; routine care to be provided; education; anticipatory guidance; review of previous diagnostics; and follow-up) (is missing four to five minor details or three major details or six or more minor details or four or more major details.

Two or more questions are not answered and/or are answered incorrectly.

No references cited.

Missing several instruction requirements.

Submits post late.

20 points30OrganizationWell-organized content with a clear and complex purpose statement and content argument. Writing is concise, with a logical flow of ideas.

5 pointsOrganized content with an informative purpose statement, supportive content, and summary statement. Argument content is developed, with minimal issues in content flow.

4 pointsPoor organization and flow of ideas distract from content. Narrative is difficult to follow and frequently causes reader to reread work.

Purpose statement is noted.

3 pointsIllogical flow of ideas. Prose rambles. Purpose statement is unclear or missing.

Demonstrates incomplete understanding of content and/or inadequate preparation.

No purpose statement.

Submits assignment late.

2 points5APA, Grammar, and SpellingCorrect APA formatting with no errors.

The writer correctly identifies reading audience, as demonstrated by appropriate language (avoids jargon and simplifies complex concepts appropriately).

Writing is concise, in active voice, and avoids awkward transitions and overuse of conjunctions.

There are no spelling, punctuation, or word-usage errors.

5 pointsCorrect and consistent APA formatting of references and cites all references used.

No more than two unique APA errors.

The writer demonstrates correct usage of formal English language in sentence construction. Variation in sentence structure and word usage promotes readability.

There are minimal to no grammar, punctuation, or word-usage errors.

4 pointsThree to four unique APA formatting errors.

The writer occasionally uses awkward sentence construction or overuses/inappropriately uses complex sentence structure. Problems with word usage (evidence of incorrect use of thesaurus) and punctuation persist, often causing some difficulties with grammar. Some words, transitional phrases, and conjunctions are overused.

Multiple grammar, punctuation, or word usage errors.

3 pointsFive or more unique formatting errors, or no attempt to format in APA.

The writer demonstrates limited understanding of formal written language use; writing is colloquial (conforms to spoken language).

The writer struggles with limited vocabulary and has difficulty conveying meaning such that only the broadest, most general messages are presented.

Grammar and punctuation are consistently incorrect. Spelling errors are numerous.

2 points5Total Points100 

PLEASE FOLLOW THE INSTRUCTIONS BELOW

4 REFRENCES

ZERO PLAGIARISM

, you collaborated with colleagues as you participated in your first clinical supervision. This week, you have the opportunity to continue your collaboration as you reflect on and discuss your experiences with counseling children and adolescents in group settings. Psychotherapy with these clients is often more complex than psychotherapy with the general adult population. Personal reflection and discussion with colleagues are essential to your development and success as a psychiatric mental health nurse practitioner. For this clinical supervision, consider a child or adolescent client you are counseling who you do not think is adequately progressing according to expected clinical outcomes.

Learning Objectives

Students will:

• Assess clients presenting for child and adolescent group psychotherapy
• Evaluate the effectiveness of therapeutic approaches for clients receiving child and adolescent group psychotherapy

To prepare:

• Review this week’s media and consider the insights provided on group therapy with children and adolescents.
• Reflect on a child and adolescent group that you are currently counseling at your practicum site.

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 you cannot post anonymously. Please check your post carefully before clicking Submit!

Note about Uploading Media: Refer to the Kaltura Media Uploader instructions document located in the menu bar. It provides guidance on how to upload media for the Clinical Supervision Discussions.

By Day 3

Post a 3- to 5-minute Kaltura video that addresses the following:

• Describe a child and adolescent group you are counseling.
• Describe a client from the group who you do not think is adequately progressing according to expected clinical outcomes. Note: Do not use the client’s actual name.
• Explain your therapeutic approach with the group, including your perceived effectiveness of your approach with the client you identified.
• Identify any additional information about this group and/or client that may potentially impact expected outcomes.

colon assessment

This week’s assignment is STEP 2 – Project Purpose Statement, Background & Significance and PICOt Formatted Clinical Project Question.

The student will answer the items below in a Word doc and submit to the assignment link.

1. Provide a title that conveys or describes the assignment.
2. Project Purpose Statement – Provide a declarative sentence or two which summarizes the specific topic and goals of the project.
3. Background and Significance – State the importance of the problem and emphasize what is innovative about your proposed project. Discuss the potential impact of your project on your anticipated results to the betterment of health and/or health outcomes.
4. PICOt formatted Clinical Project Questions – Provide the Population, Intervention, Comparison, Expected Outcomes and timeframe for the proposed project.
5. References – Cite references using APA 7th ed format.
6. 5 pages.

my PICO formatted project question is Question: On a medical-surgical hospital unit (P), how does implementing hourly nursing rounding (I), compared to no scheduled rounding (C), affect patient safety (O), within 6 months of implementing (T)?