Working With Children and Adolescents Versus Adults

 PLEASE FOLLOW THE INSTRUCTIONS BELOW

4 REFERENCES

ZERO PLAGIARISM

Infant, childhood, and adolescent development are a continual interplay between nature (genetic or biologic predisposition) and nurture (environmental experiences). The nature/nurture continuum and debate will always be a part of your career as a PMHNP.  Knowing common developmental milestone is important in the role as a child provider. Not only is it essential to the diagnostic process, but it is also important to the interdisciplinary interactions with other mental health professionals. The study of normal developmental processes, however, is only one tool that allows the mental health professional to understand the child being evaluated. There are many different assessment instruments and interviewing techniques that PMHNPs can have in their toolkit when working with children and adolescents.

In this Discussion, you examine the differences in assessing and treating children and adolescents versus adults. You take into consideration your own clinical experiences, as well as your experiences in your clinical rotation, and the information from the readings thus far.

Learning Objectives

Students will:
  • Analyze the importance of developmental assessments
  • Analyze assessment instruments used for evaluating children and adolescents
  • Analyze treatment options used for children and adolescents
  • Analyze roles parents play in assessment and treatment

To Prepare for the Discussion

  • Review the Learning Resources concerning psychiatric assessments and assessment tools.

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 your answers to the following:

  • Explain why a developmental assessment of children and adolescents is important.
  • Describe two assessment instruments and explain why they are used for children and adolescents but not adults. 
  • Describe two treatment options for children and adolescents that may not be used when treating adults.
  • Explain the role parents play in assessment and treatment.

Peer Response Post, 2 References APA, Less 5% Similarities

SOAO Note

Patient Initials: S.M

Pt. Encounter Number: 2                                             

Date: 10/12/2020

Age: 61

Sex: Female

Allergies: NKA

Advanced Directives: No

SUBJECTIVE

Chief Complaint: “I have a lump on my right breast.”

HPI: S.M is a 61-year-old, Hispanic, female who presents to the office alarmed by a painful lump in her right breast that she discovered while showering. S.M reports the pain started 2 days ago while in the shower. The pain is felt when touching the right breast, and it felt on light touch. Current pain level is now 5/10. She does not report any skin changes. Patient denies any history of herbal medicine use and is currently on no medication. Pain gets worse with movement and with lifting weight. Pain is relieved with rest and medication. S.M gets some short relief with pain reliever ibuprofen 200mg that she takes twice a day for the past two days.

Past Medical History

Medication Intolerances: No known drug intolerance

Chronic Illnesses/Major traumas: The patient denies any history of major trauma.

Screening Hx/Immunizations Hx: last mammogram, which was normal, was 2 years ago.

OBGYN: Menarche at 10; LMP 2 weeks ago; last PAP 2019/Normal; GTPAL: 11001 score; no previous history of STDs. S.M is sexually active, have had 2 sexual partners in the past. S.M used condoms with previous partners. No previous gyn diagnoses or procedures done in the past.

Hospitalizations/Surgeries: Hospitalized once for delivery

Family History: There is no history of malignancy in first-degree relatives. She has one sister, age 58, who is in good health. Mother died at age 70; father died at age 64, from unknown causes.

Social History: S.M is married with one child. No use of alcohol; drinks wine socially; drinks one cup of coffee sometime to start her day at work. Never uses drugs.

Review of System

Constitutional: No significant gain/loss weight, no chills, no malaise or fatigue; no night sweats, no exercise intolerance. She does not report any skin changes. She has not experienced fever, weight loss, headache, nausea, vomiting, dizziness, or bone pain.

Skin: Denies rashes, pigmentation changes, lesions, or hair or nail changes.

Eyes: denies vision changes, diplopia, blurred vision, reports wearing eyeglasses.

Ears: Denies loss of hearing, ear pain, drainage, sensation of ears feeling full, ringing in the ear, or ear trauma.

Nose/Mouth/Throat: Denies sore throat, hoarseness, difficulty swallowing, postnasal

drip. No report of mouth or lips sore, bleeding gums, ulcerations or lesions of tongue or

mucosa; no dentures or dental appliances, or missing teeth reported.

Breast: Refers to right breast pain, or discomfort to right breast. Reports some brownish nipple discharges when squeezing the nipple and denies any breast trauma.

Heme/Lymph/Endo: Denies history of anemia, no bruising, no abnormal bleeding, and no swollen glands.

Cardiovascular: Denies chest pain, palpitations, orthopnea, edema, claudication, murmurs, or history of cardiac disease.

Respiratory: S.M reports no cough, sputum, wheezing, no recurrent URIs, hemoptysis,

 bronchitis, pneumonia, or history of TB.

Gastrointestinal: Patient denies abdominal pain, nauseas, or vomiting. Denies bloating,

 flatulence, diarrhea, constipation, changes in stools; black tarry stools, or bright rectal

 bleeding after defecation. S.M reports normal appetite.

Genitourinary/Gynecological: denies dysuria, frequency, urgency, and urge to urine after she had emptied her bladder. Denies nocturia, or hematuria; denies genital discharge, or sensation of bladder fullness; no abnormal bleeding, and no history of STD.

Musculoskeletal: No muscular aches or weakness, no arthralgia, denies history of falls, no loss of balance.

Neurological: Denies changes in LOC, Denies history of tremors, seizure, weakness, numbness, dizziness, headaches, memory lapses or loss. Denies sleep disturbances.

Psychiatric: Denies hallucination, depression, or any thoughts to harm self or others. Also denies psychosocial, or emotional disorder at this point in time.

OBJECTIVE

Vital Signs: BP: 130/78, P: 74, R18; T: 97.3; O2 Sat: 99 %. Wt.: 170 lb. Ht. 5’5″, BMI: 28.29.

Physical Examination

General Appearance: S.M is awake, alert, and oriented to time, space, and person. Speaks clearly and follows simple commands. Well nourished, developed and dressed/groomed, pleasant demeanor. Appears to be without discomfort, does not look distressed.

Skin: Normal general appearance. Warm, moist, good skin turgor. No cyanosis, rashes, or lesions noted. No wound, no change in a mole, no unusual growth, no jaundice, no bruising, no bleeding.

HEENT: Head: Is normocephalic, atraumatic, and without lesions. No tenderness elicited on palpation with both temporal pulses being regular.

Eyes: Are normal with PERRLA; with pinkish conjunctiva and whitish sclera implying no jaundice or anemia.

Ears: There is mild cerumen on external auditory meatus; tympanic membranes are also intact and pearly gray in color, with presence of light reflex.

Nose and sinuses: The patient has moist nasal mucosa with no drainage and mid sagittal septum. External nares are patent, and frontal and maxillary sinuses non-tender on palpation.

Mouth: The patient has a good oral hygiene. The lips, gums, tongue, and hard palate are normal, with all teeth intact with no discolorations. The oropharynx is moist and pinkish with no apparent enlargement of the tonsils (Hollier, 2016).

Neck: The assessment depicts no apparent tracheal deviation, without thyroid and lymph nodes not palpable. All movements are normal.

Cardiovascular: The anterior chest wall is symmetrical with AP diameter less than lateral diameter. Both S1 and S2 heard on auscultation at all valve areas with no added sounds. The apex beat at fifth intercostal space, mid clavicular line, with neither heaves nor thrills. Capillary refill is 2 second, with pulses 3+ throughout and no edema.

Respiratory: Unlabored respiration, lungs are clear bilaterally to auscultation. Breath sounds are normal on auscultation.

Gastrointestinal: Abdomen is soft, no rebound tenderness, masses, scars, herniation, or guarding. Bowels sound present to all 4 quadrants, no organomegaly, or bruits. No sign of active GI bleed.

Breast: There are no visible abnormalities on sitting or supine exam. Left breast and axilla are normal. Right breast with about 2 cm tender hard, color changed, immobile lesion with irregular borders, in superior lateral quadrant approximately 6 cm from areola. There is no palpable axillary, or supra-clavicular lymph nodes.

Genitourinary: The kidney was bimanually not palpable and non-tender, no sign of costo-vertebral angle tenderness. The bladder was not distended and devoid of urine prior to examination (Hollier, 2016).

Musculoskeletal: Full range of motion in all extremities. No abnormalities in gait or movement.

Neurological: Alert, oriented to time, place and person, Neurologic grossly intact. Memory to recent and remote events preserved. Sensation intact and preserved strength to bilateral upper and lower extremities.

Psychiatric: Patient has good judgment; mood and affect are normal. No anxiety, or depression, no irritability, and no mood swing.

Lab Tests: U/A, and C/S, no growth, WBC 5.6 and H/H 9.5/31(July 2020).

Special Tests: Last mammogram 2019/ negative; Pap smear 2018/normal

Diagnosis

C50.9- Breast cancer– Patient presents to the clinic and alarmed by a painful lump in her right breast that she discovered while showering. The reported symptoms and signs noted on physical examination suggest findings of breast carcinoma which can be justified with a mammogram and other studies (Burstein, Lacchetti, & Griggs, 2016).

Differential Diagnoses–

N64.89- Galactocele– Patient presents to her clinic alarmed by a painful lump in her right breast that she discovered while showering (Burstein, Lacchetti, & Griggs, 2016).

N60.0- Breast cyst– The patient presents to her internist alarmed by a painful lump in her right breast. Tender breast lumps are a common presentation and could point out to a wide variety of diseases. As such, it is necessary to conduct a detailed history to come up with a detailed diagnosis. On the case of S.M, histology would be of great significance to come up with a definitive diagnosis. (Burstein, Lacchetti, & Griggs, 2016).

N64.4- Mastodynia- S.M shows sign and symptom of breast tenderness of unknown cause which requires further investigation.

PLAN and education

Test: Bilateral breast mammography and Right breast U-S

Ultrasound-guided ultrasonography for histology to confirm breast cancer

Medications: Ibuprofen 400mg PO as needed TID for pain for 10 days.

Non-pharmacological treatments: applied warm compress as tolerated daily; and practice aerobic exercise for at least 1 hour a day and three days in a week for overweight to manage weight. (Hollier, A. (2016)

Education: The patient is to be educated on taking the prescribed medication and the associated side effects (Burstein, Lacchetti, & Griggs, 2016).

Beware of Ibuprofen side effects: heartburn, stomach pain, nausea, gas, and constipation (Healthline.com)

Referrals: None for now, pending Mammogram and U-S results.

Follow: Patient to come back to the clinic in 1week for histological results.

References:

Burstein, H. J., Lacchetti, C., & Griggs, J. J. (2016). Adjuvant Endocrine Therapy for Women    With Hormone Receptor–Positive Breast Cancer: American Society of Clinical Oncology      Clinical Practice Guideline Update on Ovarian Suppression Summary. Journal of oncology practice, 12 (4), 390-393.

Hollier, A. (2016). Clinical guidelines in primary care. Scott, LA: Advanced Practice     breastfeeding Associates

Mastitis (n.d). Miami Cancer Institute. Retrieved from

https://cancer.baptisthealth.net/miami-cancer-institute/cancer-care/treatments-and-

services/breast-cancer-prevention-clinic

Understanding How Ibuprofen works (n.d). Healthline. Retrieved from

https://www.healthline.com/health/pain-relief/ibuprofen-advil-side-effects

6026: Healthcare Issue

Assessment 1

  • PRINT
  • Analysis of Position Papers for Vulnerable Populations
  • Toggle DrawerOverview
    Develop a 4–6-page position about a specific health care issue as it relates to a target vulnerable population. Include an analysis of existing evidence and position papers to help support your position. Your analysis should also present and respond to one or more opposing viewpoints.
    Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, you must complete the assessments in this course in the order in which they are presented.
    Position papers are a method to evaluate the most current evidence and policies related to health care issues. They offer a way for researchers to explore the views of any number of organizations around a topic. This can help you to develop your own position and approach to care around a topic or issue.
    SHOW LESSThis assessment will focus on analyzing position papers about an issue related to addiction, chronicity, emotional and mental health, genetics and genomics, or immunity. Many of these topics are quickly evolving as technology advances, or as we attempt to push past stigmas. For example, technology advances and DNA sequencing provide comprehensive information to allow treatment to become more targeted and effective for the individual. However as a result, nurses must be able to understand and teach patients about the impact of this information. With this great power comes concerns that patient conditions are protected in an ethical and compassionate manner.
    By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

    • Competency 1: Design evidence-based advanced nursing care for achieving high-quality population outcomes. 
      • Evaluate the evidence and positions of others that could support a team’s approach to improving the quality and outcomes of care for a specific issue in a target population.
      • Evaluate the evidence and positions of others that are contrary to a team’s approach to improving the quality and outcomes of care for a specific issue in a target population.
    • Competency 2: Evaluate the efficiency and effectiveness of interprofessional interventions in achieving desired population health outcomes. 
      • Explain the role of the interprofessional team in facilitating improvements for a specific issue in a target population.
    • Competency 3: Analyze population health outcomes in terms of their implications for health policy advocacy. 
      • Explain a position with regard to health outcomes for a specific issue in a target population.
    • Competency 4: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with organizational, professional, and scholarly standards. 
      • Communicate an initial viewpoint regarding a specific issue in a target population and a synthesis of existing positions in a logically structured and concise manner, writing content clearly with correct use of grammar, punctuation, and spelling.
      • Integrate relevant sources to support assertions, correctly formatting citations and references using APA style.
    • Competency Map
      CHECK YOUR PROGRESSUse this online tool to track your performance and progress through your course.
  • Toggle DrawerContextPosition papers are a way for individuals, groups, and organizations to express their views and intentions toward a specific issue. In health care, many position papers address specific policies, regulations, or other approaches to care. As a master’s-prepared nurse, you should feel empowered to express and advocate for your own views on policy and care matters. This is especially important when it comes to populations you or your organization cares for that are not receiving the quality, type, or amount of care that they require.
    An important skill in creating a position paper or policy proposal is the ability to analyze and synthesize others’ views about the population or issue of interest to you. By synthesizing the positive and negative views of an issue, you can become better equipped to strengthen your own arguments and to respond to opposing views in an informed and convincing way.
  • Toggle DrawerQuestions to ConsiderAs you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.
    SHOW MORE
  • Toggle DrawerResourcesMSN Program Journey
    The following is a useful map that will guide you as you continue your MSN program. This map gives you an overview of all the steps required to prepare for your practicum and to complete your degree. It also outlines the support that will be available to you along the way.

  • Assessment InstructionsScenario
    Pretend you are a member of an interprofessional team that is attempting to improve the quality of health care and the outcomes in a vulnerable population. For the first step in your team’s work, you have decided to conduct an analysis of current position papers that address the issue and population you are considering.
    In your analysis you will note the team’s initial views on the issue in the population as well as the views across a variety of relevant position papers. You have been tasked with finding the most current standard of care or evidenced-based practice and evaluating both the pros and cons of the issue. For the opposing viewpoints, it is important to discuss how the team could respond to encourage support. This paper will be presented to a committee of relevant stakeholders from your care setting and the community. If it receives enough support, you will be asked to create a new policy that could be enacted to improve the outcomes related to your chosen issue and target population.
    The care setting, population, and health care issue that you use for this assessment will be used in the other assessments in this course. Consider your choice carefully. There are two main approaches for you to take in selecting the scenario for this assessment:

    1. You may use one of the issues and populations presented in the Vila Health: Health Challenges in Different Populations and Vila Health: Resources for Topical Research media pieces. For this approach, you may consider the population in the context of the Vila Health care setting, or translate it into the context in which you currently practice or have had recent experience.
    2. You may select a population and issue that is of interest to you and set them in the context of your current or desired future care setting. While you are free to choose any population of interest, the issue you choose should fall within one of the following broad categories:
      • Genetics and genomics.
        • Sickle cell, asthma, multiple sclerosis, myasthenia gravis.
      • Immunity.
        • Type 1 diabetes, systemic lupus erythematosus (SLE), congenital neutropenia syndrome.
      • Chronicity.
        • Arthritis, any type of cancer or lung or heart disease, obesity.
      • Addiction.
        • Abuse of alcohol, prescription drugs, tobacco, illegal substances.
      • Emotion and mental health.
        • Post-traumatic stress disorder (PTSD), depression, eating disorders, psychosis.
    3. Note: If you choose the second option, contact the FlexPath faculty for your section to make sure that your chosen issue and population will fit within the topic areas for this course.
      Instructions
      For this assessment you will develop a position summary and an analysis of relevant position papers on a health care issue in a chosen population. The bullet points below correspond to the grading criteria in the scoring guide. Be sure that your submission addresses all of them. You may also want to read the Analysis of Position Papers for Vulnerable Populations Scoring Guide and Guiding Questions: Analysis of Position Papers for Vulnerable Populations to better understand how each grading criterion will be assessed.
    • Explain a position with regard to health outcomes for a specific issue in a target population.
    • Explain the role of the interprofessional team in facilitating improvements for a specific issue in a target population.
    • Evaluate the evidence and positions of others that could support a team’s approach to improving the quality and outcomes of care for a specific issue in a target population.
    • Evaluate the evidence and positions of others that are contrary to a team’s approach to improving the quality and outcomes of care for a specific issue in a target population.
    • Communicate an initial viewpoint regarding a specific issue in a target population and a synthesis of existing positions in a logically structured and concise manner, writing content clearly with correct use of grammar, punctuation, and spelling.
    • Integrate relevant sources to support assertions, correctly formatting citations and references using APA style.
    • Example Assessment: You may use the assessment example, linked in the Assessment Example section of the Resources, to give you an idea of what a Proficient or higher rating on the scoring guide would look like.
      Additional Requirements
    • Length of submission: 4–6 double-spaced, typed pages, not including the title and reference pages. Your plan should be succinct yet substantive. No abstract is required.
    • Number of references: Cite a minimum of 3–5 sources of scholarly or professional evidence that support your initial position on the issue, as well as a minimum of 2–3 sources of scholarly or professional evidence that express contrary views or opinions. Resources should be no more than five years old.
    • APA formatting: Use the APA Style Paper Template linked in the Resources. An APA Style Paper Tutorial is also provided to help you in writing and formatting your analysis.

nursing partophysiology

  

1. On a patient who had a transfemoral amputation of the right leg. What would be the preferred post-operative position and why?

2. What are fontanelles? What would you expect to see in a newborn’s, and in a 6-month old infant’s head upon examination? What would you expect to see when they are dehydrated?

3. What is scombroid poisoning? How is this treated?

4. What is nonmelanoma skin cancer? What is the mechanism of action for ultraviolet radiation to cause nonmelanoma?

5. What are the signs, symptoms and lab results you would see for hypothyroidism and hyperthyroidism? What is myxedema? What are the signs and symptoms of myxedema?

Psychotherapy With group

Psychiatric mental health nursing practice is one of the newest disciplines to be licensed to provide psychotherapy As such, the majority of psychotherapy research is centered on other disciplines such as psychology, social work, marriage/family therapy, art therapy, psychiatry, and mental health counseling. This makes it essential for you to be able to translate current literature from other disciplines into your own clinical practice. For this Assignment, you practice this skill by examining literature on group work and group therapy and considering its applicability to your own clients.

Learning Objectives

Students will:
  • Evaluate the application of current literature to clinical practice
To prepare:
  • Review this week’s Learning Resources and reflect on the insights they provide on group work and group therapy.
  • Select one of the articles from the Learning Resources to evaluate for this Assignment.

Note: In nursing practice, it is not uncommon to review current literature and share findings with your colleagues. Approach this Assignment as though you were presenting the information to your colleagues.

The Assignment 

In a 5- to 10-slide PowerPoint presentation, address the following:

  • Provide an overview of the article you selected, including answers to the following questions:
    • What type of group was discussed?
    • Who were the participants in the group? Why were they selected?
    • What was the setting of the group?
    • How often did the group meet?
    • What was the duration of the group therapy?
    • What curative factors might be important for this group and why?
    • What “exclusion criteria” did the authors mention?
  • Explain the findings/outcomes of the study in the article. Include whether this will translate into practice with your own client groups. If so, how? If not, why?
  • Explain whether the limitations of the study might impact your ability to use the findings/outcomes presented in the article.

Note: The presentation should be 5–10 slides, not including the title and reference slides. Include presenter notes (no more than a half page per slide) and use tables and/or diagrams where appropriate. Be sure to support your work with specific citations from the article you selected. Support your presentation with evidence-based literature.

article

The Effect of Cognitive-Behavioral Group Marital Therapy on Marital Happiness and Problem Solving Self-Appraisal By: Belanger, Claude, Laporte, Lise, Sabourin, Stephane, Wright, John, AMERICAN JOURNAL OF FAMILY THERAPY, 01926187, , Vol. 43, Issue 2

HIMA350 Week 6 Forum

Answer the following questions:

  • Choose one data display tool (line graph) covered in your reading this week.
  • Think of a common HIM activity that uses data that could be displayed with your tool of choice.
  • Describe how this would look and how it would be useful

300-350 words total

No special formatting required.

sepsis

Lab Analysis Paper on Sepsis

Case Study HESI Mr. Peterson Is To be used for your Lab Paper it gives labs results and follows nursing care planning. Mr. Perterson is a Coronary Artery By-Pass This patient is prone to Hypovolemic Shock as well as at Risk for Sepsis

instructions

Write using APA formatting 

use the lab values attached 

use the attached sample as a guide. tabulate assignment too

Discussion Mental Health apn week 4

 

Apply information from the Aquifer Case Study to answer the following discussion questions:

  • Discuss the Mrs. Gomez’s history that would be pertinent to her difficulty sleeping. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know.
  • Describe the physical exam and diagnostic tools to be used for Mrs. Gomez. Are there any additional you would have liked to be included that were not? 
  • Please list 3 differential diagnoses for Mrs. Gomez and explain why you chose them.  What was your final diagnosis and how did you make the determination?
  • What plan of care will Mrs. Gomez be given at this visit, include drug therapy and treatments; what is the patient education and follow-up? 
  • THe example is uplaod