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I NEED A RESPONSE TO ASSIGNMENT

2 REFERENCES

Personality disorders refer to a group of mental illnesses that involve enduring patterns of thoughts, feelings, and behaviors that are not healthy which significantly and adversely affect how an individual functions in work, relationships, and various aspects of life.  According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), personality disorders fall into 10 distinct types: paranoid, schizoid, schizotypal, antisocial, borderline, histrionic, narcissistic, avoidant, dependent, and obsessive-compulsive. The DSM-5 further divides PDs into three categories of clusters.  Cluster A: schizoid, schizotypal, paranoid the client may have odd or eccentric behaviors.  Cluster B borderline, histrionic, antisocial, narcissistic with dramatic behaviors.  Cluster C avoidant, dependent, obsessive-compulsive which includes anxious and fearful behaviors (American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 2013). 

This paper will discuss Narcissistic personality disorder a cluster B disorder.  A narcissistic personality disorder is characterized by a persistent pattern of grandiosity, fantasies of unlimited power or importance, and the need for admiration or special treatment. The client with NPD may experience significant psychological distress related to interpersonal conflict and functional impairment. Research has shown that core features of the NPD are associated with a poor prognosis in therapy, slow progress to behavioral change, premature patient-initiated termination, and negative therapeutic alliance (Dixon-Gordon et al., 2015).  A narcissistic personality disorder is prevalent, highly comorbid with other disorders, and associated with significant functional impairment and psychosocial disability.  NPD is a challenging clinical syndrome, variable presentation, difficult to treat, and often exists with co-occurring disorders which further complicates treatment.  

Therapeutic Approach

 Due to the complexity of identifying and treating NPD and the absence of expertise or resources for longer-term treatment of personality disorders, some specific approaches and techniques can be implemented to improve general clinical management of patients with the disorder.  There are no FDA-approved treatments for NPD, or any other personality disorder and clinicians use psychotherapy but the personality disorder is a challenging condition to treat (Dixon-Gordon et al., 2015).  Treatments for narcissistic personality disorder current treatment recommendations are based on clinical experience and theoretical formulations. Psychodynamic formulations have led to an increase in various treatment approaches, and case reports suggest that these treatments can be effective for some clients.  The recommended psychotherapies included: mentalization-based therapy, transference focused psychotherapy, and schema-focused psychotherapy. Each of these treatments targets psychological capacities thought to underlie and organize descriptive features of narcissistic personality disorder(Caligor et al., 2015).  However, medication may be used when clients with NPD have severe symptoms that compromise their safety. Medications include mood stabilizers or antidepressants for significant affective instability; mood stabilizer or antipsychotic for impulsive anger and aggression; or an antipsychotic for cognitive-perceptual disturbances such as paranoid thoughts, hallucination-like symptoms, depersonalization (Caligor et al., 2015).   Also, medication may be prescribed to treat co-occurring conditions, such as mood and anxiety disorders.  Clients with NPD tend to report being extra sensitive to side effects, which can cause them to stop taking their medication.  A strong therapeutic alliance has been linked to treatment success in clients with PDs. 

As the PMHNP providing care to a client with NPD, the diagnosis must be shared with the client.  This is an important part of informed consent.  In providing care for an NPD client it is imperative to discuss the etiology, clinical manifestations, course of illness, and treatment options.  Withholding diagnostic information may cause problems by focusing on comorbid conditions like depression or anxiety which the client may respond poorly to treatment.  Hence, if the narcissistic problems are not also addressed then the psychotherapies and medications to address depression and anxiety may be ineffective, lead to clinical worsening, and contribute to high drop out rates for NPD clients (Dixon-Gordon et al., 2011).      

In conclusion client with NPD are difficult to treat based on symptoms are closely linked to other psychosocial disorders and comorbid disorders. Also, treatment for NPD can be difficult for the client and therapist due to the frustration of the therapeutic progress.  NPD is an often misunderstood mental condition where a person acts arrogantly, lacks empathy, needs constant attention and admiration, and has an inflated sense of self.  There is still considerable research that needs to be done regarding the treatment of personality disorders. However, research suggests there is hope for the future in making significant changes in the psychosocial treatment for clients with personality disorders (Dixon-Gordon et al., 2011).  The PMHNP must be knowledgeable of available evidence-based practice, and well-trained to treat clients suffering from personality disorders.   Evidence has shown that PDs are treatable disorders.   The therapeutic alliance is an essential ingredient in all successful doctor-patient interactions, it is especially important when treating a narcissist. Patients with narcissistic traits commonly terminate treatment with medical providers after incidents that providers perceive as harmless misunderstandings.  Increased awareness of the clinician’s feelings when treating these patients will allow the clinician to better recognize the presence of narcissistic traits. This awareness, coupled with an improved understanding of what drives narcissistic behavior, will allow practitioners to manage these patients more effectively in a variety of medical settings.

References

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). (2013). American Psychiatric Association.

Caligor, E., Levy, K. N., & Yeomans, F. E. (2015). Narcissistic personality disorder: Diagnostic and clinical challenges. American Journal of Psychiatry, 172(5), 415–422. https://doi.org/10.1176/appi.ajp.2014.14060723

Dixon-Gordon, K. L., Turner, B. J., & Chapman, A. L. (2011). Psychotherapy for personality disorders. International Review of Psychiatry, 23(3), 282–302. https://doi.org/10.3109/09540261.2011.586992

Dixon-Gordon, K. L., Whalen, D. J., Layden, B. K., & Chapman, A. L. (2015). A systematic review of personality disorders and health outcomes. Canadian Psychology/Psychologie canadienne, 56(2), 168–190. https://doi.org/10.1037/cap0000024

Responses to at least two classmates’ postings should be approximately 200 words and should be thoughtful, substantial, polite and more extensive than a simple “well done” phrase or “I agree.” Consider points of agreement, disagreement, assumptions, and value judgments. You will be able to respond to others after you submit your initial post. Your grade will be affected by how thoughtful your replies and initial questions are answered.

Assignment:

Roy and Neuman

Create a PowerPoint presentation that addresses each of the following points/questions. Be sure to completely answer all the questions for each bullet point. Use clear headings that allow your professor to know which bullet you are addressing on the slides in your presentation. Support your content with at least one (1) source and the textbook using APA citations throughout your presentation. Make sure to cite the sources using the APA writing style for the presentation. Include a slide for your references at the end. Follow best practices for PowerPoint presentations related to text size, color, images, effects, wordiness, and multimedia enhancements. Review the rubric criteria for this assignment.

Create a PowerPoint Presentation to discuss the following…

Sgt. Eddie Johns leaned back against the chair in the outpatient orthopedic clinic. His head was killing him! He wasn’t sure which was worse, the “morning after” headache or not being able to sleep at night. At least when he had a few beers under his belt so he could catch a few hours of sleep. It had been like this since he was air evacuated back stateside from Afghanistan after the roadside bomb went off. He was thankful that he had only broken his leg in a couple of places and gotten a bad bump on the head. They called that traumatic brain injury but he didn’t know what that was and really didn’t believe them anyway. He was still thinking just fine. His friend Joe wasn’t so lucky! How was Joe going to learn to walk on those artificial legs? He was still in the hospital in Washington, DC. That was pretty far from his home. Eddie wished he could visit Joe. They had been in the same platoon for 9 months. But, Eddie was glad that he had been able to come back to his own home town for outpatient treatment. It took an hour to get here but at least he could see his girl almost every day. Sure he had moved back in with his mom but it was easier to have someone to help him get around and cook for him. It was a bummer that he couldn’t work right now. He guessed it didn’t matter much since he really didn’t have a job to go back to. He had been replaced at the plant. They said they would find something for him to do once he could get around more easily. Eddie sure hoped the doc would take the pins out of his leg today and give him a clearance to work.

• How would the use of the Roy Adaptation Model assist the nurse in planning the continuation of care for Sgt. Johns?
• Describe the influence of Roy’s Theory in guiding the nurse’s actions in promoting Sgt. Johns adjusted self-concept.
• From the perspective of the Roy Adaptation Model, why is it important for the nurse to listen to Sgt. Johns’ “story” in his own words and not just base her interactions on information from the chart, fellow colleagues, or his family?
• Based on Neuman System’s Model, identify at least 4 stressors from the case study. Create a plan of care based on Neuman Systems Model for Sgt. Johns.

Assignment Expectations:

Length: 10-15 slides

Structure: Include a title slide, objective slide, content slides, reference slide in APA format. Title/Objective/Reference slides do not count towards the minimum slide count for this assignment.

References: Use appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of one (1) outside scholarly sources and the textbook are required for this assignment.

Rubric: This assignment uses a rubric for scoring. Please review it as part of your assignment preparation and again prior to submission to ensure you have addressed its criteria at the highest level.

Format: Save your assignment as a Microsoft PPT document (.pptx) or a PDF document (.pdf)

File name: Name your saved file according to your first initial, last name, and the assignment number (for example, “RHall Assignment 1.docx”)

M5 Assignment UMBO – 1, 2, 3

M5 Assignment PLG – 1, 6

M5 Assignment CLO – 1, 2, 4

Statistical Analyses in Nursing

Researchers must make informed choices about the type of statistical analysis that best addresses the research question. For the past several weeks, you have been considering how and when a particular statistic should be employed. This week, you have focused on the use of nonparametric tests.

Nonparametric methods are useful to researchers in performing statistical analyses of quantitative data sets that do not follow normal distributions and that have inconsistent variation. Nonparametric methods are often applied when ordinal-level data are collected and, as such, rely on fewer assumptions than their parametric counterparts.

In this Discussion, you examine the two articles in this week’s Learning Resources, both of which employ nonparametric methods of statistical analysis. In addition, as the final week of exploring quantitative statistics, you consider which statistical method is most frequently used in your area of nursing practice.

Note: This Discussion takes place in small groups, which should have been assigned by your Instructor.

To prepare:

• Review the articles presented in this week’s Learning Resources and analyze each study’s use of nonparametric tests.
• Critically analyze each article, considering the following questions in your analysis:
  • What are the goals and purpose of the research study each article describes?
  • How are nonparametric tests used in each study? What are the results of their use?
  • Why are parametric methods (t tests and ANOVA) inappropriate for the statistical analysis of each study’s data?
  • What are the strengths and weaknesses of each study (e.g., study design, sampling, and measurement)?
  • How could the findings and recommendations of each study contribute to evidence-based practice in the health care field?
• Reflect on the quantitative statistical analyses presented throughout this course in the research literature, the Learning Resources, media presentations, and those articles you reviewed for your abbreviated research proposal.
• Ask yourself: Which method is most commonly used in research studies that pertain to my area of nursing practice, and why this might be so?

By Day 3

Post a cohesive response in your small group that addresses the following:

• Critically analyze each article, including the items noted above.
• Identify one statistical analysis method that you found recurring in many of the articles you used in your literature review for your research proposal. This method does not necessarily have to be nonparametric.
• Based on your area of nursing practice, which method of statistical analysis is most frequently used in the research literature? Why do you think other forms of statistical analysis are less frequently used? Provide a rationale for your response.

Your comprehensive health history that was assigned in Module 01 is 10/28/20 due. Complete a comprehensive history, utilizing the form linked below, on either someone over the age of 65 or someone that you know has a lot of medical problems. Write the results in narrative format and include the family history as a genogram (see your text).

Visit the following link for help with narrative format: http://rasmussen.libanswers.com/faq/32455  

Comprehensive Health History Form

Comprehensive Health History Assignment

Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates.

 Discussion board. APA style. Each question separately. 2 references leas than 5 years. 

1-WHEN WAS PRESCRIPTION AUTHORITY FOR APRN APPROVED, SPECIFICALLY IN FLORIDA?

2-WHICH ARE THE REQUIREMENTS FOR THE APRN BE GRANTED AUTHORIZATION/PRIVILEGES TO PRESCRIBED CONTROLLED SUBSTANCE?

3-WHAT IS CONSIDERED CONTROLLED SUBSTANCE?

4-HOW TO APPLY FOR DEA NUMBER?

5-VISIT THE CDC WEBSITE, AND ELABORATE ON THE CURRENT ISSUE WITH CONTROLLED SUBSTANCE ABUSE IN THE USA AND FLORIDA?

Refer to the following website and review the Florida controlled substance law for us as APRN.

https://floridasnursing.gov/new-legislation-impacting-your-profession/

https://www.flmedical.org/Florida/Florida_Public/Docs/FMA-Opioid-HB21.pdf

https://fnpn.enpnetwork.com/nurse-practitioner-news/133651-dea-licensure-information-for-florida-

https://www.cdc.gov/drugoverdose/prescribing/guideline.html

https://www.cdc.gov/drugoverdose/data/index.html

Respond  by providing at least two contributions  about Rumination disorder for improving or including  in their Parent  Guide and at least two things that you like about their  guide

Positive comment

Cite references

Pls, include 2 references. post should be at least 250 words. 

Read the following vignette about a child with ADHD and answer each of the three questions at the end:

Scott is 8 years old. At 7 AM, his mother looks into Scott’s bedroom and sees Scott playing. “Scott, you know the rules: no playing before you are ready for school. Get dressed and come eat breakfast.” Although these rules for a school day have been set for the past 7 months, Scott always tests them. In about 10 minutes, he is still not in the kitchen. His mother checks his room and finds Scott on the floor, still in his pajamas, playing with miniature cars. 

Ten minutes later, Scott bounds into the kitchen, still without socks and shoes, and hair tousled. “You forgot your socks, and your hair isn’t combed,” his mother reminds him. “Oh yeah. What’s for breakfast?” he says. “Scott, finish dressing first.” “Well, where are my shoes?” “By the back door where you left them.” This is the specially designated place where Scott is supposed to leave his shoes so he doesn’t forget.

Scott starts toward his shoes but spots his younger sister playing with blocks on the floor. He hurries to her. “Wow, Amy, watch this—I can make these blocks into a huge tower, all the way to the ceiling.” He grabs the blocks and begins to stack them higher and higher. “Scott makes a better tower than Amy,” he chants. Amy shrieks at this intrusion, but she is used to Scott grabbing things from her. The shriek brings their mother into the room. She notices Scott’s feet still do not have socks and shoes.

“Scott, get your socks and shoes on now and leave Amy alone!” “Where are my socks?” he asks. “Go to your room and get a clean pair of socks and brush your teeth and hair. Then come eat your breakfast or you’ll miss the bus.”

1. What sort of problems would you expect Scott to have at school? 
2. What are some teachings you might provide for this parent?
3. What interventions would give Scott the best chance of having positive outcomes?