Case: An elderly widow who just lost her spouse.
Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:
• Metformin 500mg BID
• Januvia 100mg daily
• Losartan 100mg daily
• HCTZ 25mg daily
• Sertraline 100mg daily
Current weight: 88 kg
Current height: 64 inches
Temp: 98.6 degrees F
BP: 132/86
Insomnia is a disorder linked with difficulty in sleep quality, initiating or maintaining sleep, along with substantial distress and impairments of daytime functioning. Its prevalence ranges from 10 to 15% among the general population, with higher rates seen among females, divorced or separated individuals, those with loss of loved ones, and older people (Bollu & Kaur, 2019). Insomnia can simply be defined as a sleep disorder where the patient has trouble falling asleep or staying asleep. According to Krystal et al (2019), it is a common condition that is linked with noticeable deterioration in function and quality of life, mental and physical morbidity. The complaints of insomnia are present in 60–90% of patients with major depression, Complaints of disrupted sleep are very common in patients suffering from depression, (Wichniak, etal., 2017).
Questions you might ask the patient and rationale
The diagnosis and treatment of insomnia rely mainly on a thorough sleep history to address the precipitating factors as well as maladaptive behaviors resulting in poor sleep (Bollu & Kaur, 2019).
What is your sleep pattern including how many hours of sleep do you get at night prior to your husband’s demise and what it has been in the 10 months since his death? Does she perform certain rituals or do something special before she sleeps. This assesses if the insomnia started before or after the husband’s death. This provides a clue to insomnia that may be related to bereavement.
What time do you go to bed every night and what is your normal routine before going to bed? This is to check if the patient is doing something differently which has disrupted her normal routine and caused insomnia.
How often do you wake up to urinate at night? This question is asked to assess for nocturia due to diabetes that may lead to insomnia. Nocturia can prevent the patient from having a good night’s sleep. , changes in blood glucose levels at night causesto hypoglycemic and hyperglycemic episodes, nocturia and associated .
Week 5 Focused SOAP Note and Patient Case Presentation Cosamirapdcosden
Week 5: Focused SOAP Note and Patient Case Presentation
College of Nursing-PMHNP, Walden University
NRNP 6675: PMHNP Care Across the Lifespan 2 Practicum
Introduction
Psychosis is a mental condition in which a person's ideas and perceptions are disrupted,
and the individual may have difficulty distinguishing between what is real and what is not.
A health condition, medications, or drug usage can all contribute to psychosis. Delusions,
hallucinations, incomprehensible speech, and agitation are all possible signs; the patient has
incorrect beliefs and sees or hears things that others do not see or hear. The person suffering from
the disease is usually unaware of his or her actions. Medication, psychotherapy, peer support,
family support and education, and talk therapy are all options for treatment. More or less every
mental intervention is backed by evidence accumulated during the patient's initial interview; each
patient's therapy begins with a thorough medical and mental health evaluation, the incorporation
of trust, and a discussion of past mental health history, substance misuse history, family mental
health history, and so on. In this example, the patient's evaluation was documented, and a
diagnosis was made based on the information collected from the patient during the evaluation.
When the case was being developed, a therapeutic approach was designed. The patient is a 53-
year-old Caucasian male who was scheduled for an initial screening for a psychotic disorder after
his sister recommended a visit to the psychiatrist because patient's behavior changed since the
mother passed away.
Patient Initial: S.T Age: 53 Gender: Male
Subjective Data:
CC: "I was brought here by my sister because since my mother passed away, I was living on my
own and not bothering anyone. Those people outside my window they are after me. They just
want me dead".
HPI: When patient was asked " what people?". Patient said " the government sent them to get
me because my taxes are high". Suddenly patient asked the provider if she can see the birds or
hear any loud noise. The provider responded by redirecting the patient that she does not hear any
voice or see anything. When the provider how long he is been hearing the voices or seeing
things, patient said " for weeks, weeks and weeks". Patient also said the sister tapped her phone
with the government. When asked about sleep, patient said " I have not slept well because the
voices keep me up for days. I try to watch the TV, they poison my food on TV, I locked
everything down in the fridge". Suddenly patient asked " Can I smoke?". Provider said "no you
can't smoke here". Patient admit that he smokes all day about 3 packs a day. Drinks alcohol
which his sister purchased for him to last him for weeks. Patient denies use of drugs. Admit to
history of marijuana use 3 years ago before the m ...
Week 5 Focused SOAP Note and Patient Case Presentation Cosamirapdcosden
Week 5: Focused SOAP Note and Patient Case Presentation
College of Nursing-PMHNP, Walden University
NRNP 6675: PMHNP Care Across the Lifespan 2 Practicum
Introduction
Psychosis is a mental condition in which a person's ideas and perceptions are disrupted,
and the individual may have difficulty distinguishing between what is real and what is not.
A health condition, medications, or drug usage can all contribute to psychosis. Delusions,
hallucinations, incomprehensible speech, and agitation are all possible signs; the patient has
incorrect beliefs and sees or hears things that others do not see or hear. The person suffering from
the disease is usually unaware of his or her actions. Medication, psychotherapy, peer support,
family support and education, and talk therapy are all options for treatment. More or less every
mental intervention is backed by evidence accumulated during the patient's initial interview; each
patient's therapy begins with a thorough medical and mental health evaluation, the incorporation
of trust, and a discussion of past mental health history, substance misuse history, family mental
health history, and so on. In this example, the patient's evaluation was documented, and a
diagnosis was made based on the information collected from the patient during the evaluation.
When the case was being developed, a therapeutic approach was designed. The patient is a 53-
year-old Caucasian male who was scheduled for an initial screening for a psychotic disorder after
his sister recommended a visit to the psychiatrist because patient's behavior changed since the
mother passed away.
Patient Initial: S.T Age: 53 Gender: Male
Subjective Data:
CC: "I was brought here by my sister because since my mother passed away, I was living on my
own and not bothering anyone. Those people outside my window they are after me. They just
want me dead".
HPI: When patient was asked " what people?". Patient said " the government sent them to get
me because my taxes are high". Suddenly patient asked the provider if she can see the birds or
hear any loud noise. The provider responded by redirecting the patient that she does not hear any
voice or see anything. When the provider how long he is been hearing the voices or seeing
things, patient said " for weeks, weeks and weeks". Patient also said the sister tapped her phone
with the government. When asked about sleep, patient said " I have not slept well because the
voices keep me up for days. I try to watch the TV, they poison my food on TV, I locked
everything down in the fridge". Suddenly patient asked " Can I smoke?". Provider said "no you
can't smoke here". Patient admit that he smokes all day about 3 packs a day. Drinks alcohol
which his sister purchased for him to last him for weeks. Patient denies use of drugs. Admit to
history of marijuana use 3 years ago before the m ...
a case study on alcohol withdrawal syndrome martinshaji
this case gives a brief idea about treatment , diagnosis, management , pharmacist interventions, patient counselling & discussion about alcohol withdrawal syndrome.
please comment
thank u
Hypertension, Ischemic Heart Disease, Diabetes Mellitus- Case PresentationCHANDANAC24
CASE PRESENTATION ON TYPE-II DIABETES MELLITUS, ISCHAEMIC HEART DISEASE WITH HYPERTENSION
Presented by:-
CHANDANA C
2nd PHARM.D
SREE SIDDAGANGA COLLEGE OF PHARMACY
Chief Complaints on admission:-
Hyperglycemia and chest pain
Provisional Diagnosis:-
Diabetes mellitus with Ischemic Heart Disease
Final Diagnosis:-
Type-II Diabetes mellitus , Ischaemic Heart Disease with Hypertension
Treatment goals:-
To relieve signs and symptoms
To prevent the complication
To prevent the progression of the disease
To achieve the targeted BP
To reduce hypertension, diabetes mellitus ,ischaemic heart disease morbidity and mortality
Problems Identified:-
Failure to receive the drugs
Overdose
Sub therapeutic
Route of administration
Dose frequency
Goals achieved:-
Reduction in BP
Pharmacotherapy initiated to control hypertension , diabetes mellitus
Symptoms are reduced
Monitoring parameters:-
Vitals(BP,HR,PR)
Serum creatinine
RBS(Random glucose test)
Hematological analysis
ECG
Adverse drug reaction
Patient Counselling:-
About disease:-
Educate the patient about Control
Risk factors
Complications
THANK YOU
Vortioxetine Brintellix Trintellix Clinical and Pre-clinical DataAmit Vishwakarma
Vortioxetine is indicated for the treatment of Major Depressive Disorder
Vortioxetine has several novel pharmacological properties
Vortioxetine is different from SSRIs/SNRIs due to direct effects at 5-HT receptors
In addition to being a SSRI, vortioxetine has modulating activity of a variety of serotonin receptors
Cognitive improvement is novel in series of antidepressant drugs
This is a very basic presentation for anyone who would like to have more information about schizophrenia. This was intended for the third year medical students. The criteria described are based on fourth edition of the DSM ( DSMIV). All these demarcations (types of) schizophrenia will be scrapped by the DSM V (this is the proposal as of now). But this could serve a historical puspose if seen after 2013.
a case study on alcohol withdrawal syndrome martinshaji
this case gives a brief idea about treatment , diagnosis, management , pharmacist interventions, patient counselling & discussion about alcohol withdrawal syndrome.
please comment
thank u
Hypertension, Ischemic Heart Disease, Diabetes Mellitus- Case PresentationCHANDANAC24
CASE PRESENTATION ON TYPE-II DIABETES MELLITUS, ISCHAEMIC HEART DISEASE WITH HYPERTENSION
Presented by:-
CHANDANA C
2nd PHARM.D
SREE SIDDAGANGA COLLEGE OF PHARMACY
Chief Complaints on admission:-
Hyperglycemia and chest pain
Provisional Diagnosis:-
Diabetes mellitus with Ischemic Heart Disease
Final Diagnosis:-
Type-II Diabetes mellitus , Ischaemic Heart Disease with Hypertension
Treatment goals:-
To relieve signs and symptoms
To prevent the complication
To prevent the progression of the disease
To achieve the targeted BP
To reduce hypertension, diabetes mellitus ,ischaemic heart disease morbidity and mortality
Problems Identified:-
Failure to receive the drugs
Overdose
Sub therapeutic
Route of administration
Dose frequency
Goals achieved:-
Reduction in BP
Pharmacotherapy initiated to control hypertension , diabetes mellitus
Symptoms are reduced
Monitoring parameters:-
Vitals(BP,HR,PR)
Serum creatinine
RBS(Random glucose test)
Hematological analysis
ECG
Adverse drug reaction
Patient Counselling:-
About disease:-
Educate the patient about Control
Risk factors
Complications
THANK YOU
Vortioxetine Brintellix Trintellix Clinical and Pre-clinical DataAmit Vishwakarma
Vortioxetine is indicated for the treatment of Major Depressive Disorder
Vortioxetine has several novel pharmacological properties
Vortioxetine is different from SSRIs/SNRIs due to direct effects at 5-HT receptors
In addition to being a SSRI, vortioxetine has modulating activity of a variety of serotonin receptors
Cognitive improvement is novel in series of antidepressant drugs
This is a very basic presentation for anyone who would like to have more information about schizophrenia. This was intended for the third year medical students. The criteria described are based on fourth edition of the DSM ( DSMIV). All these demarcations (types of) schizophrenia will be scrapped by the DSM V (this is the proposal as of now). But this could serve a historical puspose if seen after 2013.
Respond of your colleagues who were assigned to a different.docxwilfredoa1
Respond
of your colleagues who were assigned to a different case than you. Explain how you might apply knowledge gained from your colleagues’ case studies to you own practice in clinical settings as a Psychiatric Nurse Practitioner.
NOTE: Positive comment
Main Post
The three questions this writer would as the patient are:
Did your depressive symptoms worsen after the death of your husband?
How many hours per night do you sleep on average?
Do you sleep throughout those hours of sleep or do you wake constantly?
Do you ingest any stimulants like coffee or chocolate before bed?
Do you sleep during the daytime?
The rationale behind question one is to gauge the timeline of the patient’s depression. She appears to have been suffering with untreated depression for a long time, however the additional symptoms of insomnia and tearfulness seemed to worsen after his death. With this information the nurse practitioner will know if her depression is in an acute state and the severity of her illness.The patient is reporting sleeplessness; however the nurse practitioner needs to gauge if the patient is participating in restful sleep. Sleep of two hours or less may only consist of REM sleep (Boland et al., 2020). If the patient is not getting restful sleep, she is not benefiting from the bodily repair that takes place during sleep (Fitzgerald et al., 2017). This can place her at an increased risk for other illnesses and heighten depressive symptoms (Uchmanowicz et al., 2019).Knowing if the patient sleeps consistently throughout those hours of sleep will provide information to the nurse about the kind and amount of sleep the patient is getting. Ingesting certain stimulants like caffeinated drinks, coffee or chocolate can affects the client’s sleep by providing wakefulness (Ulke et al., 2017). If the patient is sleeping during the daytime, her circadian rhythm could have been reversed where she will need less sleep during the night time hours (Fitzgerald et al., 2017).
The people this writer would interview are:
The patient’s aide
The patient’s son
The patient aide may be able to provide more information about observed sleepiness during the daytime. In addition, she will be able to provide information on the patient’s dietary patterns and physical activity. The questions to the aide would be:
Does she easily nod off during the daytime?
Does she easily become fatigued?
Does she consume a well-balanced diet?
Question one would illicit answers about her getting sleep.
It appears that she in fact getting sleep but because of a revered circadian rhythm she is not able to get the sleep at the night which is the desired time. Question two will help the nurse practitioner gauge the extent of the effects that non sleep has taken on the patient’s life. The patient, if constantly fatigued throughout the day has a life that has been highly impacted by the .
Respond of your colleagues who were assigned to a different .docxwilfredoa1
Respond
of your colleagues who were assigned to a different case than you. Explain how you might apply knowledge gained from your colleagues’ case studies to you own practice in clinical settings.
NOTE: Positive comment
Main Post
The three questions this writer would as the patient are:
Did your depressive symptoms worsen after the death of your husband?
How many hours per night do you sleep on average?
Do you sleep throughout those hours of sleep or do you wake constantly?
Do you ingest any stimulants like coffee or chocolate before bed?
Do you sleep during the daytime?
The rationale behind question one is to gauge the timeline of the patient’s depression. She appears to have been suffering with untreated depression for a long time, however the additional symptoms of insomnia and tearfulness seemed to worsen after his death. With this information the nurse practitioner will know if her depression is in an acute state and the severity of her illness.The patient is reporting sleeplessness; however the nurse practitioner needs to gauge if the patient is participating in restful sleep. Sleep of two hours or less may only consist of REM sleep (Boland et al., 2020). If the patient is not getting restful sleep, she is not benefiting from the bodily repair that takes place during sleep (Fitzgerald et al., 2017). This can place her at an increased risk for other illnesses and heighten depressive symptoms (Uchmanowicz et al., 2019).Knowing if the patient sleeps consistently throughout those hours of sleep will provide information to the nurse about the kind and amount of sleep the patient is getting. Ingesting certain stimulants like caffeinated drinks, coffee or chocolate can affects the client’s sleep by providing wakefulness (Ulke et al., 2017). If the patient is sleeping during the daytime, her circadian rhythm could have been reversed where she will need less sleep during the night time hours (Fitzgerald et al., 2017).
The people this writer would interview are:
The patient’s aide
The patient’s son
The patient aide may be able to provide more information about observed sleepiness during the daytime. In addition, she will be able to provide information on the patient’s dietary patterns and physical activity. The questions to the aide would be:
Does she easily nod off during the daytime?
Does she easily become fatigued?
Does she consume a well-balanced diet?
Question one would illicit answers about her getting sleep.
It appears that she in fact getting sleep but because of a revered circadian rhythm she is not able to get the sleep at the night which is the desired time. Question two will help the nurse practitioner gauge the extent of the effects that non sleep has taken on the patient’s life. The patient, if constantly fatigued throughout the day has a life that has been highly impacted by the lack of sleep. The aide would be able to provide a clear, picture of the patient’s diet. The aide would be .
ASSIGNMENTRespond to at least two of your colleagues by c.docxmckellarhastings
ASSIGNMENT:
Respond
to at least
two
of your colleagues by comparing the differential diagnostic features of the disorder you were assigned(
HYPERSOMNIA)
to the diagnostic features of the disorder your colleagues were assigned.
Note:
Support your responses with evidence-based literature with at least two references in each colleague’s response with proper citation in APA Format.
Colleagues
Respond # 1
The assigned sleep/wake disorder is Insomnia. According to Ruiz, Sadock, & Sadock (2014) insomnia is defined as difficulty initiating or maintaining sleep. It is currently considered as an independent condition where as in the past causes of the condition rather than symptoms were treated.
Diagnostic Criteria for Insomnia
According to American psychiatric association (2013), individuals need to meet criteria A to criteria H to diagnose insomnia. Criteria A requires one or more of the three symptoms such as difficulty in initiating sleep, difficulty in maintain sleep and early morning awakening with inability to return back to sleep which cause dissatisfaction with the sleep quantity or quality (American Psychiatric association 2013). The other criteria from B to H explains that the sleep disturbance causes impairment in social, occupational, educational, educational, behavioral or other important areas of functioning, disturbance occurs three nights per week and present for at least three months, it occurs despite adequate opportunity to sleep, insomnia do not caused by another sleep wake disorder, not attributable to physiological effect of a substance, and coexisting mental disorders or medical condition do not adequately explain insomnia (American psychiatric association 2013).
Psychotherapy Treatment
The psychological and behavioral therapies for insomnia according to Gabbard (2014) are sleep hygiene education, stimulus control therapy, sleep restriction, cognitive therapy, and relaxation therapies. Sleep focused cognitive-behavior therapy (SCBT) is a combination of various non pharmacological strategies and it is structured and time limited with a focus on sleep related issues (Gabbard 2014). It is for 6-8 weeks, once in each week. The treatment has shown benefit for up to six months after termination of SCBT (Gabbard 2014). However, there are some pitfalls with this treatment as it requires patient initiative, motivation and active participation in the treatment process, along with greater time commitment and limited availability of practitioners (Gabbard 2014).
Psychopharmacological Treatments
The pharmacological treatment of insomnia are hypnotics and the sleep medications according to Ruiz et al (2014) should not be prescribed for more than 2 weeks due to development of tolerance and withdrawal. According to Gabbard (2014) the FDA approved hypnotic agents are benzodiazepines, non-benzodiazepines, melatonin receptor agonists, and Histamine H1 receptor antagonists. For Treatment of insomnia character.
The man whose antidepressants stopped workingMajor depress.docxpoulterbarbara
: The man whose antidepressants stopped working
Major depressive disorder is one of the most prevalent disorders we will see in our clinical practice. Treatment options for MDD can vary greatly contingent on the appropriate psychopharmacologic interventions being adopted for our clients.
Medication nonadherence for patients with chronic diseases is extremely common, affecting as many as 40% to 50% of patients who are prescribed medications for management of chronic conditions (Kleinsinger, 2018). Nonadherence isn't a new problem. However, offering clients valuable interventions and education to overcome any potential compliance barriers will help the provider identify any challenges and decide how to achieve mutually agreed-upon goals to improve their health.
Questions
1.
Do you ever feel that taking your medications is a nuisance or inconvenience? Do you have a difficult time remembering to take your medications or forget?
•&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;Developing a medication schedule, It is difficult to come up with a schedule to take medications every day for some patients. Collaboratively we need to come up with a convenient time to take the antidepressant and the other prescribed medication for them to be effective.
2.
Does your prescribed medications and treatment regimen still leave you feeling depressed? Do you have a difficult time adhering to a prescribed regimen?
•&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;The patient discontinued his Effexor although it appeared to be effective. It is essential to find out the patient’s reason for not following the prescribed regimen and come up with a solution together.
•&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;It is crucial for the patient to take his antidepressants accordingly, as well as not skip or alter the dosage, nor terminate the medication once you start feeling better.
3.
Have the side effects of your medications been difficult to cope with or manage? Do you sometimes stop taking your medications because of the adverse effects?
Sertraline has been prescribed in the past and discontinued several times. The patient experienced side effects of sexual dysfunction and stopped taking. Encourage the patient to monitor any side effects, physical and emotional changes or occurrences.
Stopping medications and treatment regimens prematurely or abruptly have been associated with high relapse rates and can cause serious withdrawal symptoms (Henssler, Heinz, Brandt, & Bschor, 2019).
Important People
Family members and other caregivers bring personal knowledge on the suitability or lack thereof regarding different treatments for the patient's circumstances and preferences (Smith, 2013). The patient is married, so I would address additional questions to his wife. After getting permission to discuss his medical records with his family members, I would ask the wife if she knew what medications her husband was taking? If she knew why he was taking them? Informed and en.
For this Discussion, review the case Learning Resources and the DustiBuckner14
For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.
Case: An elderly widow who just lost her spouse.
Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:
•
Metformin 500mg BID
•
Januvia 100mg daily
•
Losartan 100mg daily
•
HCTZ 25mg daily
•
Sertraline 100mg daily
Current weight: 88 kg
Current height: 64 inches
Temp: 98.6 degrees F
BP: 132/86
By Day 3 of Week 7
Post
a response to each of the following:
• List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
• Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
• Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.
• List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
• List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
• For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?
• Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.
Respond to the these discussions. All questions need to be addressed.
Discussion 1 En
Three questions to ask the patient and a rationale for asking these questions.
How may I be of assistance today? This question creates a rapport between you and the patients, and it makes her know that the doctor is ready to listen and help her.
What are you doing to cope with grief after losing your husband? This question will help the care ...
Melissa Hinkhouse
Advanced Pharmacology NURS-6521N-43
Professor Dr. Vicki Gardin
Discussion Board Week 1-Original Post
11/30/2020
I have worked in an outpatient behavioral health clinic for the past seven years with many different providers. I live in a rural community, many patients wait six to twelve months to be seen. Patients being treated for Attention Deficit Disorder must be officially tested before being seen by a Psychologist. For this discussion board post, I have changed the name of my patient to Paul to ensure patient confidentially. The provider I worked with this particular patient will also be referred to as PMHNP to ensure provider confidentiality.
Paul was a ten-year-old Caucasian male referred to our clinic diagnosed per DSM criteria, confirmed via Psychologist testing with ADHD. When he saw the Psychologist, he was also diagnosed with mild depression and anxiety. He struggled with concentration, hyperactivity, impulse control, and disorganization. He presented to his appointment with his mother and father, clean, well-nourished, pleasant, interactive with staff, reported no medication allergies, current medication Zyrtec for seasonal allergies. Paul just had his well-child exam and is current on vaccinations and his primary care provider completed lab work to include CBC, CMP, TSH, Vit D, B12, and A1C, all have returned normal. Family history reported father has a history of ADHD (never medicated), brother has a history of depression and anxiety (never medicated treating with psychotherapy), no other significant family history to report. Paul’s current weight at his appointment was 30kg.
PMHNP spent one hour with Paul and his parents for the initial new patient appointment (Thursday). It was decided Paul would be prescribed Strattera (atomoxetine) 40mg once a day for one week then increase to 80mg once a day. I returned to work on Monday and received a call from Paul’s mom, she said he was acting strange. He was tearful, had been in his room with the door closed for most of the weekend, she stated on Sunday she went into his room and he was crying and said he was just thinking about dying and his parents dying. She stated he had already had his meds Sunday so she kept him with her that entire day and made Sunday night a campout night in the Livingroom so he would think it was fun and she could keep a close eye on him. I had a cancelation that morning for him to come to see PMHNP and he was in to see her within twenty minutes and removed from Strattera. His parents decided medications were no longer the route they wanted to try for treatment and a referral was made for psychotherapy.
The only medication Paul takes on occasion is Zyrtec which is in an antihistamine drug class, Strattera is a selective norepinephrine reuptake inhibitor; there is no known drug interaction between the two medications. Reflecting on his age and the medication, Strattera has a black box labeled for suicidal ideation with adolescents dia.
I need a response for this assignment1 pagezero plagiarism.docxflorriezhamphrey3065
I need a response for this assignment
1 page
zero plagiarism
Volume 2, Case #11: The figment of a man who looked upon the lady
The client is a 42-year-old woman with a chief complaint of depression and interpersonal stress. She has a past psychiatric history of PTSD related to abuse in her childhood that led to a dependency on alcohol and drugs to cope. She has been 10 years sober and attends AA and Narcotics Anonymous meetings regularly which have helped with good results. The client reports occasional PTSD with nightmares, flashbacks and panic attacks. The questions I would ask her during this visit include:
When was the last time you had PTSD symptoms of nightmares, flashbacks and panic attacks? What is triggers these symptoms? The rationale behind this question is trying to establish a baseline and know the triggers that may result in flashbacks and panic attacks.
What happens when you experience these PTSD flashbacks and what coping mechanisms do you use at that time? Do you have any family support system? Have these coping mechanisms helped? Rationale: it is important to establish what type of behaviors the client exhibits during these times, and also if her coping mechanisms are truly assisting her to cope positively or negatively. Asking about her support system will inform me about what her support systems are outside of attending her regular AA and NA meetings or therapy appointments. It is also good to know if she has a good support system which could be family and friends can be present during her therapies or appointments as they may be able to help with de-escalating her thoughts and calming her down when she experiences these symptoms. Another peer support is defined as the process of giving and receiving nonprofessional help and assistance from people with similar conditions or circumstances to yours is listed as beneficial to the client’s success in treatment (Tracy & Wallace, 2016).
Do you have suicidal or homicidal ideations, auditory or visual hallucinations now or when you are experiencing these PTSD symptoms? Traumatic events such as childhood sexual abuse increase a person’s suicide or homicidal risk (Stahl, 2014). Do the thoughts that you might have nightmares prevent you from going to sleep? How many hours do you sleep at night? What is causing your present stress? Rationale: Ensuring that the patient and others around the patient are safe is a priority, and also knowing if the client is seeing images or hearing voices. Lack of adequate sleep can cause stress that may trigger the other symptoms that the client experiences. If the client is going through any type of stress which may be personal life or work life related, this may also trigger the symptoms she is having. Also, knowing if the client has taken any sleep aid in the past will determine if she can be put on sleep aid medication treatment and monitored. The client had initially stated that she has insomnia, however later in the case study, she tal.
1
6
Assignment template
Subjective Section
Chief complainant
The patient starts by saying, "I can't stop crying, all the time." The patient complains that since she gave birth to her child two months ago, she has been experiencing mood disorders and difficulties falling asleep even after the baby is already asleep. She complains that especially when the baby cries, she loses her appetite and is not comfortable with her new body shape and size. She says nothing interests her, even writing, which was one of the things she loved before she gave birth. She does not want to contact her friends, and everything seems to be upsetting her.
History of present illness (HPI)
L.T is a 32-year-old black female who resents for psychiatric evaluation due to mood depression. The patient has not been prescribed any psychotropic drugs recently.
Past psychiatric history
The patient has never been examined or treated for any mental disorders in the past. Recently she was hospitalized for a standard childbirth procedure.
Medication trials and current medication
She has not tried any medications in the past, neither is she under any medication currently.
Psychotherapy or previous psychiatric diagnosis
The patient has no history of psychiatric illness and has not been diagnosed or treated with any mental health disorder.
Pertinent substance use, social, and medical history
The patient denies any use of alcohol or cases of drug abuse in the family. Although she says that her uncle was not an opioid abuser, he committed suicide using GSW. She is married and currently lives with her husband with their two kids. She has been working in the retail business for the past five years, but currently, she is a housewife. The patient grew up with her sister together with her both parents. She has been diagnosed with hypertension recently, and she is taking drugs labelled as labetalol 100mg for HTN, which she says that she sometimes forgets to take them. The patient has no legal history or any issues related to violence.
Allergies
L.T is allergic to codeine. She gave birth two months ago, which automatically means that she is lactating. Currently, she is not using any form of contraceptive, and she has had no desire for sex since she gave birth.
ROS
General: No weight loss, fatigue or chills experienced by the patient.
HEET: Her vision is the same no issues of double vision or jaundice. Her ears, nose and throat are okay.
Skin: Her skin has not changed either is she having rashes.
Cardiovascular: No chest discomfort or pains.
Respiratory: She is not coughing or producing sputum, implying her respiratory is fine.
Gastrointestinal: She has eventually lost her appetite and wants to lose weight, although she is not vomiting or feeling abdominal pain.
Genitourinary: The urine colour or odour has not changed, and she is not experiencing any burns during urination. No headaches, no back or joint pains.
Hematologic: No bleeding realized or enlarged nodes.
Endocri ...
1
6
Assignment template
Subjective Section
Chief complainant
The patient starts by saying, "I can't stop crying, all the time." The patient complains that since she gave birth to her child two months ago, she has been experiencing mood disorders and difficulties falling asleep even after the baby is already asleep. She complains that especially when the baby cries, she loses her appetite and is not comfortable with her new body shape and size. She says nothing interests her, even writing, which was one of the things she loved before she gave birth. She does not want to contact her friends, and everything seems to be upsetting her.
History of present illness (HPI)
L.T is a 32-year-old black female who resents for psychiatric evaluation due to mood depression. The patient has not been prescribed any psychotropic drugs recently.
Past psychiatric history
The patient has never been examined or treated for any mental disorders in the past. Recently she was hospitalized for a standard childbirth procedure.
Medication trials and current medication
She has not tried any medications in the past, neither is she under any medication currently.
Psychotherapy or previous psychiatric diagnosis
The patient has no history of psychiatric illness and has not been diagnosed or treated with any mental health disorder.
Pertinent substance use, social, and medical history
The patient denies any use of alcohol or cases of drug abuse in the family. Although she says that her uncle was not an opioid abuser, he committed suicide using GSW. She is married and currently lives with her husband with their two kids. She has been working in the retail business for the past five years, but currently, she is a housewife. The patient grew up with her sister together with her both parents. She has been diagnosed with hypertension recently, and she is taking drugs labelled as labetalol 100mg for HTN, which she says that she sometimes forgets to take them. The patient has no legal history or any issues related to violence.
Allergies
L.T is allergic to codeine. She gave birth two months ago, which automatically means that she is lactating. Currently, she is not using any form of contraceptive, and she has had no desire for sex since she gave birth.
ROS
General: No weight loss, fatigue or chills experienced by the patient.
HEET: Her vision is the same no issues of double vision or jaundice. Her ears, nose and throat are okay.
Skin: Her skin has not changed either is she having rashes.
Cardiovascular: No chest discomfort or pains.
Respiratory: She is not coughing or producing sputum, implying her respiratory is fine.
Gastrointestinal: She has eventually lost her appetite and wants to lose weight, although she is not vomiting or feeling abdominal pain.
Genitourinary: The urine colour or odour has not changed, and she is not experiencing any burns during urination. No headaches, no back or joint pains.
Hematologic: No bleeding realized or enlarged nodes.
Endocri ...
Depression (also called major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how we feel, think, and handle daily activities, such as sleeping, eating, or working.
Depression is a common illness worldwide, with an estimated 3.8% of the population affected, including 5.0% among adults and 5.7% among adults older than 60 years. Approximately 280 million people in the world have depression
Case Study 1 Applying Theory to PracticeSocial scientists hav.docxcowinhelen
Case Study 1: Applying Theory to Practice
Social scientists have proposed a number of theories to explain juvenile delinquency. Each has its own strengths and weaknesses. For this assignment, go to the following Website, located at http://listverse.com/2011/05/14/top-10-young-killers/ and select one of the juvenile case studies.
After reading the case, select one (1) of the psychological theories discussed in Chapter 4 of the text.
Write a two to three (2-3) page paper in which you:
1. Summarize three (3) key aspects of the juvenile case study that you selected.
2. Highlight at least three (3) factors that you believe are important for one to understand the origins of the juvenile’s delinquent behavior.
3. Apply at least two (2) concepts from the theory that you chose from the text that would help explain the juvenile’s behavior.
4. Identify one (1) appropriate strategy geared toward preventing delinquency that is consistent with the theory you chose.
5. Use at least three (3) quality references. Note: Wikipedia and other Websites do not qualify as academic resources.
Discussion-
"The Changing Family System"
Using what you’ve learned this week, respond to the following prompts in your post:
· Explain at least two (2) roles that different parenting styles play in shaping the overall behavior of children. Next, indicate the significant impacts that each role has in contributing to delinquent behavior among juveniles.
· Think about the following question: Should juvenile delinquents be removed from their home and parent(s) and placed in a foster home or group home if the child continues to commit criminal acts after repeated attempts at treatment and confinement? Based on this question, discuss your thoughts on this subject. Provide support for your response.
Discussion-
"Exploring Monopolies and Oligopolies"
Watch this video, Oligopolies and Monopolistic Competition, to help you prepare for this week’s discussion.
Reply to these prompts by using the company for which you currently work, a business with which your familiar, or a dream business you want to start:
· With your selected business in mind, determine if it is competitive, monopolistic competitive, an oligopoly, or pure monopoly. Explain how you drew your conclusion about its market structure.
· How does the business/firm in this industry determine the price it will charge for the products or services it sells?
Discussion-
"Considering Tradeoffs You Make Every Day"
Let's talk about two tradeoffs we face every day: how we spend our time and money.
We can only do two things with income: spend it or save it. Time is the ultimate resource. We can choose to spend time working to earn an income or we can do other things, broadly classified as leisure. Reply to these prompts to start your discussion:
· How does a change in interest rate affect your decision to spend or save? How would a change in the interest rate affect a firm's decision to invest or save?
· How might an increas.
Case Study - Option 3 BarbaraBarbara is a 22 year old woman who h.docxcowinhelen
Case Study - Option 3: Barbara
Barbara is a 22 year old woman who has recently graduated from college with a psychology degree. She is currently working as a waitress at a popular restaurant near campus, and says she has always planned to attend law school. Barbara was born in a New Orleans, Louisiana. Her mother is an African American who is an assistant manager at a grocery store. Her father is Caucasian and works at a department store. Barbara reports that she was a shy, unattractive child, but that in general her early childhood was "pretty happy." Barbara says that during elementary school, she was constantly harassed by classmates about being of mixed race. Still, she says that she felt very close to her family during this period. She now insists that "I am not black or white, I am me."
Barbara is sexually active and engages in sexual activity with different men at least 1 time a week. Barbara indicates that she does not need protection because she is on the pill. She says she is simply too young to settle down. During her junior year of high school, Barbara had her first serious boyfriend, Morris, who was a high school classmate. She describes the relationship as warm and supportive and they became sexually active during her senior year of high school. They broke up soon after the first sexual interaction. In college, Barbara has dated and she acknowledges some bisexual experimentation. Barbara says that she prefers heterosexual relationships, however.
Although Barbara appears to be a natural athlete, she leads a relatively sedentary lifestyle. She does not exercise regularly and indicates that it is just not enjoyable.
Barbara does not like her job at the restaurant, but seems unwilling to look for other employment. She says that she feels "very jittery" whenever she gets ready for work, and she uses any excuse to take days off. She also refuses to associate with fellow employees, and reports getting very anxious when she was given a surprise birthday party. Recently, she has lost interest in cleaning her house and seldom cooks for herself. She also attends less to her personal grooming.
Diagnosis – Social Anxiety Disorder/Minor Depression
DSM-5 – Diagnostic Criteria for Social Anxiety Disorder
1. Fear or anxiety specific to social settings, in which a person feels noticed, observed, or scrutinized.
2. Typically the individual will fear that they will display their anxiety and experience social rejection,
3. Social interaction will consistently provoke distress,
4. Social interactions are either avoided, or painfully and reluctantly endured,
5. The fear and anxiety will be grossly disproportionate to the actual situation,
6. The fear, anxiety or other distress around social situations will persist for six months or longer and
7. Cause personal distress and impairment of functioning in one or more domains, such as interpersonal or occupational functioning,
8. The fear or anxiety cannot be attributed to a medical disorder, s.
Case Study - Cyberterrorism—A New RealityWhen hackers claiming .docxcowinhelen
Case Study - Cyberterrorism—A New Reality:
When hackers claiming to support the Syrian regime of Bashar Al-Assad attacked and disabled the website of Al Jazeera, the Qatar-based satellite news channel, in September 2012, the act was another act of hacktivism, purporting to promote a specific political agenda over another. Hacktivism has become a very visible form of expressing dissent. Even though there have been numerous incidents reported by the media, the first case of hacktivism was documented in 1989 when a member of the Cult of the Dead Cow hacker collective named Omega coined the term in 1996. However, hacktivism is not the only form of cyber protest and conflict that has everyone from ICT professionals to governments scrambling for solutions. Individuals, enterprises, and governments alike rely in many instances almost completely on network computing technologies, including cloud computing. The international and ever-evolving nature of the Internet along with inadequate law enforcement and the anonymity the global architecture offers creates opportunities for hackers to attack vulnerable nodes for personal, financial, or political gain.
The Internet is also rapidly becoming the political and advocacy platform of choice, bringing with it both positive and negative consequences. Increasingly sophisticated off-the-shelf technologies and easy access to the Internet are significantly increasing incidents of cyberterrorism, netwars, and cyberwarfare. The following are a few examples.
• According to The Israel Electric Company, Israel is attacked 1,000 times a minute by cyberterrorists targeting the country’s infrastructure—water, electricity, communications, and other services.• The New York Times, quoting military officials, said there was a seventeen-fold increase in cyberattacks targeting the US critical infrastructure between 2009 and 2011.• The 2010 Data Breach Investigations Report has data recording more than 900 instances of computer hacking and other data breaches in the past seven years, resulting in some 900 million compromised records. In 2012, the same study listed 855 breaches, resulting in 174 million compromised records in 2011 alone, up from 4 million in 2010.• Another study of 49 breaches in 2011 reported that the average organizational cost of a data breach (including detection, internal response, notification, post notification cost) was $5.5 million. This number was down from $7.2 million in 2010.14 The Telegraph (London) reported that “India blamed a new ‘cyber-jihad’ by Pakistani militant groups for the exodus of thousands of people from India’s north-eastern minorities from its main southern cities in August after text messages warning them to flee went viral.”
There have been recorded instances of nations allegedly engaging in cyberwarfare. The Center for the Study of Technology and Society has identified five methods by which cyberwarfare can be used as a means of military action. These include defacing or di.
Case Study - APA paper with min 4 page content Review the Blai.docxcowinhelen
Case Study - APA paper with min 4 page content
Review the
Blaine
case on the capital structure by understanding the case well enough to help the CEO make informed analysis and decisions on the issues listed in the second paragraph.
I want you to, of course, show me that you understand the situation but then to add the
.
Case Study - Global Mobile Corporation Damn it, .docxcowinhelen
Case Study - Global Mobile Corporation
“Damn it, he's done it again!”
Charlie Newburg had to get up and walk around his office, he was so frustrated. He had been
reviewing the most recent design, parts, and assembly specifications for Global Mobile's latest
smart phone (code named: Nonphixhun) that had been released for production the previous
Thursday. The files had just come back to Charlie's engineering services department with a
caustic note that began, “This one can't be produced, either…” It was the fourth time production
had returned the design.
Newburg, director of engineering for the Global Mobile Corporation, was normally a quiet
person. But the Nonphixhun project was stretching his patience; it was beginning to appear like
several other new products that had hit delays and problems in the transition from design to
production during the eight months Charlie had worked for Global Mobile. These problems were
nothing new at Global Mobile's Asian factory; Charlie's predecessor in the engineering job had
run afoul of them, too, and had finally been fired for protesting too vehemently about the other
departments. But the Nonphixhun phone should have been different. Charlie and the firm's
president, Hannah Hoover, had video-conferenced two months earlier (on July 3, 2006) with the
factory superintendent, Tyson Wang, to smooth the way for the new phone's design. He thought
back to the meeting …
• “Now, we all know there's a tight deadline on the Nonphixhun,” Hannah Hoover said, “and
Charlie's done well to ask us to talk about its introduction. I'm counting on both of you to find
any snags in the system, and to work together to get that first production run out by October
2. Can you do it?” “We can do it in production if we get a clean design two weeks from
now, as scheduled,” answered Tyson Wang, the factory manager. “Charlie and I have already
talked about that, of course. I've spoken with our circuit board and other parts suppliers and
scheduled assembly capacity, and we'll be ready. If the design goes over schedule, though, I'll
have to fill in with other runs, and it will cost us a bundle to break in for the Nonphixhun.
How does it look in engineering, Charlie?” “I've just reviewed the design for the second
time,” Charlie replied. “If Marianne Price can keep the salespeople out of our hair, and avoid
any more last minute changes, we've got a shot. I've pulled my technical support people off of
three other overdue jobs to get this one out. But, Tyson, that means we can't spring engineers
loose to confer with your production people on other manufacturing problems.” “Well
Charlie, most of those problems are caused by the engineers, and we need them to resolve the
difficulties. We've all agreed that production problems come from both of us bowing to sales
pressure, and putting equipment into production before the designs are really ready. That's
just wh.
Case Study #3Apple Suppliers & Labor PracticesWith its h.docxcowinhelen
Case Study #3
Apple Suppliers & Labor Practices
With its highly coveted line of consumer electronics, Apple has a cult following among loyal consumers. During the 2014 holiday season, 74.5 million iPhones were sold. Demand like this meant that Apple was in line to make over $52 billion in profits in 2015, the largest annual profit ever generated from a company’s operations. Despite its consistent financial performance year over year, Apple’s robust profit margin hides a more complicated set of business ethics. Similar to many products sold in the U.S., Apple does not manufacture most its goods domestically. Most of the component sourcing and factory production is done overseas in conditions that critics have argued are dangerous to workers and harmful to the environment.
For example, tin is a major component in Apple’s products and much of it is sourced in Indonesia. Although there are mines that source tin ethically, there are also many that do not. One study found workers—many of them children—working in unsafe conditions, digging tin out by hand in mines prone to landslides that could bury workers alive. About 70% of the tin used in electronic devices such as smartphones and tablets comes from these more dangerous, small-scale mines. An investigation by the BBC revealed how perilous these working conditions can be. In interviews with miners, a 12-yearold working at the bottom of a 70-foot cliff of sand said: “I worry about landslides. The earth slipping from up there to the bottom. It could happen.”
Apple defends its practices by saying it only has so much control over monitoring and regulating its component sources. The company justifies its sourcing practices by saying that it is a complex process, with tens of thousands of miners selling tin, many of them through middle-men. In a statement to the BBC, Apple said “the simplest course of action would be for Apple to unilaterally refuse any tin from Indonesian mines. That would be easy for us to do and would certainly shield us from criticism. But that would also be the lazy and cowardly path, since it would do nothing to improve the situation. We have chosen to stay engaged and attempt to drive changes on the ground.”
In an effort for greater transparency, Apple has released annual reports detailing their work with suppliers and labor practices. While more recent investigations have shown some improvements to suppliers’ working conditions, Apple continues to face criticism as consumer demand for iPhones and other products continues to grow.
Essay directions –
Students will have to identify and analyze the above ethical dilemma. Write a 750 – 1000 word, double-spaced paper, and APA style.
Students are expected to identify the key stakeholders, discussion of the implications of the ethical dilemma, and answer the case study questions. Each paper should have the following sections: • Introduction of the case• The ethical dilemma • Stakeholders • Questions • Conclusions • References .
CASE STUDY (Individual) Scotland In terms of its physical l.docxcowinhelen
CASE STUDY (Individual): Scotland
* In terms of its physical landscape, where is the region that is experiencing a devolutionary process located and what type of climate is prevalent? (use Figure 2.5 and 2.4 of the textbook).
* According to the sources you have consulted, do these physical/natural characteristics have played any role in the historical background for this devolutionary process? How?
* How do the people that inhabit the region you are studying speak about their relationship to the land and the environment? Do they express any ideas on biodiversity conservation?
* Do they say anything about their homeland? If the region you are studying has a website (official or not), what role do maps play on their web site/s?
* Is this region located close to or far from the center of power of the country (the national capital city)?
* Does this condition have any impact on the reasons why they would like to gain at-least more autonomy to make their own decisions?
* According to the source/s you have consulted, what are the main reason/s why this population would like to break-up from the country in which they live in?
Do this/these source/s mention any explanation/s based on cultural or ethnic characteristics? For example, speaking a different language? Which one? Professing a different religion? Which one? Economic disparities
.
Case Study #2 T.D. enjoys caring for the children and young peop.docxcowinhelen
Case Study #2
T.D. enjoys caring for the children and young people in the schools where she works, but sometimes she is faced with tough situations such as suspected child abuse and neglect, teen pregnancy, and alcohol and drug use among teenagers. She works hard to ensure that the children in her schools receive the best care possible.
Question:
Several third graders reports having received no breakfast at home for more than a week. T.D. is exercising Advocacy for the students under her care. What type of actions she might be doing to exercise advocacy for the students?
Discuss this:
Moral distress is a frequent situation where health care providers should face. Please define and discuss a personal experience where you have faced Moral distress in your practice.
Discuss how health promotion relates to morality.
Discuss your insights about your own communication strengths and weaknesses. Identify situations in which it may be difficult for you to establish or terminate a therapeutic relationship.
*
formatted and cited in current APA style with support from at least 2 academic sources.
.
CASE STUDY #2 Chief Complaint I have pain in my belly”.docxcowinhelen
CASE STUDY #2
Chief Complaint:
“I have pain in my belly”
History of Present Illness (HPI):
A 25-year-old female presents to the emergency room (ER) with complaints of severe abdominal pain for 2 weeks . The pain is sharp and crampy It hurts if I run, sit down hard, or if I have sex
PMH:
Patient denies
Drug Hx:
Birth control
Allergies:
NKA
Subjective:
Nausea and vomiting, Last menstrual period 5 days ago, New sexual partner about 2 months ago, No condoms, he hates them No pain, blood or difficulty with urination
Objective Data:
PE:
B/P 138/90; temperature 99°F; (RR) 20; (HR) 110, regular; oxygen saturation (PO2) 96%; pain 5/10
General:
acute distress and severe pain
HEENT:
Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, nasopharynx clear, good dentition. Piercing in her right nostril and lower lip.
Lungs:
CTA AP&L
Card:
S1S2 without rub or gallop
Abd:
INSPECTION: no masses or thrills noted; no discoloration and skin is warm to; no tattoos or piercings; abdomen is nondistended and round
• AUSCULTATION: bowel sounds (BS) are normal in all four quadrants, no bruits noted
• PALPATION: on palpation, abdomen is tender to touch in four quadrants; tenderness noted on light palpation, deep palpation reveals no masses, spleen and liver unremarkable
• PERCUSSION: tympany heard in all quadrants, no dullness noted in abdominal area
GU:
• EXTERNAL: mature hair distribution; no external lesions on labia
• INTROITUS: slight green-gray discharge, no lesions
• VAGINAL: normal rugae; moderate amount of green discharge on vaginal walls
• CERVIX: nulliparous os with small amount of purulent discharge from os with positive cervical motion tenderness (CMT)
• UTERUS: ante-flexed, normal size, shape, and position
• ADNEXA: bilateral tenderness with fullness; both ovaries without masses
• RECTAL: deferred
• VAGINAL DISCHARGE: green in color
Ext:
no cyanosis, clubbing or edema
Integument:
intact without lesions masses or rashes
Neuro:
No obvious deficits and CN grossly intact II-XII
Then answer the following questions:
What other subjective data would you obtain?
What other objective findings would you look for?
What diagnostic exams do you want to order?
Name 3 differential diagnoses based on this patient presenting symptoms?
Give rationales for your each differential diagnosis.
-
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
.
Case Study #1Jennifer is a 29-year-old administrative assistan.docxcowinhelen
Case Study #1
Jennifer is a 29-year-old administrative assistant married to Antonio, an Italian engineer, whom Jennifer met four years earlier while on a business trip for her marketing company. The couple now lives in Nebraska, where Antonio works for the county's transportation department and Jennifer commutes an hour each way to her marketing office. They have been trying to start a family for over a year. Eight months ago, Jennifer miscarried in her second month of pregnancy. Antonio's parents love Jennifer and often ask her if she is expecting again, hoping to encourage her to focus on her next baby. Jennifer's mother passed away two years ago and her father's health is rapidly deteriorating. Jennifer faces the probability of placing her father in a skilled nursing care facility within the next few months, against his wishes.
At work, Jennifer runs a tight ship. She is organized and prepares lists to assure that everything is done according to schedule. Everyone counts on Jennifer and she takes pride in never letting people down.
Jennifer has visited her physician numerous times in the last six months, complaining of headaches, backaches, and indigestion. Jennifer insists that she is happy and is not feeling stressed, yet she finds herself making more mistakes at work, unable to keep up with housework, and feeling tired and overwhelmed; she has begun to question her effectiveness as an employee, wife, daughter, and potential mother. Her pains seem to be increasing, but her doctor cannot find a physical cause for her discomfort.
Case Study #2
Michael is a 40-year-old airline pilot who has recently begun to experience chest pains. The chest pains began when Michael signed his final divorce papers, ending his 15-year marriage. He fought for joint custody of his two children, ages 12 and 10, but although he wants to be with them more frequently, he only sees them every two weeks. This schedule is, in great part, a result of his employer's announcement that budget constraints would result in layoffs. Michael worries that without his job he will be unable to support his children and lose the new townhouse that he purchased. Michael's chest pains are becoming more frequent and he fears that he may be dying.
Review case studies 1 and 2.
Choose one case study.
Complete the following questions in 150 to 200 words each. Be as detailed as possible and use the information you have learned throughout this course.
• What are the causes of stress in Michael’s or Jennifer’s life? How is stress affecting Michael’s or Jennifer’s health?
• How are these stressors affecting Michael’s or Jennifer’s self-concept and self-esteem?
• How might Michael’s or Jennifer’s situation illustrate adjustment? How might this situation become an opportunity for personal growth?
• What defensive coping methods is Michael or Jennifer using? What active coping methods might be healthier for Michael or Jennifer to use? Explain why you would recom.
Case Study # 2 –Danny’s Unhappy DutyEmployee ProfilesCaro.docxcowinhelen
Case Study # 2 –Danny’s Unhappy Duty
Employee Profiles
:
Carol Brown, Danny Winthrop, Thomas Fletcher
Carol, the Department Secretary for Purchasing and General Stores, has been
working at St. Louis Memorial Hospital for sixteen years, four of which have
been for the present Manager, Dan Winthrop. Carol likes her Boss, who gives
his employees more leeway than most. Carol’s main interests are her work and
her home—traits also typical of the other people who work in the Department.
Carol feels she is part of a close, cooperative group of employees.
Dan, or Danny, as he likes to be called, arrived at St. Louis Memorial four years
ago as a replacement for a Department manager who had been at the Hospital
for a number of years. Danny’s predecessor, Bill Taylor, was very strict in
everything from insisting that employees take exactly one-half hour for lunch
breaks to not having a coffee pot in the Department. When Danny came on
board as a Department Manager, his management style was much less strict.
The result was that Danny’s employees were much happier, and began to meet
and exceed expectations in getting their work done. St. Louis Memorial’s
previous CEO was a good friend and frequently complimented Danny on his
efficient and effective staff. Now a new CEO, Thomas Fletcher, has been hired
by the Hospital’s Board of Directors. Things are about to change.
Thomas Fletcher, new CEO and a recent graduate from a superior school of
hospital management, has always believed in “doing things by the book”.
Thomas originally had wanted to become a doctor, but decided two years into
the process that it was going to take him too long, and that he would be better
off becoming an administrator. He likes the idea of being an administrator,
and wants to be a good one. He has decided to start out his career at St. Louis
Memorial, of the smaller hospitals in the St. Louis area, but hopes to progress to a
a much larger facility in about four years, once he develops a track record at
St. Louis Memorial.
The Challenge: Communication, Criticism and Discipline, Leadership, Motivation,
Rules and Policies
Danny knows his employees quite well. They are generally a happy, cohesive, and cooperative group. They joke around a lot among themselves, but get the work done more than satisfactorily. All of them seem to give a
gr.
Case Study – Multicultural ParadeRead the Case below, and answe.docxcowinhelen
Case Study – Multicultural Parade
Read the Case below, and answer the following questions:
(No references needed, 2 pages double space, label the answer without copying the question in the paper)
1. What images come to mind when you hear the term “costume”? In what ways might it be considered demeaning?
2. Often people conflate “culture,” “ethnicity,” “heritage,” “race,” and “nationality,” or use them interchangeably. How are these concepts different from one another? Is a “Multicultural Day” different than an “International Day”?
3. How is Ms. Morrison’s definition of “cultural clothing” different from her definition of “ethnic heritage”? Did her explanation clarify things for Keisha and Emily?
4. How might activities that require students to share part of their ethnic heritage alienate students or contribute to students’ and teachers’ existing stereotypes and biases?
5. Connect to 3 of the core themes:
(Equity in Education/ Theories of Learning, Culture, and Identity/ Teaching and Learning in a Multicultural Society/ Research and Educational Knowledge )
-------------------------------------------------------------------------------------------------------------------------------
Case Study:
In an effort to celebrate the growing racial and ethnic diversity at Eastern School, the school’s Diversity Committee decided to sponsor Multicultural Day. Numerous performers were hired for assemblies and presentations. During the day’s feature event, the “Culture Parade,” students were asked to showcase cultural clothing as they walked through the hallways. Teachers were encouraged by the committee to discuss clothing from countries outside the United States and to invite students who had such clothing to bring it to school for the parade.
Ms. Morrison was excited about Multicultural Day because many of her students had parents who were immigrants. She imagined the day as an opportunity for those students to teach others about their cultures.
A week before the event, Ms. Morrison brought a kilt to class and explained its significance to the students. “This represents my Scottish heritage,” she said, “and I am proud to show it to you today.” She then asked whether students had “special costumes” at home that represented their cultures. Several students raised their hands, which prompted Ms. Morrison to discuss the events planned for Multicultural Day, including the parade.
During dismissal the day before the parade Ms. Morrison announced, “Don’t forget to bring your costumes to class tomorrow!”
The next day, Ms. Morrison was pleased to see several Hmong and Liberian students came with bags of clothing. She saw that two other students, Emily and Keisha, brought clothing, so she inquired about what was in their bags. Emily, a white student excitedly pulled out her soccer uniform, and Keisha, an African American student, pulled jeans and her favorite sweatshirt out of her bag. Ms. Morrison told the two girls she appreciated the.
Case Study THE INVISIBLE SPONSOR1BackgroundSome execut.docxcowinhelen
Case Study : THE INVISIBLE SPONSOR1
Background
Some executives prefer to micromanage projects whereas other executives
are fearful of making a decision because, if they were to make the wrong
decision, it could impact their career. In this case study, the president of the company assigned one of the vice presidents to act as the project sponsor on a project designed to build tooling for a client. The sponsor, however, was reluctant to make any decisions.
Assigning the VP
Moreland Company was well-respected as a tooling design-and-build
company. Moreland was project-driven because all of its income came
from projects. Moreland was also reasonably mature in project management.
When the previous VP for engineering retired, Moreland hired an executive from a manufacturing company to replace him. The new VP for engineering, Al Zink, had excellent engineering knowledge about tooling but had worked for companies that were not project-driven. Al had very little knowledge about project management and had never functioned as a project sponsor. Because of Al’s lack of experience as a sponsor, the president decided that Al should “get his feet wet” as quickly as possible and assigned him as the project sponsor on a mediumsized project. The project manager on this project was Fred Cutler. Fred was an engineer with more than twenty years of experience in tooling design and manufacturing. Fred reported directly to Al Zink administratively.
Fred's Dilemma
Fred understood the situation; he would have to train Al Zink on how to
function as a project sponsor. This was a new experience for Fred because subordinates usually do not train senior personnel on how to do their job. Would Al Zink be receptive?
Fred explained the role of the sponsor and how there are certain project documents that require the signatures of both the project manager and the project sponsor. Everything seemed to be going well until Fred informed Al that the project sponsor is the person that the president eventually holds accountable for the success or failure of the project. Fred could tell that Al was
quite upset over this statement.
Al realized that the failure of a project where he was the sponsor could damage his reputation and career. Al was now uncomfortable about having to act as a sponsor but knew that he might eventually be assigned as a sponsor on other projects. Al also knew that this project was somewhat of a high risk. If Al could function as an invisible sponsor, he could avoid making any critical decisions.
In the first meeting between Fred and Al where Al was the sponsor, Al asked Fred for a copy of the schedule for the project. Fred responded: I’m working on the schedule right now. I cannot finish the schedule until you tell me whether you want me to lay out the schedule based upon best time, least cost, or least risk.
Al stated that he would think about it and get back to Fred as soon as possible.
During the middle of the next week, Fred and Al m.
CASE STUDY Experiential training encourages changes in work beha.docxcowinhelen
CASE STUDY: Experiential training encourages changes in work behavior and growth in one’s abilities, which is accomplished through a multitude of methods. Experiential training has proven to be cost-effective while motivating employees as well as improving self-awareness, personal accountability, teamwork skills, and communication skills (Ritchie, 2011). Additionally, the training methods provide trainees with direct experience, the opportunity to reflect on that experience, and share models to help trainees to deduce using both present and past experience, while accommodating learning styles and strengths (Ritchie, 2011). Valkanos and Fragoulis identify several reasons why experiential training provides value:
1. Ongoing advances in technology requiring changes in knowledge, skills, and abilities
2. Divergence between theory and practice
3. Mergers and acquisitions of enterprises which tend to bring new jobs, organizational culture, and work content
4. Constant environment of change, from working conditions to processes and procedures relating to organizational issues, quality, and new products or services, and requiring new competencies, duties, or work content (Valkanos & Fragoulis, 2007, p. 22).
Method
Description
On-the-job Training
Receives instructions on the functions of their job in their assigned workplace.
Simulators
Teaches employees on how to operate equipment in a given context
Role Playing
Developing interpersonal and business skills, such as decision-making, communication, conflict resolution, and solving complex problems.
Case Study
Develops critical thinking skills to include analytical, higher-level skills, and exploring and resolving complex problems.
Games
Develops general business and organizational principles addressing application in a variety of situations.
Behavior Modeling
Used when learning goals are a rule and inflexible procedures. Provides skills and practice to modify and model behavior.
In-basket Techniques
A variety of items placed in an envelope that reflects what might be found in an inbox. This activity is used to assist trainees in developing and applying their strategic and operational skills.
(Blanchard & Thacker, 2013, pp. 222-223)
References:
· Blanchard, P. N., & Thacker, J. W. (2013). Effective training: Systems, strategies, and practices (5th ed.). Upper Saddle River, NJ: Pearson Education, Inc.
· Valkanos, E., & Fragoulis, I. (2007). Experiential learning – its place in in‐house education and training. Development and Learning in Organizations: An International Journal, 21(5), 21-23. doi:10.1108/14777280710779454
Discussion Question--Choose one perspective in which to respond.
Non-HR Perspective: Your department is not meeting performance expectations. What steps do you take to resolve the issue? Is training a possible solution; if so, which of the above training methods would be the most effective in addressing the issue? Would you, at any point, involve HR--if so, at what point and why?.
Case Study Hereditary AngioedemaAll responses must be in your .docxcowinhelen
Case Study: Hereditary Angioedema
All responses must be in your own words. Answers that have been copied and pasted will not receive credit.
1. Translate “angioedema”. [Note: I am not looking for a description of the disorder. Rather, I would like you to translate the medical term itself.]
2. The complement system is described as a ‘cascade system’. How does the system fit into this description of being a cascade? [Suggestion: Google the definition of cascade, then think about the complement system in light of the definition]
3. Is complement involved in the innate, or the adaptive immune system, or both? Please explain you answer.
4. What role does C1INH play in the complement system? Why is it so important?
5. What was the physiologic cause of Richard’s abdominal pain?
6. How can one distinguish the swelling of HAE from the swelling of allergic angioedema?
7. What is bradykinin’s role in HA?
8. Do you think Richard’s infancy colic was related to his HA? No need to research this. Just use your intuition. Explain your thinking.
9. What is typically used to treat attacks of HAE?
10. Swelling in the extremities is not dangerous. What other areas of the body are subject to swelling? What is the most dangerous location for swelling to occur and why is it the most dangerous?
2018
BUS 308 Week 2 Lecture 1
Examining Differences - overview
Expected Outcomes
After reading this lecture, the student should be familiar with:
1. The importance of random sampling.
2. The meaning of statistical significance.
3. The basic approach to determining statistical significance.
4. The meaning of the null and alternate hypothesis statements.
5. The hypothesis testing process.
6. The purpose of the F-test and the T-test.
Overview
Last week we collected clues and evidence to help us answer our case question about
males and females getting equal pay for equal work. As we looked at the clues presented by the
salary and comp-ratio measures of pay, things got a bit confusing with results that did not see to
be consistent. We found, among other things, that the male and female compa-ratios were fairly
close together with the female mean being slightly larger. The salary analysis showed a different
view; here we noticed that the averages were apparently quite different with the males, on
average, earning more. Contradictory findings such as this are not all that uncommon when
examining data in the “real world.”
One issue that we could not fully address last week was how meaningful were the
differences? That is, would a different sample have results that might be completely different, or
can we be fairly sure that the observed differences are real and show up in the population as
well? This issue, often referred to as sampling error, deals with the fact that random samples
taken from a population will generally be a bit different than the actual population parameters,
but will be “close” enough to the actual.
case studieson Gentrification and Displacement in the Sa.docxcowinhelen
case studies
on Gentrification and Displacement
in the San Francisco Bay Area
Authors:
Miriam Zuk and Karen Chapple
Chapter 3: Nicole Montojo
Chapter 4: Sydney Cespedes, Mitchell Crispell, Christina Blackston, Jonathan Plowman, and
Edward Graves
Chapter 5: Logan Rockefeller Harris, Mitchell Crispell, Fern Uennatornwaranggoon, and Hannah Clark
Chapter 6: Nicole Montojo and Beki McElvain
Chapter 7: Celina Chan, Viviana Lopez, Sydney Céspedes, and Nicole Montojo
Chapter 8: Alexander Kowalski, Julia Ehrman, Mitchell Crispell and Fern Uennatornwaranggoon
Chapter 9: Mitchell Crispell
Chapter 10: Logan Rockefeller Harris and Sydney Cespedes
Chapter 11: Mitchell Crispell
Partner Organizations:
Causa Justa :: Just Cause, Chinatown Community Development Center, Marin Grassroots, Monument
Impact, People Organizing to Demand Environmental & Economic Rights (PODER), San Francisco
Organizing Project / Peninsula Interfaith Action , Working Partnerships USA
Acknowledgements:
Research support was provided by Maura Baldiga, Julian Collins, Mitchell Crispell, Julia Ehrman, Alex
Kowalski, Jenn Liu, Beki McElvain, Carlos Recarte, Maira Sanchez, Mar Velez, David Von Stroh, and
Teo Wickland. Report layout and design was done by Somaya Abdelgany.
Additional advisory support was provided by Carlos Romero. This case study was funded in part by
the Regional Prosperity Plan1 of the Metropolitan Transportation Commission as part of the “Regional
Early Warning System for Displacement” project and from the California Air Resources Board2 as part
of the project “Developing a New Methodology for Analyzing Potential Displacement.”
The Center for Community Innovation (CCI) at UC-Berkeley nurtures effective solutions that expand
economic opportunity, diversify housing options, and strengthen connection to place. The Center
builds the capacity of nonprofits and government by convening practitioner leaders, providing techni-
cal assistance and student interns, interpreting academic research, and developing new research out
of practitioner needs.
communityinnovation.berkeley.edu
July 2015
Cover Photographs: Robert Campbell, Ricardo Sanchez, David Monniaux, sanmateorealestateonline.com/Redwood-City, marinretail-
buzz.blogspot.com, trulia.com/homes/California/Oakland , bloomingrock.com, sharks.nhl.com/club/gallery, panoramio.com
1 The work that provided the basis for this publication was supported by funding under an award with the U.S. Department of Hous-
ing and Urban Development. The substance and findings of the work are dedicated to the public. The author and publisher are solely
responsible for the accuracy of the statements and interpretations contained in this publication. Such interpretations do not neces-
sarily reflect the views of the Government.
2 The statements and conclusions in this report are those of the authors and not necessarily those of the California Air Resources
Board. The mention of commercial products, their source, or their u.
Case Studt on KFC Introduction1) Identify the type of .docxcowinhelen
Case Studt on KFC
Introduction
1) Identify the type of business organization and strategies
2) Key players
Body
1. Opportunities
2. Threats
Closing/Conclusion
1. Make recommendations
2. Offer a plan for implementation
.
Case Study Crocs Revolutionizing an Industry’s Supply Chain .docxcowinhelen
Case Study Crocs: Revolutionizing an Industry’s Supply Chain Model for
Competitive Advantage
If the products sell extremely well, we will
build more in season, and will be back on the
shelves in a few weeks. And we’ll build even
more, and even more, and even more, in that
same season. We’re not going to wait with a
hot new product until next year, when hope-
fully the same trend is alive.
—Ronald Snyder, CEO of Crocs, Inc.1
On May 3, 2007, Crocs, Inc. released its results for the
first quarter of the year. The footwear company,
which had sold its first shoes in 2003, reported reve-
nues of $142 million for the quarter, more than three
times its sales for the first quarter of 2006. Net in-
come, at $0.61 per share was more than 17 percent
of sales, nearly four times higher than the previous
year.2 These results far exceeded market expecta-
tions, which had been for earnings of $0.49 per share
on $114 million of revenue.3 As part of the earnings
release, the company announced a two-for-one stock
split. Immediately after the announcement, the stock
price jumped 15 percent.
The growth and profitability of Crocs, which made
funky, brightly colored shoes using an extremely com-
fortable plastic material, had been astounding. Much
of this growth had been made possible by a highly
flexible supply chain which enabled the company to
build additional product to fulfill new orders quickly
within the selling season, allowing it to respond to un-
expectedly high demand—a capability that was previ-
ously unheard of in the footwear industry. This ability
to fulfill the needs of retailers also made the company
a very popular supplier to shoe sellers.
This success also raised questions about how
the company should grow in the future. Should it
vertically integrate or grow through product line
extension? Should it grow organically or through ac-
quisition? Would potential growth paths exploit
Crocs’ core competencies or defocus them?
CROCS, INC.
In 2002, three friends from Boulder, Colorado went
sailing in the Caribbean. One brought a pair of foam
clog shoes that he had bought from a company in
Canada. The clogs were made from a special mate-
rial that did not slip on wet boat decks, was easy
to wash, prevented odor, and was extremely com-
fortable. The three, Lyndon “Duke” Hanson, Scott
Seamans, and George Boedecker, decided to start a
business selling these Canadian shoes to sailing en-
thusiasts out of a leased warehouse in Florida, as
Hanson said, “so we could work when we went on
sailing trips there.”4 The founders wanted to name
the shoes something that captured the amphibious
nature of the product. Since “Alligator” had already
been taken, they chose to name the shoes “Crocs.”
The shoes were an immediate success, and word
of mouth expanded the customer base to a wide
range of people who spent much of their days stand-
ing, such as doctors and gardeners. In October 2003,
as the business began to grow, th.
Case Studies Student must complete 5 case studies as instructed.docxcowinhelen
Case Studies: Student must
complete 5 case studies
as instructed by course
materials. Fill out form below for 5 different people (imaginary is okay).
Master Herbalist Questionnaire
Date: _____________________
Name: _________________________________ Age: ______ Birth date:_____________
Address: ________________________________________________________________
Home Phone: _________________________ Work Phone:________________________
Height: _________ Weight: _________ 1 year ago:__________ 5 years ago:_________
Occupation: _______________________________________ Full Time Part Time
Living situation: Alone Friends Partner Spouse Parents Children Pets
What are your major health concerns and intentions for your visit today?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Please list any other health care providers or consultants you are currently working with:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Please list any current health conditions diagnosed by a medical doctor:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Please use this form
as a source of
reference when
conducting your
Case-Studies.
Treat this part as information only as you are not to treat or prescribe treatment for any specific diseases
It is important to know if the client is receiving treatment from other practitioners and what these entail
Since legally you are not allowed to diagnose disease, it is helpful to get one from an MD
When was your last physical exam?
________________________________________________________________________
Please list all herbs, vitamins, and dietary supplements you are currently taking, includingdosage and frequency:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
List all medication.
Case Studies in Telehealth AdoptionThe mission of The Comm.docxcowinhelen
Case Studies in Telehealth Adoption
The mission of The Commonwealth
Fund is to promote a high performance
health care system. The Fund carries
out this mandate by supporting
independent research on health care
issues and making grants to improve
health care practice and policy. Support
for this research was provided by
The Commonwealth Fund. The views
presented here are those of the author
and not necessarily those of The
Commonwealth Fund or its directors,
officers, or staff.
For more information about this study,
please contact:
Andrew Broderick, M.A., M.B.A.
Codirector, Center for Innovation
and Technology in Public Health
Public Health Institute
[email protected]
The Veterans Health Administration:
Taking Home Telehealth Services to
Scale Nationally
Andrew Broderick
ABSTRACT: Since the 1990s, the Veterans Health Administration (VHA) has used infor-
mation and communications technologies to provide high-quality, coordinated, and com-
prehensive primary and specialist care services to its veteran population. Within the VHA,
the Office of Telehealth Services offers veterans a program called Care Coordination/
Home Telehealth (CCHT) to provide routine noninstitutional care and targeted care man-
agement and case management services to veterans with diabetes, congestive heart fail-
ure, hypertension, post-traumatic stress disorder, and other conditions. The program uses
remote monitoring devices in veterans’ homes to communicate health status and to cap-
ture and transmit biometric data that are monitored remotely by care coordinators. CCHT
has shown promising results: fewer bed days of care, reduced hospital admissions, and
high rates of patient satisfaction. This issue brief highlights factors critical to the VHA’s
success—like the organization’s leadership, culture, and existing information technology
infrastructure—as well as opportunities and challenges.
OVERVIEW
Since the 1990s, information and communications technologies—including tele-
health—have been at the core of the Veterans Health Administration’s (VHA’s)
successful system-level transformation toward providing continuous, coordinated,
and comprehensive primary and specialist care services. The VHA’s leadership
and culture; underlying health information technology infrastructure; and strong
commitment to standardized work processes, policies, and training have all con-
tributed to the home telehealth program’s success in meeting the chronic care
needs of a population of aging veterans and reducing their use of institutional
care and its associated costs. The home teleheath model also encourages patient
activation, self-management, and helps in the early detection of complications.
To learn more about new publications
when they become available, visit the
Fund's website and register to receive
Fund email alerts.
Commonwealth Fund pub. 1657
Vol. 4
January 2013
www.commonwealthfund.org
www.commonwealthfund.org
mailto:[email pro.
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
The Art Pastor's Guide to Sabbath | Steve ThomasonSteve Thomason
What is the purpose of the Sabbath Law in the Torah. It is interesting to compare how the context of the law shifts from Exodus to Deuteronomy. Who gets to rest, and why?
The Indian economy is classified into different sectors to simplify the analysis and understanding of economic activities. For Class 10, it's essential to grasp the sectors of the Indian economy, understand their characteristics, and recognize their importance. This guide will provide detailed notes on the Sectors of the Indian Economy Class 10, using specific long-tail keywords to enhance comprehension.
For more information, visit-www.vavaclasses.com
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Overview on Edible Vaccine: Pros & Cons with Mechanism
Case An elderly widow who just lost her spouse. Subjective.docx
1. Case: An elderly widow who just lost her spouse.
Subjective: A patient presents to your primary care office today
with chief complaint of insomnia. Patient is 75 YO with PMH
of DM, HTN, and MDD. Her husband of 41 years passed away
10 months ago. Since then, she states her depression has gotten
worse as well as her sleep habits. The patient has no previous
history of depression prior to her husband’s death. She is
awake, alert, and oriented x3. Patient normally sees PCP once
or twice a year. Patient denies any suicidal ideations. Patient
arrived at the office today by private vehicle. Patient currently
takes the following medications:
• Metformin 500mg BID
• Januvia 100mg daily
• Losartan 100mg daily
• HCTZ 25mg daily
• Sertraline 100mg daily
Current weight: 88 kg
Current height: 64 inches
Temp: 98.6 degrees F
BP: 132/86
Insomnia is a disorder linked with difficulty in sleep
quality, initiating or maintaining sleep, along with substantial
2. distress and impairments of daytime functioning. Its prevalence
ranges from 10 to 15% among the general population, with
higher rates seen among females, divorced or separated
individuals, those with loss of loved ones, and older people
(Bollu & Kaur, 2019). Insomnia can simply be defined as a
sleep disorder where the patient has trouble falling asleep or
staying asleep. According to Krystal et al (2019), it is a
common condition that is linked with noticeable deterioration
in function and quality of life, mental and physical morbidity.
The complaints of insomnia are present in 60–90% of patients
with major depression, Complaints of disrupted sleep are very
common in patients suffering from depression, (Wichniak,
etal., 2017).
Questions you might ask the patient and rationale
The diagnosis and treatment of insomnia rely mainly
on a thorough sleep history to address the precipitating factors
as well as maladaptive behaviors resulting in poor sleep (Bollu
& Kaur, 2019).
What is your sleep pattern including how many hours of sleep
do you get at night prior to your husband’s demise and what it
has been in the 10 months since his death? Does she perform
certain rituals or do something special before she sleeps. This
assesses if the insomnia started before or after the husband’s
death. This provides a clue to insomnia that may be related to
bereavement.
What time do you go to bed every night and what is your
normal routine before going to bed? This is to check if the
patient is doing something differently which has disrupted her
normal routine and caused insomnia.
How often do you wake up to urinate at night? This question is
asked to assess for nocturia due to diabetes that may lead to
3. insomnia. Nocturia can prevent the patient from having a good
night’s sleep. , changes in blood glucose levels at night
causesto hypoglycemic and hyperglycemic episodes, nocturia
and associated depression and insomnia ( Khandelwal et al.,
2017).
Do you sleep during the day time. This provides information
that evaluates if day time sleeping may be affecting her ability
to sleep at night.
Are you taking your medications as prescribed? This patient
takes sertraline for depression. Did the insomnia start after the
pt started taking sertraline or after the death of her husband.
Identify people in the patient’s life you would need to speak to
or get feedback from to further assess the patient’s situation
Children
Are there are things that disrupts her sleep? for example,
music/TV noise or crying/playing children. This is important to
ascertain that her condition is not caused by environmental
factors. Epidemiologic research according to Johnson et al
(2018) has shown that social features of environments, family,
social cohesion, safety, noise, and neighborhood disorder can
cause changes in sleep patterns; and other factors like light,
noise, traffic, etc., can also affect sleep and is attributed to
sleep disorders among adults and children.
What does she do when she wakes up at night? does she eat,
drink coffee or smoke. This is to determine if midnight
activities may hinder her from falling asleep.
Does she complain of having a hard time falling asleep or
sleeping for a short period and waking up, unable to go back to
sleep? This assesses how sleep and rest she may be getting.
4. Who caters to the needs of this patient? This is to assess if she
is well cared for or if the patient is concerned about her self
care.
Relatives
Has the patient complained to you about difficulty falling
asleep?
Does the patient complain about waking up in the middle of the
night and finding it hard to go back to sleep?
Who does the patient leave with?
Friends
Does she complain of feeling tired because of not sleeping?
Does this patient communicate appropriately or is she
withdrawn when you see her?
When did you see the patient last?
Primary care physician
Has this patient complained about any sleep problems in the
past? This provides collaboration between health care providers
to ensure proper management and delivery of patient-centered
care.
Physical Exams
Psychiatric evaluation:
A mental health evaluation should be done to assess the
patient’s overall mental state including presenting symptoms,
5. thoughts, feelings, or behavior. PMHNP’s can use the Geriatric
Depression Scale (GDS) which is a self-reported measure of
depression in the older adult. Cornell Scale for Depression in
Dementia (CSDD). The CSDD focuses on an interview with a
family member or caregiver as well as with the patient and is
confirmed for use in patients with or without dementia. Also,
the Zung Self-Rating Depression Scale (SDS) which is used as
a screening tool, covering affective, psychological and somatic
symptoms associated with depression.
Polysomnogram ( sleep study):
can be performed to diagnose sleep disorders such as
insomnia
Sleep diary:
Evaluating the patient’s sleep patterns through a sleep diary
provides information on the patient’s sleep pattern and a
diagnosis of insomnia.
Epworth Sleepiness Scale:
This a questionnaire used to evaluate daytime sleepiness.
Thyroid function test:
Production of little or much thyroid hormone, can affect sleep.
HBA1C
: The patient has a history of diabetes, monitoring her HbA1C
is important. This is because Individuals with a diagnosis of
diabetes report higher rates of insomnia, poor sleep quality,
excessive daytime sleepiness ( Khandelwal et al., 2017).
Actigraphy:
is an objective measurement of sleep schedule, rest-activity
patterns used to help confirm insomnia.
Lab test:
6. such as random glucose test, liver function test, complete
blood count, Erythrocyte Sedimentation Rate, kidney function
test.
Differential diagnosis
Late-life spousal bereavement : bereavement is known to cause
depression and complicated grief ( Holm etal., 2019).
Late life depression (LLD) Predisposing factors include
previous clinical depression, persistent sleep difficulties,
female gender, being widowed or divorced ( Blackburn etal.,
2017). Complicated grief
Medicated-related insomnia
Sleep apnea. Sleep apnea is considered to be prevalent in more
in persons with diabetes ( Khandelwal et al., 2017).
The most likely differential diagnosis, in my opinion,
would be late-life spousal bereavement. (LLSB). The patient
was diagnosed with MDD, she lost her husband (died) ten
months ago, and she is still suffering from depression and
insomnia. Being widowed causes impairments in sleep (Monk
et al., 2008).
Pharmacologic Agents
Sertraline (SSRI) causes insomnia as a side effect. Augmenting
sertraline with a different medication in the elderly may lead to
polypharmacy. Therefore, switching sertraline with a
medication to help with MDD and insomnia will be more
helpful. I would choose to stop sertraline and start trazadone.
sedative antidepressants (such as trazadone 25-50mg) are a safe
when given in low doses and are given in patient groups where
hypnotics are contraindicated, e.g., in the elderly and patients
7. with sleep apnea (Wichniaketal., etal., 2017). Trazodone is an
antidepressant that functions by inhibiting serotonin transporter
and serotonin type 2 receptors. Trazodone in low doses
provides a sedative effect for sleep through antagonism of 5-
HT-2A receptor, H1 receptor, and alpha-1-adrenergic receptors
( Shin & Saadabadi., 2020). Trazodone also improves apnea
and hypopnea episodes in patients known to have with
obstructive sleep apnea (OSA), and it does not worsen
hypoxemic episodes. This patient can be started on trazadone
25- 50mg at bedtime.
A second drug choice is an antidepressant mirtazapine.
It is effective in managing major depressive disorder and has
sedative properties which is helpful in relieving sleep problems
like insomnia and can be used in the elderly. Mirtazapine is
known as an atypical antidepressant with an off label use for
insomnia. It works by exerting antagonist effects on the central
presynaptic alpha-2-adrenergic receptors, causing an elevated
release of serotonin and norepinephrine. Mirtazapine is also
sometimes called a noradrenergic and specific serotonergic
antidepressant (NaSSA). I would recommend starting the
patient on 15 mg of mirtazapine at bedtime. Mirtazapine is
known to treat MDD in patients that were no unresponsive to
SSRIs. I prefer to start this patient on trazadone, rather than
mirtazapine. Mirtazapine has side effects of increased appetite,
increased weight gain and this patient is already obese with
weigh 88kg, height 64 inches (bmi 34.4), increased cholesterol.
Further increase in weight would increase risk for
cardiovascular problems. Trazadone is quickly absorbed and
has a faster onset with hypnotic properties. This makes it more
appropriate for this patient.
Identify any contraindications to / Ethnicities
A consideration for administration of trazadone is the
age of this patient. The dose in the elderly should not be more
8. than 100 mg/day. There is a risk for orthostatic hypotension is
in the elderly, especially in the elderly with with pre-existing
heart conditions (hypertension) ( ( Shin & Saadabadi., 2020).
The metabolism of trazadone should also be considered in
different ethnicities as poor CYP2D6 metabolizers are known
to have therapeutic response. In the Asian ethnicity,
medications that metabolized by CYP2D6 should not be
prescribed (Kitada, 2003). Therefore, if this patient is Asian
increasing the dose of trazadone will be considered or choosing
a different medication to enable the patient get a full effect of
the drug. If the patient were of Asian descent, I would have to
decide on increasing the dose of Trazadone if they were a poor
metabolizer or choosing another medication that was not
affected by CYP2D6.
Check Points
Monitor the patient closely after changing her drug therapy.
Side effects of the medication should be clearly explained to
the patient and family importantly if hallucination is noted,
immediate report to the PMHNP for discontinuation of the
medication. The patient should be be monitored for suicide
ideation, especially at the beginning of the treatment or when
the dose is modified (Shin & Saadabadi., 2020). I would
observe how this patient will adjust to trazadone 25-50mg in 4
weeks to determine dose adjustment.
References
Blackburn, P., Wilkins-Ho, M., Wiese, B. (2017). Depression in
older adults: Adults and management
. BCMJ, 59
(3).
https://bcmj.org/articles/depression-older-adults-
diagnosis-and-management
9. Bollu, P., Kaur, H. ( 2019). Sleep Medicine: Insomnia and Sleep
. The Journal of Missouri State Medication Association, 116
(1), 68–75.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6390785/
Khandelwal, D., Dutta, D., Chittawar, S., Kalra, S. (2017).
Sleep disorders in type 2 diabetes.
Indian Journal of Endocrinology and Metabolism, 21
(5), 758–761. doi: 10.4103/ijem.IJEM_156_17
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5628550/
Kitada M. (2003) Genetic polymorphism of cytochrome P450
enzymes in Asian populations:
Focus on CYP2D6
. International Journal of Clinical Pharmacological
Research,23
(1),31-5. https://pubmed.ncbi.nlm.nih.gov/14621071/
Holm, N. Severinsson, E., Berland, A. (2019). The meaning of
bereavement following spousal loss: A qualitative study of
the experiences of older adults.
https://doi.org/10.1177/2158244019894273
https://journals.sagepub.com/doi/full/10.1177/21582440198942
73
Monk, T. H., Germain, A., & Reynolds, C. F. (2008). Sleep
disturbance in bereavement.
10. Psychiatric Annals, 38(10), 671–675.
https://doi.org/10.3928/00485713-20081001-06
Shin, J., Saadabadi., A. (2020). Trazodone. StatPearls.
https://www.ncbi.nlm.nih.gov/books/NBK470560/
Wichniak, A., Wierzbicka, A., Walęcka, M., Jernajczyk, W.
(2017). Effects of Antidepressants on sleep.
Current Psychiatry Reports, 19
(9), 63. doi: 10.1007/s11920-017-0816-4
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5548844/
