Delusional Disorders
Pakistani hought Processes
BACKGROUND
The client is a 34-year-old Pakistani female who moved to the United States in her late teens/early 20s. She is currently in an “arranged” marriage (her husband was selected for her since she was 9 years old). She presents to your office today following a 21 day hospitalization for what was diagnosed as “brief psychotic disorder.” She was given this diagnosis as her symptoms have persisted for less than 1 month.
Prior to admission, she was reporting visions of Allah, and over the course of a week, she believed that she was the prophet Mohammad. She believed that she would deliver the world from sin. Her husband became concerned about her behavior to the point that he was afraid of leaving their 4 children with her. One evening, she was “out of control” which resulted in his calling the police and her subsequent admission to an inpatient psych unit.
During today’s assessment, she appears quite calm, and insists that the entire incident was “blown out of proportion.” She denies that she believed herself to be the prophet Mohammad and states that her husband was just out to get her because he never loved her and wanted an “American wife” instead of her. She tells you that she knows this because the television is telling her so.
She currently weighs 140 lbs, and is 5’ 5”
SUBJECTIVE
Client reports that her mood is “good.” She denies auditory/visual hallucinations, but believes that the television does talk to her. She believes that Allah sends her messages through the TV. At times throughout the clinical interview, she becomes hostile towards the PMHNP, but then calms down.
You reviewed her hospital records and find that she has been medically worked up by a physician who reported her to be in overall good health. Lab studies were all within normal limits.
Client admits that she stopped taking her Risperdal about a week after she got out of the hospital because she thinks her husband is going to poison her so that he can marry an American woman.
MENTAL STATUS EXAM
The client is alert, oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Her speech is slow and at times, interrupted by periods of silence. Self-reported mood is euthymic. Affect constricted. Although the client denies visual or auditory hallucinations, she appears to be “listening” to something. Delusional and paranoid thought processes as described, above. Insight and judgment are impaired. She is currently denying suicidal or homicidal ideation.
The PMHNP administers the PANSS which reveals the following scores:
-40 for the positive symptoms scale
-20 for the negative symptom scale
-60 for general psychopathology scale
Diagnosis: Schizophrenia, paranoid type
RESOURCES
§ Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulleti.
Examine Case Study Pakistani Woman with Delusional Thought Processe.docxcravennichole326
Examine Case Study: Pakistani Woman with Delusional Thought Processes.
You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
At each decision point stop to complete the following:
Decision #1
Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients.
BACKGROUND
The client is a 34-year-old Pakistani female who moved to the United States in her late teens/early 20s. She is currently in an “arranged” marriage (her husband was selected for her since she was 9 years old). She presents to your office today following a 21 day hospitalization for what was diagnosed as “brief psychotic disorder.” She was given this diagnosis as her symptoms have persisted for less than 1 month.
Prior to admission, she was reporting visions of Allah, and over the course of a week, she believed that she was the prophet Mohammad. She believed that she would deliver the world from sin. Her husband became concerned about her behavior to the point that he was afraid of leaving their 4 children with her. One evening, she was “out of control” which resulted in his calling the police and her subsequent admission to an inpatient psych unit.
During today’s assessment, she appears quite calm, and insists that the entire incident was “blown out of proportion.” She denies that she believed herself to be the prophet Mohammad and states that her husband was just out to get her because he never loved her and wanted an “American wife” instead of her. She tells you that she knows this because the television is telling her so.
She currently weighs .
Delusional DisordersPakistani Female with Delusional Thought ProLinaCovington707
Delusional Disorders
Pakistani Female with Delusional Thought Processes
BACKGROUND
The client is a 34-year-old Pakistani female who moved to the United States in her late teens/early 20s. She is currently in an “arranged” marriage (her husband was selected for her when she was 9 years old). She presents following a 21-day hospitalization for what was diagnosed as “brief psychotic disorder.” She was given this diagnosis as her symptoms have persisted for less than 1 month.
Prior to admission, she was reporting visions of Allah, and over the course of a week, she believed that she was the prophet Mohammad. She believed that she would deliver the world from sin. Her husband became concerned about her behavior to the point that he was afraid of leaving their 4 children with her. One evening, she was “out of control,” which resulted in his calling the police and her subsequent admission to an inpatient psych unit.
During today’s assessment, she appears quite calm and insists that the entire incident was “blown out of proportion.” She denies that she believed herself to be the prophet Mohammad and states that her husband was just out to get her because he never loved her and wanted an “American wife” instead of her. She says she knows this because the television is telling her so.
She currently weighs 140 lbs., and she is 5’ 5.
SUBJECTIVE
Client reports that her mood is “good.” She denies auditory/visual hallucinations but believes that the television talks to her. She believes that Allah sends her messages through the TV. At times throughout the clinical interview, she becomes hostile towards you but then calms down.
A review of her hospital records shows that she received a medical workup from a physician, who reported her to be in overall good health. Lab studies were all within normal limits.
Client admits that she was tolerating her Risperdal well but stopped taking about a week after she got out of the hospital because she thinks her husband is going to poison her so that he can marry an American woman.
MENTAL STATUS EXAM
The client is alert and oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Her speech is slow and, at times, interrupted by periods of silence. Self-reported mood is euthymic. Affect is constricted. Although the client denies visual or auditory hallucinations, she appears to be “listening” to something. Delusional and paranoid thought processes as described above. Insight and judgment are impaired. She is currently denying suicidal or homicidal ideation.
You administer the PANSS which reveals the following scores:
-40 for the positive symptoms scale
-20 for the negative symptom scale
-60 for general psychopathology scale
Diagnosis: Schizophrenia, paranoid type
RESOURCES
PANSS Scale. Available at: http://egret.psychol.cam.ac.uk/medicine/scales/PANSS
§ Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Po ...
Assessing and Treating Clients With Psychosis and Schizophrenia .docxcargillfilberto
Assessing and Treating Clients With Psychosis and Schizophrenia
Delusional Disorders
Pakistani Female With Delusional Thought Processes
Examine Case Study: Pakistani Woman with Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
At each decision point stop to complete the following:
Decision #1,#2,#3
o Which decision did you select?
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
CONCLUSION: Also include how ethical considerations might impact your treatment plan and communication with clients
BACKGROUND
The client is a 34-year-old Pakistani female who moved to the United States in her late teens/early 20s. She is currently in an “arranged” marriage (her husband was selected for her since she was 9 years old). She presents to your office today following a 21 day hospitalization for what was diagnosed as “brief psychotic disorder.” She was given this diagnosis as her symptoms have persisted for less than 1 month.Prior to admission, she was reporting visions of Allah, and over the course of a week, she believed that she was the prophet Mohammad. She believed that she would deliver the world from sin. Her husband became concerned about her behavior to the point that he was afraid of leaving their 4 children with her. One evening, she was “out of control” which resulted in his calling the police and her subsequent admission to an inpatient psych unit.During today’s assessment, she appears quite calm, and insists that the entire incident was “blown out of proportion.” She denies that she believed herself to be the prophet Mohammad and states that her husband was just out to get her because he never loved her and wanted an “American wife” instead of her. She tells you that she knows this because the television is telling her so. She currently weighs 140 lbs, and is 5’ 5”
SUBJECTIVE
Client reports that her mood is “good.” She denies auditory/visual hallucinations, but believes that the television does talk to her. She believes that Allah sends her messages through the TV. At times throughout the clinical interview, she becomes hostile towards the PMHNP, but then calms down.You reviewed her hospital records and find that she has been medically worked up by a physician who reported her to be in overall good health. Lab studies were all within normal limits.Client admits that she stopped taking her Risperdal about a week after she .
ntroduction to the case (1 page)Briefly explain and summarize .docxdunhamadell
ntroduction to the case (1 page)
Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)
Which decision did you select?
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion (1 page)
Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
Decision Point One
Start Zyprexa (olanzapine) 10 mg orally at BEDTIME
RESULTS OF DECISION POINT ONE
·
Client returns to clinic in four weeks
·
Her PANSS decreases to a partial response (decrease in positive symptoms by 25%)
·
She comes in today with a reported weight gain of 5 pounds. When questioned further on this point, she states that she can never seem to get f.
The AssignmentExamine Case Study A Young Caucasian Girl With AD.docxrtodd17
The Assignment
Examine Case Study: A Young Caucasian Girl With ADHD You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
At each decision point stop to complete the following:
At each decision point stop to complete the following:
· Decision #1
· Which decision did you select?
· Why did you select this decision? Support your response with evidence and references to the Learning Resources.
· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
· Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
· Decision #2
· Why did you select this decision? Support your response with evidence and references to the Learning Resources.
· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
· Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
· Decision #3
· Why did you select this decision? Support your response with evidence and references to the Learning Resources.
· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
· Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
case Study and the decisions
BACKGROUND
Katie is an 8 year old Caucasian female who is brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katie’s teacher suggested that she may have ADHD. Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine whether or not she has this condition.
The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised”. This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their family primary care provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. The teacher opined that she lacks interest in school work and is easily distracted. Katie is also noted to start things but never finish them, and seldom follows through on instructions and fails to finish her school work.
Katie’s parents actively deny that Katie has ADHD. “She would be running around like a wild person if she had ADHD” reports her mother. “She is never defiant or has temper outburst” adds her father.
SUBJEC.
PLEASE FOLLOW THE INSTRUCTIONS AS INDICATED BELOW1). ZERO (0) PL.docxcherry686017
PLEASE FOLLOW THE INSTRUCTIONS AS INDICATED BELOW
1). ZERO (0) PLAGIARISM
2). ATLEAST 5 REFERENCES, NO MORE THAN 5 YEARS
3). PLEASE SEE ATTACHED RUBRIC DETAILS AND RECOMMENDED COURSE WRITING TEMPLATE AND APA 7 STYLE
4). Please review and follow the grading rubric details, and include each component in the assignment as required. Also, follow the APA writing rules and style, Title page, summary, Purpose statement, Conclusion.
For your Assignment, your Instructor will assign you one of the decision tree interactive media pieces provided in the Resources. As you examine the patient case studies in this module’s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders.
To Prepare
Review the interactive media piece assigned.
Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.
Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.
You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.
Write a 1- to 2-page summary paper that addresses the following:
Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.
Alzheimer’s Disease
76-year-old Iranian Male
BACKGROUND
Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CT-scan of the head) were normal.
According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.”
Over the c.
CASE STUDYSubjectivePatient is 24-year-old AA female seen MaximaSheffield592
CASE STUDY
Subjective
Patient is 24-year-old AA female seen today via Telehealth with consent obtained. She reports that she has been going through stuffs and need specialist to address her mood issues. She continued that this mood issue days' back to 2019 and she was put on Seroquel. However, she admits that because she was pregnant then, she did not go back to continue to get help. After birth according to her, she navigated through life barely until now. Presently, I have been going through stressful things and am beginning to get aggressive with people. I noticed that am verbally and physically abusive to people for little stuff or triggers." I need help". She gave a background history that she experienced traumatic life with stepfather children abuse sexually at age of 10. Growing up with no parents in my life affected me also. I had couple of medical and mental health hospitalization. In one of the admissions in psychiatric hospital, I was given Seroquel and I feel like i need to get back to that as it helps me with my mood and sleep. Currently, I hardly get 4 hours of sleep and sometimes I do not get any.
Assessment
Patient report that her mood issue dates to 2019 and she was put on Seroquel. However, she admits that because she was pregnant then, she did not go back to continue to get help. After birth according to her, she navigated through life barely until now. Presently, I have been going through stressful things and am beginning to get aggressive with people. I noticed that am verbally and physically abusive to people for little stuff or triggers." I need help". She gave a background history that she experienced traumatic life with stepfather children abuse sexually at age of 10. Growing up with no parents in my life affected me also. I had couple of medical and mental health hospitalization. In one of the admissions in psychiatric hospital, I was given Seroquel and I feel like i need to get back to that as it helps me with my mood and sleep. Currently, I hardly have up to 4 hours of sleep and sometimes I do not get any. The provider reviewed her chart and condition and believe she will benefit from Therapy and will resume Seroquel 50mg at bedtime. Educated her about her disease’s progression and medication side effects.
PHQ 9 score-18/27
Diagnoses (F31.9) Bipolar disorder, unspecified
Plan
Plan in 90 days is to decrease mood disorder
To call 911 feeling suicidal or homicidal
Take prescribed Seroquel 50mg
Educated her on medication side effects or interactions
Patient is refer to Psychotherapy
To follow up in 4 weeks.
MEDICATIONS
Quetiapine Fumarate (SEROquel) 50 MG 1 tablet by mouth daily at bedtime
CH 12Problem # 1Sales Forecasts: For the prior three years, sales for Nathional Beverage Company have been $21,962,000 (2015), $23,104,000 (2016), and $24,088,000 (2017). The Company uses the prior two years average growth rate to predict the coming year's sales. What were the sales growth rates for 2016 and 2017? What is t ...
Examine Case Study Pakistani Woman with Delusional Thought Processe.docxcravennichole326
Examine Case Study: Pakistani Woman with Delusional Thought Processes.
You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
At each decision point stop to complete the following:
Decision #1
Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients.
BACKGROUND
The client is a 34-year-old Pakistani female who moved to the United States in her late teens/early 20s. She is currently in an “arranged” marriage (her husband was selected for her since she was 9 years old). She presents to your office today following a 21 day hospitalization for what was diagnosed as “brief psychotic disorder.” She was given this diagnosis as her symptoms have persisted for less than 1 month.
Prior to admission, she was reporting visions of Allah, and over the course of a week, she believed that she was the prophet Mohammad. She believed that she would deliver the world from sin. Her husband became concerned about her behavior to the point that he was afraid of leaving their 4 children with her. One evening, she was “out of control” which resulted in his calling the police and her subsequent admission to an inpatient psych unit.
During today’s assessment, she appears quite calm, and insists that the entire incident was “blown out of proportion.” She denies that she believed herself to be the prophet Mohammad and states that her husband was just out to get her because he never loved her and wanted an “American wife” instead of her. She tells you that she knows this because the television is telling her so.
She currently weighs .
Delusional DisordersPakistani Female with Delusional Thought ProLinaCovington707
Delusional Disorders
Pakistani Female with Delusional Thought Processes
BACKGROUND
The client is a 34-year-old Pakistani female who moved to the United States in her late teens/early 20s. She is currently in an “arranged” marriage (her husband was selected for her when she was 9 years old). She presents following a 21-day hospitalization for what was diagnosed as “brief psychotic disorder.” She was given this diagnosis as her symptoms have persisted for less than 1 month.
Prior to admission, she was reporting visions of Allah, and over the course of a week, she believed that she was the prophet Mohammad. She believed that she would deliver the world from sin. Her husband became concerned about her behavior to the point that he was afraid of leaving their 4 children with her. One evening, she was “out of control,” which resulted in his calling the police and her subsequent admission to an inpatient psych unit.
During today’s assessment, she appears quite calm and insists that the entire incident was “blown out of proportion.” She denies that she believed herself to be the prophet Mohammad and states that her husband was just out to get her because he never loved her and wanted an “American wife” instead of her. She says she knows this because the television is telling her so.
She currently weighs 140 lbs., and she is 5’ 5.
SUBJECTIVE
Client reports that her mood is “good.” She denies auditory/visual hallucinations but believes that the television talks to her. She believes that Allah sends her messages through the TV. At times throughout the clinical interview, she becomes hostile towards you but then calms down.
A review of her hospital records shows that she received a medical workup from a physician, who reported her to be in overall good health. Lab studies were all within normal limits.
Client admits that she was tolerating her Risperdal well but stopped taking about a week after she got out of the hospital because she thinks her husband is going to poison her so that he can marry an American woman.
MENTAL STATUS EXAM
The client is alert and oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Her speech is slow and, at times, interrupted by periods of silence. Self-reported mood is euthymic. Affect is constricted. Although the client denies visual or auditory hallucinations, she appears to be “listening” to something. Delusional and paranoid thought processes as described above. Insight and judgment are impaired. She is currently denying suicidal or homicidal ideation.
You administer the PANSS which reveals the following scores:
-40 for the positive symptoms scale
-20 for the negative symptom scale
-60 for general psychopathology scale
Diagnosis: Schizophrenia, paranoid type
RESOURCES
PANSS Scale. Available at: http://egret.psychol.cam.ac.uk/medicine/scales/PANSS
§ Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Po ...
Assessing and Treating Clients With Psychosis and Schizophrenia .docxcargillfilberto
Assessing and Treating Clients With Psychosis and Schizophrenia
Delusional Disorders
Pakistani Female With Delusional Thought Processes
Examine Case Study: Pakistani Woman with Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
At each decision point stop to complete the following:
Decision #1,#2,#3
o Which decision did you select?
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
CONCLUSION: Also include how ethical considerations might impact your treatment plan and communication with clients
BACKGROUND
The client is a 34-year-old Pakistani female who moved to the United States in her late teens/early 20s. She is currently in an “arranged” marriage (her husband was selected for her since she was 9 years old). She presents to your office today following a 21 day hospitalization for what was diagnosed as “brief psychotic disorder.” She was given this diagnosis as her symptoms have persisted for less than 1 month.Prior to admission, she was reporting visions of Allah, and over the course of a week, she believed that she was the prophet Mohammad. She believed that she would deliver the world from sin. Her husband became concerned about her behavior to the point that he was afraid of leaving their 4 children with her. One evening, she was “out of control” which resulted in his calling the police and her subsequent admission to an inpatient psych unit.During today’s assessment, she appears quite calm, and insists that the entire incident was “blown out of proportion.” She denies that she believed herself to be the prophet Mohammad and states that her husband was just out to get her because he never loved her and wanted an “American wife” instead of her. She tells you that she knows this because the television is telling her so. She currently weighs 140 lbs, and is 5’ 5”
SUBJECTIVE
Client reports that her mood is “good.” She denies auditory/visual hallucinations, but believes that the television does talk to her. She believes that Allah sends her messages through the TV. At times throughout the clinical interview, she becomes hostile towards the PMHNP, but then calms down.You reviewed her hospital records and find that she has been medically worked up by a physician who reported her to be in overall good health. Lab studies were all within normal limits.Client admits that she stopped taking her Risperdal about a week after she .
ntroduction to the case (1 page)Briefly explain and summarize .docxdunhamadell
ntroduction to the case (1 page)
Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)
Which decision did you select?
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion (1 page)
Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
Decision Point One
Start Zyprexa (olanzapine) 10 mg orally at BEDTIME
RESULTS OF DECISION POINT ONE
·
Client returns to clinic in four weeks
·
Her PANSS decreases to a partial response (decrease in positive symptoms by 25%)
·
She comes in today with a reported weight gain of 5 pounds. When questioned further on this point, she states that she can never seem to get f.
The AssignmentExamine Case Study A Young Caucasian Girl With AD.docxrtodd17
The Assignment
Examine Case Study: A Young Caucasian Girl With ADHD You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
At each decision point stop to complete the following:
At each decision point stop to complete the following:
· Decision #1
· Which decision did you select?
· Why did you select this decision? Support your response with evidence and references to the Learning Resources.
· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
· Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
· Decision #2
· Why did you select this decision? Support your response with evidence and references to the Learning Resources.
· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
· Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
· Decision #3
· Why did you select this decision? Support your response with evidence and references to the Learning Resources.
· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
· Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
case Study and the decisions
BACKGROUND
Katie is an 8 year old Caucasian female who is brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katie’s teacher suggested that she may have ADHD. Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine whether or not she has this condition.
The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised”. This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their family primary care provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. The teacher opined that she lacks interest in school work and is easily distracted. Katie is also noted to start things but never finish them, and seldom follows through on instructions and fails to finish her school work.
Katie’s parents actively deny that Katie has ADHD. “She would be running around like a wild person if she had ADHD” reports her mother. “She is never defiant or has temper outburst” adds her father.
SUBJEC.
PLEASE FOLLOW THE INSTRUCTIONS AS INDICATED BELOW1). ZERO (0) PL.docxcherry686017
PLEASE FOLLOW THE INSTRUCTIONS AS INDICATED BELOW
1). ZERO (0) PLAGIARISM
2). ATLEAST 5 REFERENCES, NO MORE THAN 5 YEARS
3). PLEASE SEE ATTACHED RUBRIC DETAILS AND RECOMMENDED COURSE WRITING TEMPLATE AND APA 7 STYLE
4). Please review and follow the grading rubric details, and include each component in the assignment as required. Also, follow the APA writing rules and style, Title page, summary, Purpose statement, Conclusion.
For your Assignment, your Instructor will assign you one of the decision tree interactive media pieces provided in the Resources. As you examine the patient case studies in this module’s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders.
To Prepare
Review the interactive media piece assigned.
Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.
Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.
You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.
Write a 1- to 2-page summary paper that addresses the following:
Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.
Alzheimer’s Disease
76-year-old Iranian Male
BACKGROUND
Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CT-scan of the head) were normal.
According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.”
Over the c.
CASE STUDYSubjectivePatient is 24-year-old AA female seen MaximaSheffield592
CASE STUDY
Subjective
Patient is 24-year-old AA female seen today via Telehealth with consent obtained. She reports that she has been going through stuffs and need specialist to address her mood issues. She continued that this mood issue days' back to 2019 and she was put on Seroquel. However, she admits that because she was pregnant then, she did not go back to continue to get help. After birth according to her, she navigated through life barely until now. Presently, I have been going through stressful things and am beginning to get aggressive with people. I noticed that am verbally and physically abusive to people for little stuff or triggers." I need help". She gave a background history that she experienced traumatic life with stepfather children abuse sexually at age of 10. Growing up with no parents in my life affected me also. I had couple of medical and mental health hospitalization. In one of the admissions in psychiatric hospital, I was given Seroquel and I feel like i need to get back to that as it helps me with my mood and sleep. Currently, I hardly get 4 hours of sleep and sometimes I do not get any.
Assessment
Patient report that her mood issue dates to 2019 and she was put on Seroquel. However, she admits that because she was pregnant then, she did not go back to continue to get help. After birth according to her, she navigated through life barely until now. Presently, I have been going through stressful things and am beginning to get aggressive with people. I noticed that am verbally and physically abusive to people for little stuff or triggers." I need help". She gave a background history that she experienced traumatic life with stepfather children abuse sexually at age of 10. Growing up with no parents in my life affected me also. I had couple of medical and mental health hospitalization. In one of the admissions in psychiatric hospital, I was given Seroquel and I feel like i need to get back to that as it helps me with my mood and sleep. Currently, I hardly have up to 4 hours of sleep and sometimes I do not get any. The provider reviewed her chart and condition and believe she will benefit from Therapy and will resume Seroquel 50mg at bedtime. Educated her about her disease’s progression and medication side effects.
PHQ 9 score-18/27
Diagnoses (F31.9) Bipolar disorder, unspecified
Plan
Plan in 90 days is to decrease mood disorder
To call 911 feeling suicidal or homicidal
Take prescribed Seroquel 50mg
Educated her on medication side effects or interactions
Patient is refer to Psychotherapy
To follow up in 4 weeks.
MEDICATIONS
Quetiapine Fumarate (SEROquel) 50 MG 1 tablet by mouth daily at bedtime
CH 12Problem # 1Sales Forecasts: For the prior three years, sales for Nathional Beverage Company have been $21,962,000 (2015), $23,104,000 (2016), and $24,088,000 (2017). The Company uses the prior two years average growth rate to predict the coming year's sales. What were the sales growth rates for 2016 and 2017? What is t ...
students often do not remember or are not able to apply a large amount of the content they learn in the classroom. Strategies to increase retention and critical thinking were presented. Brain-based learning and active learning methods work together with increased faculty-student interaction to improve both cognitive and affective learning. Specific examples from the undergraduate nursing classroom were noted and explained. Experiential learning, clinical reasoning scenarios in the classroom, roleplay, audio/visual aids, case studies, learning with peers, and deliberate practice with feedback were some examples of active learning covered in this presentation. Allowing repeated sessions for practice and time for reflection were other strategies that the presenters found helpful. Creating a climate of warmth and reducing threat in the classroom was emphasized as essential for increasing student learning and retention.
evaluvation methods in nursing clinical care conference.pptxSusilaSekaran
clinical care conference is one of the evaluvation method in nursing care.
it is one of the objective method to evaluvate nursing students and give clinical training
Phil 2230 Philosophy of ReligionFinal Essay AssignmentThe A.docxmattjtoni51554
Phil 2230: Philosophy of Religion
Final Essay Assignment
The Assignment: An argumentative essay (defending a thesis) evaluating an argument or view we have discussed in the second portion of the course – from the midterm essay through the end of the course. In using the word “evaluate” I mean to give you a lot of freedom with respect to constructing your thesis. You could argue that C. Stephen Evans’ criteria for identifying revelation suggest that the Qu’ran is in fact more likely to be revelation from God than the Bible is (or the opposite). Or you could argue that Evans’s criteria are not actually good ways to identify revelation. Or you could argue that Freud’s objection to religious belief succeeds – or fails. Or that Manis’s view of Hell is better than the alternatives. Or that no view of hell avoids objections, and so we shouldn’t believe in hell. And so forth – you have a lot of freedom. Just make sure that you are making, and defending, a claim about one of the views or arguments we have discussed.
Grading: I will grade for these factors:
· There must be a clear thesis and well-structured, clear arguments supporting the thesis. (This is by far the most important element of the grade.)
· Your statement of the argument or view which you are evaluating should be clear and fair; you should indicate understanding of the issues involved.
· Grammar and writing should be free of errors.
If you do everything right – you have a good thesis, solid arguments, good composition – you will get an A-. A full A requires that you do something outstanding – most likely an interesting original argument or view, or perhaps a really outstanding and insightful way of stating a problem, or something of that sort. So a full A is a significant achievement. An A+ means that the paper could, with work, be a publishable piece – this is graduate-quality work, and undergraduates almost never receive this grade.
Here is a complete statement of my grading scale:
A+: The idea is an original contribution to the debate and is the sort of paper that may be published in a professional journal or presented at a professional conference. This is graduate-level work, and undergraduates rarely receive this grade.
A: You did everything right, and had something extra special, most likely interesting and original arguments or ideas, or perhaps a particularly insightful way of putting a problem or some especially brilliant writing.
A-: You did everything right – good, clear thesis and organization, good arguments, and good writing – but you are missing the extra originality or creativity to make this an A.
B+: You did what was asked of you (pretty clear thesis, pretty good writing, and decent arguments), but something on that list (thesis, writing, arguments) is quite good, above the B level.
B: You did what was asked of you – you have a pretty clear thesis, pretty good writing, and decent arguments.
B-: You pretty much did what was asked of you, but something import.
Case Discussion Pulmonary - Part 2 Follow up VisitPurposeThe.docxcowinhelen
Case Discussion Pulmonary - Part 2 Follow up Visit
Purpose
The purpose of this assignment is for students to:
Improve their ability to formulate diagnoses based on the clinical presentation of patients
Improve their ability to understand and apply National Guidelines for the diagnosis and treatment of Pulmonary disorders
Design a relevant treatment plan
Activity Learning Outcomes
Through this
discussion, the student will demonstrate the ability to:
Utilize healthcare delivery system resources in a fiscally responsible manner in the diagnosis and treatment of patients and families across the lifespan. (PO 5)
Develop management plans based on current scientific evidence and national guidelines. (PO 5)
Educate patients on treatment decisions (WO1)
Select an evidence-based article to support the plan of care for the case study patient. (WO2)
Analyze national guidelines and apply them to specific case study situations. (WO3)
Review appropriate antibiotic prescribing guidelines. (WO4)
Requirements: (IMPORTANT INFORMATION HERE)
Michelle continues to work in the bakery and her asthma has been well controlled on a low-dose inhaled corticosteroid inhaler, Singular 10mg daily, and Albuterol prn which she uses 1-2 times per week. Michelle presents to the clinic with an acute illness that developed 2 days ago and has a respiratory rate of 24, mild SOB with exertion, O2 saturation of 94%, and complaint of inspiratory and expiratory wheezing. She is able to speak and states her temperature over the last 2 days has been 101 to 102 F. Cough is productive of white sputum. Influenza A is going around the bakery. Exam findings show a woman who appears her stated age and is alert and oriented and though calm, is having mild work of breathing. AR 110 BPM, BP is 150/85, RR: 24, Temp 101.4. She has a nonproductive, dry cough, is mildly short of breath, fair chest expansion, + inspiratory/expiratory wheezes, no rales, no rhonchi. Auscultation reveals no thrills, gallops or extra heart sounds. Apical rate is elevated at 110. Physical exam is otherwise unremarkable. The MA has swabbed her for Influenza A- test is positive.
Discussion Questions Part Two:
Determine an appropriate treatment plan for Michelle. Discuss medications, doses, Durable Medical Equipment, and any testing, and apply these directly to her case. Provide your rationale with evidence.
Decide whether she is safe to return home, include any prescriptions, or if a referral to a higher level of care is required. Discuss the criteria used to make your decision, how a referral is made, and defend your position.
Discuss relevant education and follow up plan.
DISCUSSION CONTENT
Application of Course Knowledge
Post contributes clinically accurate perspectives/insights applicable to the results from the physical exam and new diagnoses. Initial post includes the most likely diagnosis/specific treatment plan given case study information supported by rationale and answers all ques.
The Assignment Examine Case Study A Young Caucasian Girl with ADHD .docxbob8allen25075
The Assignment Examine Case Study: A Young Caucasian Girl with ADHD You will be asked to make three decisions concerning the medication to prescribe...
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Solution
The Assignment
Examine Case Study: A Young Caucasian Girl with ADHD
You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
At each decision point there will be three decisions. I will choose one out of the three and give the outcome. At each decision point these are the thoughts to ponder:
Decision #1
Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
***
Also include how ethical considerations might impact your treatment plan and communication with clients.***
Finally: 1. Complete the decision tree (keep track of what you selected. come up with a rational reason why you chose it. Come up with patient specific rational reason behind not choosing the other two options not chosen).
2. Write paper addressing all section listed based on the decision tree.
Case Study: A Caucasian Man with Hip Pain
BACKGROUND
Katie is an 8 year old Caucasian female who is brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katie’s teacher suggested that she may have ADHD. Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine whether or not she has this condition.
The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised”. This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their family primary care provider. According to the scoring provided by her teacher, Katie.
FREQUENTLY ASKED QUESTIONS1. What is the purpose of the comp.docxalisoncarleen
FREQUENTLY ASKED QUESTIONS
1. What is the purpose of the comprehensive examination?
The comprehensive examination is designed to assess the degree to which you have met your program goals and learner outcomes.
2. What resources are available to help me prepare for my comprehensive examination?
Comprehensive examination guide
Program outcomes
Course materials
3. What can I do to prepare for my comprehensive examination?
Review the comprehensive examination guide.
Review program outcomes.
Review your course materials.
Access the online comprehensive examination toolbox.
Read and review examples of questions posted on the online comprehensive examination course.
4. When do I take my comprehensive examination?
You should work with your department chair or designee to communicate your intention to take the comprehensive examination in the term in which you are enrolled in the last course or courses required for your program of study.
5. How do I take the comprehensive examination?
You will be attached to the online comprehensive examination course during he term in which you are scheduled to take your comprehensive examination. The examination questions are made available to students within the online comprehensive examination course on the day the exam is scheduled to begin. You will have one week to develop your responses and submit your work to the examination submissions area of the course.
6. What is the best way for me to prepare for the comprehensive examination?
You should begin preparing for the exam from your very first course in the program. Outline essential material as you progress through each course so that you will be able to draw from this when preparing for the actual exam.
7. How long do most students take to study for and prepare for their comprehensive examination?
This is a value judgment to be decided on by each student. Keep in mind that you are preparing for the exam during every course you take in the program. The exam is administered electronically and is open book and open note, so keeping your course materials, adding to your outlines, or keeping a course-by-course journal will expedite the preparation process.
8. Do I have to use APA format in my comprehensive examination?
Yes, the expectation is that you will follow APA guidelines as you complete the comprehensive examination.
9. How important are correct grammar and spelling in my comprehensive examination?
Correct spelling and grammar are expected at all times from all students.
10. Are the readers of my comprehensive examination expecting me to know all of the theories associated with my concentration?
The readers expect you to exhibit a thorough knowledge of all relevant theories as studied throughout your courses.
11. If English is not my primary language, may I have an editor review my responses and make suggestions?
Graduate students are expected to complete the comprehensive examination without the ...
Deloitte’s 2020 Global Blockchain SurveyFrom promise to re.docxrandyburney60861
Deloitte’s 2020 Global
Blockchain Survey
From promise to reality
DELOITTE BLOCKCHAIN
At Deloitte, our people collaborate globally with clients, regulators, and policymakers on how
blockchain and digital assets are changing the face of business and government today. New
ecosystems are developing blockchain-based infrastructure and solutions to create innovative
business models and disrupt traditional ones. This is occurring in every industry and in most
jurisdictions globally. Our deep business acumen and global industry-leading audit, consulting,
tax, risk, and financial advisory services help organizations across industries achieve their
varying blockchain aspirations. Reach out to our leaders to discuss the evolving momentum of
blockchain and digital assets, prioritizing initiatives, and managing the opportunities and pain
points associated with blockchain adoption efforts. To learn more, let's talk.
https://www2.deloitte.com/us/en/pages/consulting/solutions/blockchain-solutions-and-services.html
Introduction: The evolution of blockchain 2
A more “real” reality for blockchain 4
Digital assets today and tomorrow 9
Cybersecurity 13
Global digital identity 15
Regulatory considerations 17
Governance in blockchain consortia 19
Regional analysis 21
Concluding thoughts: The road taken 24
Appendix 25
Endnotes 36
Contents
2
Introduction: The
evolution of blockchain
MORE THAN A decade has passed since the introduction of what we know today as blockchain technology. Over that time,
the promise of what the technology could offer
businesses and industries has evolved from a
cryptocurrency payment platform to something
bigger, game-changing, and truly disruptive. In
recent years, we have seen sentiment about
blockchain’s potential similarly evolving, along
with companies directing actual investment
dollars toward applications.
In Deloitte’s 2019 Global Blockchain Survey,
we observed this continuing trend in thinking
and investment, even if some vestiges of doubt
and old-school thinking remained about the
technology’s promise.1 This year’s survey
suggests that those doubts are fading further,
and that blockchain is solidly entrenched in
the strategic thinking of organizations across
industries, sectors, and applications.
There are more substantive examples in
the marketplace of how both startups and
mature businesses are deploying blockchain.
Organizations appear to be more committed than
ever to blockchain and are demonstrating this by
implementing it as part of their normal course
of business.
That’s the key takeaway from our 2020 Global
Blockchain Survey, which finds that leaders no
longer consider the technology groundbreaking
and merely promising—they now see it as integral
to organizational innovation. This year, the C-suite
is putting money and resources behind blockchain
as a strategic solution in more meaningful and
tangible ways—in projects big and not so big—
putting i.
DELL COMPANY’ Application of the accounting theories on the comp.docxrandyburney60861
DELL COMPANY’
Application of the accounting theories on the company
-stakeholder theory
-shareholder theory
-conceptual framework of a company
• Purpose
• Example
Topic: Sustainability Reporting in Accounting
Task details: Research the current state of Sustainability Reporting, including the issues, practices etc. using higher order analysis and explaining the implications for various stakeholders in relation to financial decision making.
Report: 1500 wordsexcluding the references ; executive summary, table of contents, appropriate headings and subheadings, recommendations/ findings/ conclusions, in-text referencing and reference list( Harvard -anglia style)
Assessment Type: Group report– combined group and individual assessment task.
Purpose: This assessment is designed to allow students to research and analyse current social issues in accounting and evaluate their impact on various stakeholders. As a group assessment, it further develops students’ team working s******s
Value: Total value is 30% made up of 10% Group marks for report plus 20% individual marks for presentation. This assignment marks will be scaled to a mark out of 30 total subject marks.
Topic: Sustainability Reporting in Accounting
Task Details: Groups are to research the current state of Sustainability Reporting. As a result of their research groups detailing the current state of sustainability reporting including the issues, practices, etc using higher order analysis and explaining the implications for various stakeholders in relation to financial decision making. The report should conclude with supported specific recommendations as to how organisations and their accounting advisors should proceed in light of the analysis.
Research requirements: Students need to support their analysis with reference from the text and minimum of ten (10) suitable, reliable, current and academically acceptable sources – check with your tutor if unsure of the validity of sources. Groups seeking Credit or above grades should support their analysis with increased number of reference sources comparable to the grade they are seeking.
Group Report 1500 + 10% word report format – Word .doc or .docx. Title page, executive summary, table of contents, appropriate headings and sub-headings, recommendations/findings/conclusions, in-text referencing and reference list (Harvard – Anglia style), attachments if relevant. Single spaced, font Times New Roman 12pt, Calibri 11pt or Arial 10pt.
Additional details:
DELL COMPANY
• Fina******** cost**************** cost*********** cost ********wcase the benefit equally
• Corporate culture
• Look at bigger perspective
• Showing impacts: shareholders, academic, media etc
• Directors release reports
• Capital market research
• AMP general meeting
• Showvcase the good and bad of the DELL COMPANY:ACCOUNTING ISSUES
.
Deliverable Length10–15 slides not including title and refere.docxrandyburney60861
Deliverable Length:
10–15 slides not including title and reference slides with 150-200 words speaker notes
OBJECTIVES
Create a PowerPoint presentation with speaker notes to educate others regarding the development of an operational budget and a capital budget. Be sure to include the following:
Provide the process for developing an operational budget.
Provide the process for developing a capital budget.
Differentiate between the operational and capital budgets.
Explain how the capital budget is required for strategic management.
Please submit your assignment.
.
Deliverable 6 - Using Business VisualsCompetencyExamine and de.docxrandyburney60861
Deliverable 6 - Using Business Visuals
Competency
Examine and design visual media communication to produce effective business materials.
Scenario
You are a website designer and are currently being considered as the designer for a complete redesign of a medical facility's website page. They have not updated their website in over 15 years due to the lack of staff. The website needs the redesign to target the specific visual preferences of patients and medical clients. They have several other designers that they are interviewing, and you decide to create a video presentation to impress them to choose you as their website designer.
As you begin your presentation, you decide that your design will include the following visual concepts and elements:
1. Visual Organization
2. Visual Simplicity
3. Visual Interactivity
4. Charts and Graphs
5. Images
In designing these visual elements, you keep the target audience of patients and medical clients as the main focus. You carefully consider what these types of people wish to see at a medical facility. You also consider what visual elements will attract the eye, and yet enhance a specific mood and emotional response for viewers.
After creating the website, you record your explanation of your visual design choices in an audio/video screen share.
Your presentation should be a maximum of 5 minutes.
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Deliverable 5 - Proposed HR Initiatives Presentation
Assignment Content
Competency
Assess the impact of Human Resources practices on the success of the organization and its human capital.
Student Success Criteria
View the grading rubric for this deliverable by selecting the “This item is graded with a rubric” link, which is located in the
Details & Information
pane.
Scenario
The CEO of a technology-services B2B company has just announced a momentous change in its strategic direction. He wants to begin offering full turn-key technology facilities to customers instead of just offering additional technology solutions to customers’ existing facilities. This change will require many new employees with different knowledge, skills, and abilities than the current workforce. It will also require dramatically different approaches to marketing and sales. The HR Director asks you to help develop a proposal for a strategic HR plan to deal with the change and present it to the top leadership.
The plan will support the change by proposing HR initiatives related to:
Talent acquisition (new employees)
Talent development (current employees)
Instructions
Create a
presentation, with speaker’s notes
, that:
Describes at least one proposed initiative for each: talent acquisition and talent development.
Identifies metrics to be used to measure the success of initiatives.
Describes a realistic and effective data collection plan for the metrics you selected.
Identifies potential ethical issues and/or risks related to the proposed data collection plan.
Provides a risk mitigation plan as needed.
Details how each initiative would impact the business objectives of the organization.
Provides attribution for credible sources used in the presentation.
.
Deliverable 4 - Diversity and Inclusion PolicyAssignment Con.docxrandyburney60861
Deliverable 4 - Diversity and Inclusion Policy
Assignment Content
Competency
Create policies and procedures that manage risk, are legally compliant, and align to organizational strategy.
Student Success Criteria
View the grading rubric for this deliverable by selecting the “This item is graded with a rubric” link, which is located in the
Details & Information
pane.
Scenario
You are the HR Director of a 3-star hotel chain that has locations throughout the United States. In a review of last year’s recruitment, selection, and hiring data, you realize that these HR practices have not resulted in the level of employee diversity desired by the CEO. Currently, there is no formal diversity and inclusion policy for the organization. Therefore, you propose that a new policy document be written and communicated to all employees, as well as be incorporated into all training programs for those involved in the recruitment and selection processes. The CEO agrees with your proposal.
Instructions
Create a
diversity and inclusion policy
that:
Details the policy objective and scope.
Explains the difference between diversity and inclusion.
Outlines initiatives to promote diversity and inclusion throughout the organization.
Includes instructions for employees to follow if they feel they have been subjected to any treatment that is in violation of the policy and/or listed initiatives promoting diversity and inclusion.
Provides attribution for credible sources used in the policy.
.
Deliverable 4 - Global Environment ChallengesCompetencyC.docxrandyburney60861
Deliverable 4 - Global Environment Challenges
Competency
Create solutions for organizational and leadership challenges in a global environment.
Scenario
You are the HR Training and Development Manager at Lots of Stuff International, a global company. The company has offices around the globe, which requires employees to work with peers in multiple countries in cross-functional and cross-global teams. The company has recently conducted an employee engagement survey across all areas of the company. The results indicate a lack of engagement and satisfaction of employees who work in these global-cross functional teams. Upon investigation, you discover that employees indicate dissatisfaction with a lack of community and social interaction in their teams. They indicate this may be a function of culture and religious differences, time zone differences, or work ethic differences. This has led employees to be less invested in working together. The CEO, Ms. Amelia Rienhardt, has tasked you with creating a plan to develop community within these teams across the global workforce, with the end goal of enhancing engagement and satisfaction. This plan will be unveiled to all teams in a company-wide presentation.
Instructions
Create a presentation, including speaker notes, presenting your global employee engagement plan. The presentation should:
Assess factors that may lead to a lack of employee engagement and satisfaction in working in global cross-functional teams.
Address each identified factor from your assessment:
Cultural differences
Religious differences
Time zone differences
Work ethic differences
Recommend a process to develop communication channels in diverse teams.
Provide counsel on dealing with cross-cultural conflict.
Develop a strategy for ongoing cross-cultural team building.
Identify ideas for enhancing social interactions between cross-cultural work teams.
Include a plan for the use of technology for employee engagement and social interaction.
Be sure to provide proper attribution for credible sources used in the presentation.
.
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students often do not remember or are not able to apply a large amount of the content they learn in the classroom. Strategies to increase retention and critical thinking were presented. Brain-based learning and active learning methods work together with increased faculty-student interaction to improve both cognitive and affective learning. Specific examples from the undergraduate nursing classroom were noted and explained. Experiential learning, clinical reasoning scenarios in the classroom, roleplay, audio/visual aids, case studies, learning with peers, and deliberate practice with feedback were some examples of active learning covered in this presentation. Allowing repeated sessions for practice and time for reflection were other strategies that the presenters found helpful. Creating a climate of warmth and reducing threat in the classroom was emphasized as essential for increasing student learning and retention.
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Phil 2230: Philosophy of Religion
Final Essay Assignment
The Assignment: An argumentative essay (defending a thesis) evaluating an argument or view we have discussed in the second portion of the course – from the midterm essay through the end of the course. In using the word “evaluate” I mean to give you a lot of freedom with respect to constructing your thesis. You could argue that C. Stephen Evans’ criteria for identifying revelation suggest that the Qu’ran is in fact more likely to be revelation from God than the Bible is (or the opposite). Or you could argue that Evans’s criteria are not actually good ways to identify revelation. Or you could argue that Freud’s objection to religious belief succeeds – or fails. Or that Manis’s view of Hell is better than the alternatives. Or that no view of hell avoids objections, and so we shouldn’t believe in hell. And so forth – you have a lot of freedom. Just make sure that you are making, and defending, a claim about one of the views or arguments we have discussed.
Grading: I will grade for these factors:
· There must be a clear thesis and well-structured, clear arguments supporting the thesis. (This is by far the most important element of the grade.)
· Your statement of the argument or view which you are evaluating should be clear and fair; you should indicate understanding of the issues involved.
· Grammar and writing should be free of errors.
If you do everything right – you have a good thesis, solid arguments, good composition – you will get an A-. A full A requires that you do something outstanding – most likely an interesting original argument or view, or perhaps a really outstanding and insightful way of stating a problem, or something of that sort. So a full A is a significant achievement. An A+ means that the paper could, with work, be a publishable piece – this is graduate-quality work, and undergraduates almost never receive this grade.
Here is a complete statement of my grading scale:
A+: The idea is an original contribution to the debate and is the sort of paper that may be published in a professional journal or presented at a professional conference. This is graduate-level work, and undergraduates rarely receive this grade.
A: You did everything right, and had something extra special, most likely interesting and original arguments or ideas, or perhaps a particularly insightful way of putting a problem or some especially brilliant writing.
A-: You did everything right – good, clear thesis and organization, good arguments, and good writing – but you are missing the extra originality or creativity to make this an A.
B+: You did what was asked of you (pretty clear thesis, pretty good writing, and decent arguments), but something on that list (thesis, writing, arguments) is quite good, above the B level.
B: You did what was asked of you – you have a pretty clear thesis, pretty good writing, and decent arguments.
B-: You pretty much did what was asked of you, but something import.
Case Discussion Pulmonary - Part 2 Follow up VisitPurposeThe.docxcowinhelen
Case Discussion Pulmonary - Part 2 Follow up Visit
Purpose
The purpose of this assignment is for students to:
Improve their ability to formulate diagnoses based on the clinical presentation of patients
Improve their ability to understand and apply National Guidelines for the diagnosis and treatment of Pulmonary disorders
Design a relevant treatment plan
Activity Learning Outcomes
Through this
discussion, the student will demonstrate the ability to:
Utilize healthcare delivery system resources in a fiscally responsible manner in the diagnosis and treatment of patients and families across the lifespan. (PO 5)
Develop management plans based on current scientific evidence and national guidelines. (PO 5)
Educate patients on treatment decisions (WO1)
Select an evidence-based article to support the plan of care for the case study patient. (WO2)
Analyze national guidelines and apply them to specific case study situations. (WO3)
Review appropriate antibiotic prescribing guidelines. (WO4)
Requirements: (IMPORTANT INFORMATION HERE)
Michelle continues to work in the bakery and her asthma has been well controlled on a low-dose inhaled corticosteroid inhaler, Singular 10mg daily, and Albuterol prn which she uses 1-2 times per week. Michelle presents to the clinic with an acute illness that developed 2 days ago and has a respiratory rate of 24, mild SOB with exertion, O2 saturation of 94%, and complaint of inspiratory and expiratory wheezing. She is able to speak and states her temperature over the last 2 days has been 101 to 102 F. Cough is productive of white sputum. Influenza A is going around the bakery. Exam findings show a woman who appears her stated age and is alert and oriented and though calm, is having mild work of breathing. AR 110 BPM, BP is 150/85, RR: 24, Temp 101.4. She has a nonproductive, dry cough, is mildly short of breath, fair chest expansion, + inspiratory/expiratory wheezes, no rales, no rhonchi. Auscultation reveals no thrills, gallops or extra heart sounds. Apical rate is elevated at 110. Physical exam is otherwise unremarkable. The MA has swabbed her for Influenza A- test is positive.
Discussion Questions Part Two:
Determine an appropriate treatment plan for Michelle. Discuss medications, doses, Durable Medical Equipment, and any testing, and apply these directly to her case. Provide your rationale with evidence.
Decide whether she is safe to return home, include any prescriptions, or if a referral to a higher level of care is required. Discuss the criteria used to make your decision, how a referral is made, and defend your position.
Discuss relevant education and follow up plan.
DISCUSSION CONTENT
Application of Course Knowledge
Post contributes clinically accurate perspectives/insights applicable to the results from the physical exam and new diagnoses. Initial post includes the most likely diagnosis/specific treatment plan given case study information supported by rationale and answers all ques.
The Assignment Examine Case Study A Young Caucasian Girl with ADHD .docxbob8allen25075
The Assignment Examine Case Study: A Young Caucasian Girl with ADHD You will be asked to make three decisions concerning the medication to prescribe...
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Solution
The Assignment
Examine Case Study: A Young Caucasian Girl with ADHD
You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
At each decision point there will be three decisions. I will choose one out of the three and give the outcome. At each decision point these are the thoughts to ponder:
Decision #1
Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
***
Also include how ethical considerations might impact your treatment plan and communication with clients.***
Finally: 1. Complete the decision tree (keep track of what you selected. come up with a rational reason why you chose it. Come up with patient specific rational reason behind not choosing the other two options not chosen).
2. Write paper addressing all section listed based on the decision tree.
Case Study: A Caucasian Man with Hip Pain
BACKGROUND
Katie is an 8 year old Caucasian female who is brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katie’s teacher suggested that she may have ADHD. Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine whether or not she has this condition.
The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised”. This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their family primary care provider. According to the scoring provided by her teacher, Katie.
FREQUENTLY ASKED QUESTIONS1. What is the purpose of the comp.docxalisoncarleen
FREQUENTLY ASKED QUESTIONS
1. What is the purpose of the comprehensive examination?
The comprehensive examination is designed to assess the degree to which you have met your program goals and learner outcomes.
2. What resources are available to help me prepare for my comprehensive examination?
Comprehensive examination guide
Program outcomes
Course materials
3. What can I do to prepare for my comprehensive examination?
Review the comprehensive examination guide.
Review program outcomes.
Review your course materials.
Access the online comprehensive examination toolbox.
Read and review examples of questions posted on the online comprehensive examination course.
4. When do I take my comprehensive examination?
You should work with your department chair or designee to communicate your intention to take the comprehensive examination in the term in which you are enrolled in the last course or courses required for your program of study.
5. How do I take the comprehensive examination?
You will be attached to the online comprehensive examination course during he term in which you are scheduled to take your comprehensive examination. The examination questions are made available to students within the online comprehensive examination course on the day the exam is scheduled to begin. You will have one week to develop your responses and submit your work to the examination submissions area of the course.
6. What is the best way for me to prepare for the comprehensive examination?
You should begin preparing for the exam from your very first course in the program. Outline essential material as you progress through each course so that you will be able to draw from this when preparing for the actual exam.
7. How long do most students take to study for and prepare for their comprehensive examination?
This is a value judgment to be decided on by each student. Keep in mind that you are preparing for the exam during every course you take in the program. The exam is administered electronically and is open book and open note, so keeping your course materials, adding to your outlines, or keeping a course-by-course journal will expedite the preparation process.
8. Do I have to use APA format in my comprehensive examination?
Yes, the expectation is that you will follow APA guidelines as you complete the comprehensive examination.
9. How important are correct grammar and spelling in my comprehensive examination?
Correct spelling and grammar are expected at all times from all students.
10. Are the readers of my comprehensive examination expecting me to know all of the theories associated with my concentration?
The readers expect you to exhibit a thorough knowledge of all relevant theories as studied throughout your courses.
11. If English is not my primary language, may I have an editor review my responses and make suggestions?
Graduate students are expected to complete the comprehensive examination without the ...
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Deloitte’s 2020 Global Blockchain SurveyFrom promise to re.docxrandyburney60861
Deloitte’s 2020 Global
Blockchain Survey
From promise to reality
DELOITTE BLOCKCHAIN
At Deloitte, our people collaborate globally with clients, regulators, and policymakers on how
blockchain and digital assets are changing the face of business and government today. New
ecosystems are developing blockchain-based infrastructure and solutions to create innovative
business models and disrupt traditional ones. This is occurring in every industry and in most
jurisdictions globally. Our deep business acumen and global industry-leading audit, consulting,
tax, risk, and financial advisory services help organizations across industries achieve their
varying blockchain aspirations. Reach out to our leaders to discuss the evolving momentum of
blockchain and digital assets, prioritizing initiatives, and managing the opportunities and pain
points associated with blockchain adoption efforts. To learn more, let's talk.
https://www2.deloitte.com/us/en/pages/consulting/solutions/blockchain-solutions-and-services.html
Introduction: The evolution of blockchain 2
A more “real” reality for blockchain 4
Digital assets today and tomorrow 9
Cybersecurity 13
Global digital identity 15
Regulatory considerations 17
Governance in blockchain consortia 19
Regional analysis 21
Concluding thoughts: The road taken 24
Appendix 25
Endnotes 36
Contents
2
Introduction: The
evolution of blockchain
MORE THAN A decade has passed since the introduction of what we know today as blockchain technology. Over that time,
the promise of what the technology could offer
businesses and industries has evolved from a
cryptocurrency payment platform to something
bigger, game-changing, and truly disruptive. In
recent years, we have seen sentiment about
blockchain’s potential similarly evolving, along
with companies directing actual investment
dollars toward applications.
In Deloitte’s 2019 Global Blockchain Survey,
we observed this continuing trend in thinking
and investment, even if some vestiges of doubt
and old-school thinking remained about the
technology’s promise.1 This year’s survey
suggests that those doubts are fading further,
and that blockchain is solidly entrenched in
the strategic thinking of organizations across
industries, sectors, and applications.
There are more substantive examples in
the marketplace of how both startups and
mature businesses are deploying blockchain.
Organizations appear to be more committed than
ever to blockchain and are demonstrating this by
implementing it as part of their normal course
of business.
That’s the key takeaway from our 2020 Global
Blockchain Survey, which finds that leaders no
longer consider the technology groundbreaking
and merely promising—they now see it as integral
to organizational innovation. This year, the C-suite
is putting money and resources behind blockchain
as a strategic solution in more meaningful and
tangible ways—in projects big and not so big—
putting i.
DELL COMPANY’ Application of the accounting theories on the comp.docxrandyburney60861
DELL COMPANY’
Application of the accounting theories on the company
-stakeholder theory
-shareholder theory
-conceptual framework of a company
• Purpose
• Example
Topic: Sustainability Reporting in Accounting
Task details: Research the current state of Sustainability Reporting, including the issues, practices etc. using higher order analysis and explaining the implications for various stakeholders in relation to financial decision making.
Report: 1500 wordsexcluding the references ; executive summary, table of contents, appropriate headings and subheadings, recommendations/ findings/ conclusions, in-text referencing and reference list( Harvard -anglia style)
Assessment Type: Group report– combined group and individual assessment task.
Purpose: This assessment is designed to allow students to research and analyse current social issues in accounting and evaluate their impact on various stakeholders. As a group assessment, it further develops students’ team working s******s
Value: Total value is 30% made up of 10% Group marks for report plus 20% individual marks for presentation. This assignment marks will be scaled to a mark out of 30 total subject marks.
Topic: Sustainability Reporting in Accounting
Task Details: Groups are to research the current state of Sustainability Reporting. As a result of their research groups detailing the current state of sustainability reporting including the issues, practices, etc using higher order analysis and explaining the implications for various stakeholders in relation to financial decision making. The report should conclude with supported specific recommendations as to how organisations and their accounting advisors should proceed in light of the analysis.
Research requirements: Students need to support their analysis with reference from the text and minimum of ten (10) suitable, reliable, current and academically acceptable sources – check with your tutor if unsure of the validity of sources. Groups seeking Credit or above grades should support their analysis with increased number of reference sources comparable to the grade they are seeking.
Group Report 1500 + 10% word report format – Word .doc or .docx. Title page, executive summary, table of contents, appropriate headings and sub-headings, recommendations/findings/conclusions, in-text referencing and reference list (Harvard – Anglia style), attachments if relevant. Single spaced, font Times New Roman 12pt, Calibri 11pt or Arial 10pt.
Additional details:
DELL COMPANY
• Fina******** cost**************** cost*********** cost ********wcase the benefit equally
• Corporate culture
• Look at bigger perspective
• Showing impacts: shareholders, academic, media etc
• Directors release reports
• Capital market research
• AMP general meeting
• Showvcase the good and bad of the DELL COMPANY:ACCOUNTING ISSUES
.
Deliverable Length10–15 slides not including title and refere.docxrandyburney60861
Deliverable Length:
10–15 slides not including title and reference slides with 150-200 words speaker notes
OBJECTIVES
Create a PowerPoint presentation with speaker notes to educate others regarding the development of an operational budget and a capital budget. Be sure to include the following:
Provide the process for developing an operational budget.
Provide the process for developing a capital budget.
Differentiate between the operational and capital budgets.
Explain how the capital budget is required for strategic management.
Please submit your assignment.
.
Deliverable 6 - Using Business VisualsCompetencyExamine and de.docxrandyburney60861
Deliverable 6 - Using Business Visuals
Competency
Examine and design visual media communication to produce effective business materials.
Scenario
You are a website designer and are currently being considered as the designer for a complete redesign of a medical facility's website page. They have not updated their website in over 15 years due to the lack of staff. The website needs the redesign to target the specific visual preferences of patients and medical clients. They have several other designers that they are interviewing, and you decide to create a video presentation to impress them to choose you as their website designer.
As you begin your presentation, you decide that your design will include the following visual concepts and elements:
1. Visual Organization
2. Visual Simplicity
3. Visual Interactivity
4. Charts and Graphs
5. Images
In designing these visual elements, you keep the target audience of patients and medical clients as the main focus. You carefully consider what these types of people wish to see at a medical facility. You also consider what visual elements will attract the eye, and yet enhance a specific mood and emotional response for viewers.
After creating the website, you record your explanation of your visual design choices in an audio/video screen share.
Your presentation should be a maximum of 5 minutes.
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Deliverable 5 - Proposed HR Initiatives Presentation
Assignment Content
Competency
Assess the impact of Human Resources practices on the success of the organization and its human capital.
Student Success Criteria
View the grading rubric for this deliverable by selecting the “This item is graded with a rubric” link, which is located in the
Details & Information
pane.
Scenario
The CEO of a technology-services B2B company has just announced a momentous change in its strategic direction. He wants to begin offering full turn-key technology facilities to customers instead of just offering additional technology solutions to customers’ existing facilities. This change will require many new employees with different knowledge, skills, and abilities than the current workforce. It will also require dramatically different approaches to marketing and sales. The HR Director asks you to help develop a proposal for a strategic HR plan to deal with the change and present it to the top leadership.
The plan will support the change by proposing HR initiatives related to:
Talent acquisition (new employees)
Talent development (current employees)
Instructions
Create a
presentation, with speaker’s notes
, that:
Describes at least one proposed initiative for each: talent acquisition and talent development.
Identifies metrics to be used to measure the success of initiatives.
Describes a realistic and effective data collection plan for the metrics you selected.
Identifies potential ethical issues and/or risks related to the proposed data collection plan.
Provides a risk mitigation plan as needed.
Details how each initiative would impact the business objectives of the organization.
Provides attribution for credible sources used in the presentation.
.
Deliverable 4 - Diversity and Inclusion PolicyAssignment Con.docxrandyburney60861
Deliverable 4 - Diversity and Inclusion Policy
Assignment Content
Competency
Create policies and procedures that manage risk, are legally compliant, and align to organizational strategy.
Student Success Criteria
View the grading rubric for this deliverable by selecting the “This item is graded with a rubric” link, which is located in the
Details & Information
pane.
Scenario
You are the HR Director of a 3-star hotel chain that has locations throughout the United States. In a review of last year’s recruitment, selection, and hiring data, you realize that these HR practices have not resulted in the level of employee diversity desired by the CEO. Currently, there is no formal diversity and inclusion policy for the organization. Therefore, you propose that a new policy document be written and communicated to all employees, as well as be incorporated into all training programs for those involved in the recruitment and selection processes. The CEO agrees with your proposal.
Instructions
Create a
diversity and inclusion policy
that:
Details the policy objective and scope.
Explains the difference between diversity and inclusion.
Outlines initiatives to promote diversity and inclusion throughout the organization.
Includes instructions for employees to follow if they feel they have been subjected to any treatment that is in violation of the policy and/or listed initiatives promoting diversity and inclusion.
Provides attribution for credible sources used in the policy.
.
Deliverable 4 - Global Environment ChallengesCompetencyC.docxrandyburney60861
Deliverable 4 - Global Environment Challenges
Competency
Create solutions for organizational and leadership challenges in a global environment.
Scenario
You are the HR Training and Development Manager at Lots of Stuff International, a global company. The company has offices around the globe, which requires employees to work with peers in multiple countries in cross-functional and cross-global teams. The company has recently conducted an employee engagement survey across all areas of the company. The results indicate a lack of engagement and satisfaction of employees who work in these global-cross functional teams. Upon investigation, you discover that employees indicate dissatisfaction with a lack of community and social interaction in their teams. They indicate this may be a function of culture and religious differences, time zone differences, or work ethic differences. This has led employees to be less invested in working together. The CEO, Ms. Amelia Rienhardt, has tasked you with creating a plan to develop community within these teams across the global workforce, with the end goal of enhancing engagement and satisfaction. This plan will be unveiled to all teams in a company-wide presentation.
Instructions
Create a presentation, including speaker notes, presenting your global employee engagement plan. The presentation should:
Assess factors that may lead to a lack of employee engagement and satisfaction in working in global cross-functional teams.
Address each identified factor from your assessment:
Cultural differences
Religious differences
Time zone differences
Work ethic differences
Recommend a process to develop communication channels in diverse teams.
Provide counsel on dealing with cross-cultural conflict.
Develop a strategy for ongoing cross-cultural team building.
Identify ideas for enhancing social interactions between cross-cultural work teams.
Include a plan for the use of technology for employee engagement and social interaction.
Be sure to provide proper attribution for credible sources used in the presentation.
.
Deliverable 03 - Humanities (Test-Out Sophia Replacement)
Competency
Formulate, express, and support individual perspectives on diverse works and issues.
Instructions
You will act as a critic for some of the main subjects covered in the humanities. You will conduct a series of short, evaluative critiques of film, philosophy, literature, music, and myth. You will respond to five different prompts, and each response should include an analysis of the topics using terminology unique to that subject area and should include an evaluation as to why the topic stands the test of time. The five prompts are as follows:
Choose a film and offer an analysis of why it is an important film, and discuss it in terms of film as art. Your response should be more than a summary of the film.
Imagine you had known Plato and Aristotle and you had a conversation about how we
fall in love
. Provide an overview of how Plato would explain falling in love, and then provide an overview of how Aristotle might explain falling in love.
Compare and contrast the two poems below:
LOVE’S INCONSISTENCY
I find no peace, and all my war is done;
I fear and hope, I burn and freeze likewise
I fly above the wind, yet cannot rise;
And nought I have, yet all the world I seize on;
That looseth, nor locketh, holdeth me in prison, And holds me not, yet can I ’scape no wise;
Nor lets me live, nor die, at my devise,
And yet of death it giveth none occasion.
Without eyes I see, and without tongue I plain;
I wish to perish, yet I ask for health;
I love another, and yet I hate myself;
I feed in sorrow, and laugh in all my pain;
Lo, thus displeaseth me both death and life,
And my delight is causer of my grief.
Petrarch
After great pain a formal feeling comes—
The nerves sit ceremonious like tombs;
The stiff Heart questions—was it He that bore?
And yesterday—or centuries before?
The feet mechanical go round
A wooden way
Of ground or air or ought
Regardless grown,
A quartz contentment like a stone.
This is the hour of lead
Remembered if outlived
As freezing persons recollect
The snow—
First chill, then stupor, then
The letting go
Emily Dickinson
4. Compare and contrast these two pieces of music:
Beethoven’s Violin Romance No. 2
Scott Joplin’s Maple Leaf Rag
5.Explain in classical terms why a modern character is a hero. Choose from either Luke Skywalker, Indiana Jones, Bilbo Baggins, Harry Potter, Katniss Everdeen, or Ender Wiggins.
Grading Rubric
0
1
2
3
4
Category
Not Submitted
No pass
Competence
Proficiency
Mastery
Analysis
Not Submitted
Provides an explanation of the topic but doesn't use terminology common to the subject.
Provides an explanation of the topic using terminology common to the subject.
Provides a detailed explanation of the topic using terminology common to the subject.
Explains in great detail the topic using terminology common to the subject and references other ideas/works in that subject.
Evaluation
Not Submit.
Deliverable 03 - Humanities (Test-Out Sophia Replacement)
Competency
Formulate, express, and support individual perspectives on diverse works and issues.
Instructions
You will act as a critic for some of the main subjects covered in the humanities. You will conduct a series of short, evaluative critiques of film, philosophy, literature, music, and myth. You will respond to five different prompts, and each response should include an analysis of the topics using terminology unique to that subject area and should include an evaluation as to why the topic stands the test of time. The five prompts are as follows:
Choose a film and offer an analysis of why it is an important film, and discuss it in terms of film as art. Your response should be more than a summary of the film.
Imagine you had known Plato and Aristotle and you had a conversation about how we
fall in love
. Provide an overview of how Plato would explain falling in love, and then provide an overview of how Aristotle might explain falling in love.
Compare and contrast the two poems below:
LOVE’S INCONSISTENCY
I find no peace, and all my war is done;
I fear and hope, I burn and freeze likewise
I fly above the wind, yet cannot rise;
And nought I have, yet all the world I seize on;
That looseth, nor locketh, holdeth me in prison, And holds me not, yet can I ’scape no wise;
Nor lets me live, nor die, at my devise,
And yet of death it giveth none occasion.
Without eyes I see, and without tongue I plain;
I wish to perish, yet I ask for health;
I love another, and yet I hate myself;
I feed in sorrow, and laugh in all my pain;
Lo, thus displeaseth me both death and life,
And my delight is causer of my grief.
Petrarch
After great pain a formal feeling comes—
The nerves sit ceremonious like tombs;
The stiff Heart questions—was it He that bore?
And yesterday—or centuries before?
The feet mechanical go round
A wooden way
Of ground or air or ought
Regardless grown,
A quartz contentment like a stone.
This is the hour of lead
Remembered if outlived
As freezing persons recollect
The snow—
First chill, then stupor, then
The letting go
Emily Dickinson
Compare and contrast these two pieces of music:
Beethoven’s Violin Romance No. 2
Scott Joplin’s Maple Leaf Rag
Explain in classical terms why a modern character is a hero. Choose from either Luke Skywalker, Indiana Jones, Bilbo Baggins, Harry Potter, Katniss Everdeen, or Ender Wiggins.
.
DEFINITION a brief definition of the key term followed by t.docxrandyburney60861
DEFINITION
:
a brief definition of the key term followed by the APA reference for the term; this does not count in the word requirement.
SUMMARY
:
Summarize the article in your own words- this should be in the 150-200 word range. Be sure to note the article's author, note their credentials and why we should put any weight behind his/her opinions, research or findings regarding the key term.
ANALYSIS
:
Using 300-350 words, write a brief analysis, in your own words of how the article relates to the selected chapter Key Term. An analysis is not rehashing what was already stated in the article, but the opportunity for you to add value by sharing your experiences, thoughts and opinions. This is the most important part of the assignment.
REFERENCES
:
All references must be listed at the bottom of the submission--in APA format.
Be sure to use the headers in your submission to ensure that all aspects of the assignment are completed as required.
DiSCUSSION:
Describe social bandwidth and share an experience you’ve had with this concept within your previous interactions.
.
Definition of HIVAIDS. What are the symptoms and general characteri.docxrandyburney60861
Definition of HIV/AIDS. What are the symptoms and general characteristics of HIV/AIDS
What is the best way to bring awareness to AIDS in the school system.
Detailed explanation of a classroom activity, instructional technique, or program that can be utilized at a school to help a student with HIV/AIDS.
Use a minimum of three (3) resources including peer reviewed articles.
Use APA format.
.
Definition of Ethos and How to Use it1. Trustworthiness Does y.docxrandyburney60861
Definition of Ethos and How to Use it
1. Trustworthiness Does your audience believe you are a good person who can be trusted to tell the truth?
2. Similarity Does the writer try to get the reader to identify with him or her? This can be done through language
3. Authority Does the writer have formal or informal authority? Does the writer try to relate to the reader?
4. Reputation What are the expertise the writer uses? How many does he use? What are their areas of authority?
Logos: Logical reasoning, which has two bases:
Deductive reasoning, and
Inductive reasoning
Deductive Reasoning
Deductive reasoning generally start with one or more premises, and then comes to a conclusion from them. Premises can be facts, claims, evidence, or a previously proven conclusion. The key is that in a deductive argument, if the writer’s premises are true, then the conclusion must be true.
1. Education determines one’s class base.
2. One’s class base will shape one’s employment.
3. Therefore, education will determine one’s employment.
Inductive Reasoning
Inductive reasoning is similar in that it consists of premises, which lead to a conclusion. The difference is that the conclusion is not guaranteed to be true — we can only state it with some degree of confidence.
For example, consider the following inductive argument:
5. All Six Minutes articles you have read in the past were insightful. (premise)
6. This is a Six Minutes article. (premise)
Therefore, this article is insightful. (conclusion)
How to Identify Logos
Make it Understandable: Does the writer make the argument understandable? What tools does he or she use to do this?
Make it Logical: Does the arguments make sense? Or does the writer require the reader to make an extreme leap of faith? How easy is it for the writer to make a connection to the argument?
Make it Real: Does the writer make the argument real? Is the argument concrete or abstract?
The language plain language: Does the writer use technical jargon or is a portion of language used for a specific reader that isn’t familiar with the reader?
Does the writer use short words and phrases over long and convoluted counterparts?
The language is explicit: Does the writer make his or her argument plain? What techniques does he or she use to establish explicit argument?
The writer uses a couple premises, to establish his or her position? Are they relatable? Do they show relationship between them? “And these five advantages — capital costs, scheduling, inventory control, marketing, and employee satisfaction — together make this a winning proposal.”
Trace sequences or processes in order.
Does the writer jump around to different places or is there an order to his or her steps that create clarity or confusion for the reader?
Use comparisons, analogies, and metaphors.
Does the writer introduce new concepts, with an appropriate analogy which helps the audience understand the new concept in terms of how they already understand the old one?.
Definition Multimodal refers to works that use a combination .docxrandyburney60861
Definition:
Multimodal refers to works that use a combination of
modes
, including words, static images, moving images, and sounds.
Examples:
Works include print advertisements, commercials, videos, websites.
Assignment:
Write a summary-analysis paper on a multimodal advertisement.
Methods of critique
: Propaganda Techniques
Length:
2-3 pages (summary intro, two bodies, conclusion)
.
Definition Argument Essay AssignmentGoal Write a 1,500.docxrandyburney60861
Definition Argument Essay Assignment
Goal
Write a 1,500-1,750-word essay using five to seven academic resources in which you argue that a contested “case” involving the sale, trade, or donation of human organs fits (or does not fit) within a given category. A case may include a specific news article, story, or incident illustrating a dilemma or controversy relating to the exchange of human organs. The case does not need to be a court case.
Directions
Follow these steps when composing your essay:
1. Start by selecting a controversial case found in the media involving the sale, trade, or donation of human organs. For example, an appropriate case might include a story in the news about an organ broker, and the term to define might be “criminal.”
2. Decide what category you think your case belongs in, with the understanding that others may disagree with you about the definition of your category, and/or whether your chosen case matches your category.
3. In the opening of your essay, introduce the case you will examine and pose your definition question. Do not simply summarize here. Instead, introduce the issue and offer context.
4. To support your argument, define the boundaries of your category (criteria) by using a commonly used definition or by developing your own extended definition. Defining your boundaries simply means naming the criteria by which you will discuss your chosen case involving the sale, trade, or donation of human organs. If you determine, for example, that an organ broker is a criminal, what criteria constitute this? A criminal may intentionally harm others, which could be one of your criteria.
5. In the second part of your argument (the match), show how your case meets (or does not meet) your definition criteria. Perhaps by comparing or sizing up your controversial case to other cases can help you to develop your argument.
This essay is NOT simply a persuasive essay on the sale, trade, or donation of human organs. It is an argumentative essay where the writer explains what a term means and uses a specific case to explore the meaning of that term in depth.
First Draft Grading
· You will receive completion points for the first draft based upon the successful submission of a complete draft.
· Because your first draft is a completion grade, do not assume that this grade reflects or predicts the final grade. If you do not consider your instructor’s comments, you may be deducted points on your final draft.
Final Draft Grading
The essay will be graded using a rubric. Please review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations.
Sources
· Include in-text citations and a references page in GCU Style for FIVE to SEVEN scholarly sources outside of class texts.
· These sources should be used to support any claims you make and should be present in the text of the essay.
· Use the GCU Library to help you find sources.
· Include this research in the paper i.
DEFINITION a brief definition of the key term followed by the APA r.docxrandyburney60861
DEFINITION: a brief definition of the key term followed by the APA reference for the term; this does not count in the word requirement.
SUMMARY: Summarize the article in your own words- this should be in the 150-200-word range. Be sure to note the article's author, note their credentials and why we should put any weight behind his/her opinions, research or findings regarding the key term.
DISCUSSION: Using 300-350 words, write a brief discussion, in your own words of how the article relates to the selected chapter Key Term. A discussion is not rehashing what was already stated in the article, but the opportunity for you to add value by sharing your experiences, thoughts and opinions. This is the mostimportant part of the assignment.
REFERENCES: All references must be listed at the bottom of the submission--in APA format. (continued) Be sure to use the headers in your submission to ensure that all aspects of the assignment are completed as required.
.
Defining Privacy in Employee Health ScreeningCases Ethical .docxrandyburney60861
Defining Privacy in Employee Health Screening
Cases: Ethical Ramifications Concerning
the Employee/Employer Relationship
V
Michele Simms
ABSTRACT. Issues of privacy and employee health screen-
ing rank as two of the most important ethical concerns
organizations will face in the next five years. Despite the
increasing numbers of social scientists researching personal
privacy and the current focus on workplace privacy rights as
one of the most dynamic areas of employment law, the
concept of privacy remains relatively ahstract. Understand-
ing how the courts defme privacy and use the expectation of
privacy standards is paramount given the strategic impor-
tance of the law as a legal socializing agent. This article
reports on two federal court decisions involving employer
drug and HIV testing whose determinations relied on
assumptions about the psychological dimensions of privacy.
How the courts define privacy, the outcome of this defini-
tion and the ethical ramifications as it affects the employee/
employer relationship are discussed.
Introduction
Each year American companies require employees to
submit to millions of blood and urine tests, x-rays,
and other medical and laboratory procedures. "In
fact, with the exception of typing and similar skills
tests for office and clerical employees, medical
screening is the most widely used pre-employment
test in all major employment categories" (BNA,
1987). It is predicted that in the next five years
testing will become a standard requirement when
applying for employment and/or health and life
insurance (Rothstein, 1989).
Michele Simms, as an adjunct professor of business communication
and organizational behavior, has taught at the University of
Michigan, Wayne State University and Oakland University
schools of business in Michigan. In addition to teaching, she
consults in the areas of worksite wellness, alternative dispute
resolution, transition management and change.
One factor contributing to the increase in em-
ployee health screening is the development of drug
abuse and AIDS as socially compelling public health
concerns (Falco and Cikins, 1989) that are costly to
employers, thus leading to an increase and/or initia-
tion of drug and HIV testing in both private and
public sector employment. One concern associated
with health screening is the issue of privacy and the
parallel communication activity of self-disclosure
that is used to express and maintain privacy states.
The issues of privacy and testing involve the
fundamental conflict of ethical principles between
individual rights and public safety needs and are the
subject today of increasing legislative and judicial
activity. A peripheral ethical concern that has not
been addressed but of equal importance is whether
the psychological dimensions of privacy are ac-
knowledged in court decisions involving employer
health screening practices. Traditionally lawyers and
judges Htigate and decide cases based upon principles
of legal positivi.
Define diversity” and inclusion” as applied to your pre.docxrandyburney60861
Define “diversity” and “inclusion” as applied to your presentation that will compare two healthcare organizations. Describe the two healthcare organizations you are comparing, including type and degree of diversity and inclusion, as well as organization type, size, location, and other distinguishing factors. Include supporting sources.
Analyze the culture of the two healthcare organizations and how each is influenced by diversity and inclusion.
Compare the cultures of the two healthcare organizations based on the role of diversity and inclusion in each, and strengths and weaknesses that relate to or derive from the degree of diversity and inclusion.
Summarize your conclusions on the impact of diversity and inclusion on organizational culture in healthcare settings based on your comparison.
Apply leadership strategies for a nurse executive to promote greater diversity, retain diverse staff members, and build cohesive teams and work groups.
.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
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.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
1. Delusional Disorders
Pakistani hought Processes
BACKGROUND
The client is a 34-year-old Pakistani female who moved to the
United States in her late teens/early 20s. She is currently in an
“arranged” marriage (her husband was selected for her since she
was 9 years old). She presents to your office today following a
21 day hospitalization for what was diagnosed as “brief
psychotic disorder.” She was given this diagnosis as her
symptoms have persisted for less than 1 month.
Prior to admission, she was reporting visions of Allah, and over
the course of a week, she believed that she was the prophet
Mohammad. She believed that she would deliver the world from
sin. Her husband became concerned about her behavior to the
point that he was afraid of leaving their 4 children with her.
One evening, she was “out of control” which resulted in his
calling the police and her subsequent admission to an inpatient
psych unit.
During today’s assessment, she appears quite calm, and insists
that the entire incident was “blown out of proportion.” She
denies that she believed herself to be the prophet Mohammad
and states that her husband was just out to get her because he
never loved her and wanted an “American wife” instead of her.
She tells you that she knows this because the television is
telling her so.
She currently weighs 140 lbs, and is 5’ 5”
SUBJECTIVE
Client reports that her mood is “good.” She denies
auditory/visual hallucinations, but believes that the television
does talk to her. She believes that Allah sends her messages
through the TV. At times throughout the clinical interview, she
2. becomes hostile towards the PMHNP, but then calms down.
You reviewed her hospital records and find that she has been
medically worked up by a physician who reported her to be in
overall good health. Lab studies were all within normal limits.
Client admits that she stopped taking her Risperdal about a
week after she got out of the hospital because she thinks her
husband is going to poison her so that he can marry an
American woman.
MENTAL STATUS EXAM
The client is alert, oriented to person, place, time, and event.
She is dressed appropriately for the weather and time of year.
She demonstrates no noteworthy mannerisms, gestures, or tics.
Her speech is slow and at times, interrupted by periods of
silence. Self-reported mood is euthymic. Affect constricted.
Although the client denies visual or auditory hallucinations, she
appears to be “listening” to something. Delusional and paranoid
thought processes as described, above. Insight and judgment are
impaired. She is currently denying suicidal or homicidal
ideation.
The PMHNP administers the PANSS which reveals the
following scores:
-40 for the positive symptoms scale
-20 for the negative symptom scale
-60 for general psychopathology scale
Diagnosis: Schizophrenia, paranoid type
RESOURCES
§ Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive
and Negative Syndrome Scale (PANSS) for schizophrenia.
Schizophrenia Bulletin, 13(2), 261-276.
§ Clozapine REMS. (2015). Clozapine REMS: The single shared
system for clozapine. Retrieved from
https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/res
ources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.p
df
3. § Paz, Z., Nalls, M. & Ziv, E. (2011). The genetics of benign
neutropenia. Israel Medical Association Journal. 13. 625-629.
Decision Point One
Select what the PMHNP should do:
Start Zyprexa 10 mg orally at BEDTIME
Start Invega Sustenna 234 mg intramuscular X1 followed by
156 mg intramuscular on day 4 and monthly thereafter
Start Abilify 10 mg orally at BEDTIME
Delusional Disorders
Pakistani Female With Delusional Thought Processes
Decision Point One
Start Zyprexa (olanzapine) 10 mg po orally at BEDTIME
RESULTS OF DECISION POINT ONE
· Client returns to clinic in four weeks
· Client's PANSS decreases to a partial response (25%)
· Client comes in today with a reported weight gain of 5
pounds. When questioned further on this point, she states that
she can never seem to get full from her meals so she is snacking
constantly throughout the day.
Decision Point Two
Select what the PMHNP should do next:
Decrease Zyprexa to 7.5 mg BEDTIME
Change medication to Geodon 40 mg orally BID with meals
4. Add-on Wellbutrin XL 150 mg orally in the MORNING
Delusional Disorders
Pakistani Female With Delusional Thought Processes
Decision Point One
Start Invega Sustenna 234 mg intramuscular X1 followed by
156 mg intramuscular on day 4 and monthly thereafter
RESULTS OF DECISION POINT ONE
· Client returns to clinic in four weeks
· A decrease in PANSS score of 25% is noted at this visit
· Client seems to be tolerating medication
· Client's husband has made sure she makes her appointments
for injections (one thus far)
· Client has noted a 2 pound weight gain but it does not seem to
be an important point for her
· Client complains of injection site pain telling the PMHNP
that she has trouble siting for a few hours after the injections
and doesn’t like having to walk around for such a long period of
time
Decision Point Two
Select what the PMHNP should do next:
Continue same decision made but instruct administering nurse
to begin injections into the deltoid at this visit and moving
forward
Discontinue Invega Sustenna and start Haldol Decanoate
(haloperidol decanoate ) 50 mg IM q2weeks with oral Haldol 5
mg BID for the next 3 months
5. Continue Invega Sustenna. Begin injections into the deltoid and
add on Abilify Maintena 300 mg intramuscular monthly with
oral Abilify 10 mg in the MORNING for 2 weeks
Delusional Disorders
Pakistani Female With Delusional Thought Processes
Decision Point One
: Start Abilify (aripiprazole) 10 mg orally at BEDTIME
RESULTS OF DECISION POINT ONE
· Client returns to clinic in four weeks
· Client returns and looks disheveled. Upon questioning, her
husband states that she has not been sleeping at night. He states
she is up and down all night and has also been disrupting his
sleep
· Clientis unable to participate in the PANSS rating tool
because she continually is nodding off (sleeping) during the
appointment
· The appointment is not productive for assessing how she is
responding to the Abilify started 4-weeks ago
Decision Point Two
Select what the PMHNP should do next:
Change Abilify administration time to AM dosing
Reduce Abilify dose to 7.5 MG orally at BEDTIME
Discontinue Abilify and start Geodon (ziprasidone ) 40 mg
orally BID with meals
6. MGMT8110–Global Business
Perspectives
Professor Name: Rupinder Sodhi
email:[email protected]
Winter2020
Final Essay Writing Assignment
(Worth 25% of Course Grade)
Delivery Method: Uploaded to Assignments Section of
eConestoga, under category Final Essay Submission
Due Date: Tuesday, April 14, 2020 not later than 11:59 PM
Late Submissions: After Class deadline: 10% loss in marks for
per day late
After 3 days: The final essay
automatically receives a zero mark
Essay Requirements:
The essay is a well-structured research paper that opens with an
introduction (introduces the Thesis Statement), well-
7. researched arguments (minimum 2-3) with a clear conclusion in
support of your Thesis Statement.
Based on your approved topic write and submit an essay which
has the following elements:
1) Introduction: An introductory paragraph that catches the
reader’s attention and states the relevance of your topic (any
background or current issues), identifying your Thesis
Statement.
2) Body: The body should be formatted with arguments which
support and defend the Thesis Statement. These
arguments need to:
i. Be well organized and flow from a logical start to a strong
conclusion.
ii. It also needs to demonstrate the significance of your topic
from a global business perspective.
mailto:[email protected]
iii. Clearly support, defend or justify the thesis as present.
IV. Be analytical and show your abilities to develop clear
ideas with originality of thought.
V. Include evidence to demonstrate width/depth of research.
VI. To be written in descriptive form by not inserting any
8. image, graph or table etc.
3) Have good quality writing:
i. Grammar, punctuation & spelling are virtually flawless.
ii. Language and word choice are appropriate throughout.
4) Be well formatted and pleasant to read:
i. Has an opening and concluding sentence.
ii. The essay follows scholarly conventions including proper
formatting, citation methods and is virtually flawless.
5) Be original:
i. Your paper can use quotes from your research, but cannot
comprise more than 10% of your
paper.
ii. Make sure you take advantage of the Originality Check
available on eConestoga.
iii. During Originality Check on Turntin if it is found that essay
content has been put in without using
appropriate citations or referencing then a case of Academic
Dishonesty will be filed.
iv. Before the due date in order to conduct Originality Check,
you may make a multiple number of essay submissions
into the assignment folder. However, your latest submission
will be treated as your final submission.
9. 6) Have the following length and format:
i. Between 10 to12 pages excluding title page and reference
pages in
Times New Roman or Ariel, 12 points font & double-spaced
ii. Title Page must include:
tion
– Winter2020
7) Create a thread:
Starting from the Thesis Statement, create a thread of logic that
will follow throughout the essay. This thread will be
built on your research findings.
i. The thread needs to be directly related to your thesis.
ii. Creating a thread means it will have an introduction, body,
10. conclusion – all focused on supporting the Thesis
Statement.
8) Wrap up your essay with a strong concluding paragraph that
summarizes your essay with a strong concluding paragraph
that summarizes your arguments and affirm your Thesis
Statement. In references use the APA standard formatting (sixth
edition).
Your Essay will be evaluated using the following rubric:
Excellent 9-10pts Good 7-8 pts Average 5-6 pts Poor 1-4 pts
Essay Arguments (50%)
Organization
Essay proceeds logically from
start to finish and is coherent
throughout.
Essay includes some logical
inconsistencies, but they hardly
detract from the overall
coherence of the
argument
11. Significant logical
inconsistencies in parts of the
paper make the
overall credibility of the
argument somewhat
dubious.
The essay is illogical, incoherent,
and as a result completely
unconvincing.
Thesis Quality
Thesis, whether implicit or
explicit, is absolutely clear
and highly original.
Thesis, whether implicit or
explicit, is clear and
deliberate. Essay
effectively recognizes a
variety of
points of view.
12. Thesis is identifiable in
some form, with effort.
Essay does not contain–either
implicitly or explicitly-a thesis.
Objectivity
Essay demonstrates a
masterful grasp of all
sides of the issue.
Essay effectively recognizes
a variety of points of view.
Essay is clearly, albeit
unintentionally, partial. It
either fails to deal with
contrary points of view out
of ignorance or deals
with them unfairly.
13. Essay is deliberately not
impartial. The author has used
the paper as a pulpit instead of as
a framework for rigorous critical
analysis.
Analysis
Analytical abilities on display
are clearly superior and
reflect an originality of
thinking.
Analytical abilities on display
demonstrate an ability to
separate ideas into their
component parts.
Analytical abilities on
display are inconsistent.
Some ideas are clear and
fully understood; others are
14. not.
Paper reproduces arguments
from other sources without any
evidence of understanding.
Evidence supporting arguments and Thesis Statement (35%)
Depth
Essay draws from sources
that represent the best
information on the subject.
Quantity exceeds
expectations.
Essay draws from a legitimate
variety of information. Quantity
of sources meets or exceeds
expectations.
While the essay might draw
from a number of sources,
15. but the information obtained
is largely surface level.
Essay is drawn largely, if not
exclusively, from
inappropriate material.
Breadth
Essay draws from an
impressive variety of
sources and perspectives.
Essay draws from an
acceptable variety of
sources and
perspectives.
Sources either come from
a single perspective or are
insufficient to meet the
demands of the
assignment.
16. Sources are both
excessively limited in
quantity and
Represent an excessively
limited point of view.
Synthesis
Presentation of the
evidence demonstrates a
masterful understanding
of its themes, both specific
and general.
Presentation of the
evidence demonstrates
a clear understanding of
its themes, both specific
and general.
Presentation of the
evidence demonstrates
17. a flawed
understanding of either its
specific or general
themes.
Presentation of the evidence
demonstrates a flawed
understanding of both its
specific and general themes.
Relevance
Evidence is directly
applicable to the analysis
throughout
Evidence is largely
applicable to the
analysis throughout.
Some of the evidence is
clearly tangential and
detracts from the
18. credibility of the argument.
Evidence does not
contribute to a fulfillment of
the goals of the assignment.
Quality of Writing (10%)
Grammar &
Language
Grammar, punctuation,
spellings are virtually
flawless. Language and
word choice are
appropriate throughout.
Limited flaws in grammar,
punctuation, and/or spelling
do not detract from the
overall message of the
essay. Some minor
19. problems with language and
word choice are noted, but
not problematic.
Significant flaws in some
of grammar, punctuation,
spelling, language and/or
word choice.
Paper is incoherent because
of flaws in grammar,
punctuation, spelling, language,
and/or word choice.
Quality of
Format
(5%)
Essay follows scholarly
conventions including
proper formatting & citation
methods which are virtually
20. free from flaw.
Only minor flaws in terms of
scholarly conventions
including formatting & citation
methods.
Significant flaws in terms of
formatting & scholarly
conventions (likely
including problems with
citation methods).
Paper displays a blatant
disregard for proper formatting
& scholarly conventions.
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Antipsychotic agents
21. This chapter will explore antipsychotic drugs, with an emphasis
on treatments for schizophrenia.
These treatments include not only conventional antipsychotic
drugs, but also the newer atypical
antipsychotic drugs that have largely replaced the older
conventional agents. Atypical antipsychotics
are really misnamed, since they are also used as treatments for
both the manic and depressed
phases of bipolar disorder, as augmenting agents for treatment-
resistant depression, and "off-label"
for various other disorders, such as treatment-resistant anxiety
disorders. The reader is referred to
standard reference manuals and textbooks for practical
prescribing information, such as drug doses,
because this chapter on antipsychotic drugs will
Figure 5-1. . ThroughoutQualitative and semi-quantitative
representation of receptor binding properties
this chapter, the receptor binding properties of the atypical
antipsychotics are represented both graphically and
semi-quantitatively. Each drug is represented as a blue sphere,
with its most potent binding properties depicted
along the outer edge of the sphere. Additionally, each drug has
a series of colored boxes associated with it.
Each colored box represents a different binding property, and
binding strength is indicated by the size of the box
and the number of plus signs. Within the colored box series for
any particular antipsychotic, larger boxes with
more plus signs (positioned to the left) indicate stronger
binding affinity, while smaller boxes with fewer plus
signs (positioned to the right) represent weaker binding affinity.
The series of boxes associated with each drug
are arranged such that the size and positioning of a box reflect
the binding potency for a particular receptor. The
vertical dotted line cuts through the dopamine 2 (D ) receptor
23. systems ( ). Such interactionsFigure 5-1
can often explain both the therapeutic actions and the side
effects of various antipsychotic
medications and thus can be very helpful background
information for prescribers of these therapeutic
agents.
Conventional antipsychotics
What makes an antipsychotic "conventional"?
In this section we will discuss the pharmacologic properties of
the first drugs that were proven to
effectively treat schizophrenia. A list of many conventional
antipsychotic drugs is given in .Table 5-1
These drugs are usually called antipsychotics, but they are
sometimes also called conventional
antipsychotics, or antipsychotics, or antipsychotics. The
earliestclassical typical first-generation
effective treatments for schizophrenia and other psychotic
illnesses arose from serendipitous clinical
observations more than
Table 5-1 Some conventional antipsychotics still in use
60 years ago, rather than from scientific knowledge of the
neurobiological basis of psychosis, or of
the mechanism of action of effective antipsychotic agents. Thus,
the first antipsychotic drugs were
discovered by accident in the 1950s when a drug with
antihistamine properties (chlorpromazine) was
serendipitously observed to have antipsychotic effects when this
putative antihistamine was tested in
schizophrenia patients. Chlorpromazine indeed has
antihistaminic activity, but its therapeutic actions
27. antipsychotic efficacy and that for side effects in terms of D2
binding.
quell positive symptoms, one must simultaneously block the
same number of D receptors2
throughout the brain, and this causes undesirable side effects as
a "high cost of doing business" with
conventional antipsychotics ( through ). Although modern
neuroimaging techniquesFigures 5-5 5-8
are able to measure directly the blockade of D receptors in the
dorsal (motor) striatum of the2
nigrostriatal pathway, as shown in , for conventional
antipsychotics it is assumed that theFigure 5-4
same number of D receptors is blocked in all brain areas,
including the ventral limbic area of2
striatum known as the nucleus accumbens of the mesolimbic
dopamine pathway, the prefrontal
cortex of the mesocortical dopamine pathway, and the pituitary
gland of the tuberoinfundibular
dopamine pathway.
Neurolepsis
D receptors in the mesolimbic dopamine system are postulated
to mediate not only the positive2
symptoms of psychosis, but also the normal reward system of
the brain, and the nucleus accumbens
is widely considered to be the "pleasure center" of the brain. It
may be the final common pathway of
all reward and reinforcement, including not only normal reward
(such as the pleasure of eating good
food, orgasm, listening to music) but also the artificial reward
of substance abuse. If D receptors are2
stimulated in some parts of the mesolimbic pathway, this can
lead to the experience of pleasure.
Thus, if D receptors in the mesolimbic system are blocked, this
29. Extrapyramidal symptoms and tardive dyskinesia
When a substantial number of D receptors are blocked in the
nigrostriatal DA pathway, this will2
produce various disorders of movement that can appear very
much like those in Parkinson's disease;
this is why these movements are sometimes called drug-induced
Figure 5-5. . In untreated schizophrenia, theMesocortical
dopamine pathway and D antagonists2
mesocortical dopamine pathways to dorsolateral prefrontal
cortex (DLPFC) and to ventromedial prefrontal cortex
(VMPFC) are hypothesized to be hypoactive, indicated here by
the dotted outlines of the pathway. This
hypoactivity is related to cognitive symptoms (in the DLPFC),
negative symptoms (in the DLPFC and VMPFC),
and affective symptoms of schizophrenia (in the VMPFC).
Administration of a D antagonist could further reduce2
activity in this pathway and thus not only not improve such
symptoms but actually potentially worsen them.
parkinsonism. Since the nigrostriatal pathway is part of the
extrapyramidal nervous system, these
motor side effects associated with blocking D receptors in this
part of the brain are sometimes also2
called extrapyramidal symptoms, or EPS ( and ).Figures 5-4 5-6
Worse yet, if these D receptors in the nigrostriatal DA pathway
are blocked chronically ( ),2 Figure 5-7
they can produce a hyperkinetic movement disorder known as
tardive dyskinesia. This movement
disorder causes facial and tongue movements, such as constant
chewing, tongue protrusions, facial
grimacing, and also limb movements that can be quick, jerky, or
choreiform (dancing). Tardive
32. dyskinesia, characterized by facial and tongue movements (e.g.,
tongue protrusions, facial grimaces, chewing)
as well as quick, jerky limb movements. This upregulation may
be the consequence of the neuron's futile attempt
to overcome drug-induced blockade of its dopamine receptors.
dyskinesia, however, can diminish considerably after 15 years
of treatment, presumably because
patients who have not developed tardive dyskinesia despite 15
years of treatment with a
conventional antipsychotic have lower genetic risk factors for
it.
A rare but potentially fatal complication called the "neuroleptic
malignant syndrome," associated with
extreme muscular rigidity, high fevers, coma, and even death,
and possibly related in part to D2
receptor blockade in the nigrostriatal pathway, can also occur
with conventional antipsychotic agents.
Prolactin elevation
Dopamine D receptors in the tuberoinfundibular DA pathway
are also blocked by conventional2
antipsychotics, and this causes plasma prolactin concentrations
to rise, a condition called
hyperprolactinemia ( ). This is associated with conditions called
galactorrhea (i.e., breastFigure 5-8
secretions) and amenorrhea (i.e., irregular or lack of menstrual
periods). Hyperprolactinemia may
thus interfere with fertility, especially in women.
Hyperprolactinemia might lead to more rapid
demineralization of bones, especially in postmenopausal women
who are not taking estrogen
replacement therapy. Other possible problems associated with
elevated prolactin levels may include
35. Figure 5-9. . Shown here is an icon representing a conventional
antipsychoticConventional antipsychotic
drug. Conventional antipsychotics have pharmacological
properties in addition to dopamine D antagonism. The2
receptor profiles differ for each agent, contributing to divergent
side-effect profiles. However, some important
characteristics that multiple agents share are the ability to block
muscarinic cholinergic receptors, histamine H1
receptors, and/or -adrenergic receptors.1
properties ( ). One particularly important pharmacologic action
of some conventionalFigure 5-9
antipsychotics is their ability to block muscarinic M -
cholinergic receptors ( through ).1 Figures 5-9 5-11
This can cause undesirable side effects such as dry mouth,
blurred vision, constipation, and
cognitive blunting ( ). Differing degrees of muscarinic
cholinergic blockade may alsoFigure 5-10
explain why some conventional antipsychotics have a lesser
propensity to produce extrapyramidal
side effects (EPS) than others. That is, those conventional
antipsychotics that cause more EPS are
the agents that have only anticholinergic properties, whereas
those conventional antipsychoticsweak
that cause fewer EPS are the agents that have anticholinergic
properties.stronger
How does muscarinic cholinergic receptor blockade reduce the
EPS caused by dopamine D2
receptor blockade in the nigrostriatal pathway? The reason
seems to be based on the fact that
dopamine and acetylcholine have a reciprocal relationship with
each other in the nigrostriatal
37. activityDopamine, acetylcholine, and D antagonism2
when dopamine receptors are blocked. As dopamine normally
suppresses acetylcholine activity, removal of
dopamine inhibition causes an increase in acetylcholine
activity. Thus if dopamine receptors are blocked at the
D receptors on the cholinergic dendrite on the left, then
acetylcholine becomes overly active, with enhanced2
release of acetylcholine from the cholinergic axon on the right.
This is associated with the production of
extrapyramidal symptoms (EPS). The pharmacological
mechanism of EPS therefore seems to be a relative
dopamine deficiency and a relative acetylcholine excess.
C. . One compensation for the overactivity that occurs whenD
antagonism and anticholinergic agents2
dopamine receptors are blocked is to block the acetylcholine
receptors with an anticholinergic agent (M1
receptors being blocked by an anticholinergic on the far right).
Thus, anticholinergics overcome excess
acetylcholine activity caused by removal of dopamine inhibition
when dopamine receptors are blocked by
conventional antipsychotics. This also means that
extrapyramidal symptoms (EPS) are reduced.
Dopamine neurons in the nigrostriatal dopamine pathway make
postsynaptic connections with
cholinergic neurons ( ). Dopamine normally acetylcholine
release fromFigure 5-11A inhibits
postsynaptic nigrostriatal cholinergic neurons, thus suppressing
acetylcholine activity there (Figure
). If dopamine can no longer suppress acetylcholine release
because dopamine receptors are5-11A
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39. blurred vision, constipation, urinary retention, and cognitive
dysfunction ( ).Figure 5-10
Other pharmacologic properties of conventional antipsychotic
drugs
Still other pharmacologic actions are associated with the
conventional antipsychotic drugs. These
include generally undesired blockade of histamine H receptors
( ) causing weight gain and1 Figure 5-9
drowsiness, as well as blockade of -adrenergic receptors causing
cardiovascular side effects such1
as orthostatic hypotension and drowsiness. Conventional
antipsychotic agents differ in terms of their
ability to block these various receptors represented in . For
example, the popularFigure 5-9
conventional antipsychotic haloperidol has relatively little
anticholinergic or antihistaminic binding
activity, whereas the classic conventional antipsychotic
chlorpromazine has potent anticholinergic
and antihistaminic binding. Because of this, conventional
antipsychotics differ somewhat in their
side-effect profiles, even if they do not differ overall in their
therapeutic profiles. That is, some
conventional antipsychotics are more sedating than others, some
have more ability to cause
cardiovascular side effects than others, some have more ability
to cause EPS than others.
A somewhat old-fashioned way to subclassify conventional
antipsychotics is "low potency" versus
"high potency" ( ). In general, as the name implies, low-potency
agents require higher dosesTable 5-1
than high-potency agents, but, in addition, low-potency agents
tend to have more of the additional
41. Symptom dimensions in schizophrenia
Clinical description of psychosis
Psychosis is a syndrome - that is, a mixture of symptoms - that
can be associated with many different
psychiatric disorders, but is not a specific disorder itself in
diagnostic schemes such as the DSM or
ICD. At a minimum, psychosis means delusions and
hallucinations. It generally also includes
symptoms such as disorganized speech, disorganized behavior,
and gross distortions of reality.
Therefore, psychosis can be considered to be a set of symptoms
in which a person’s mental
capacity, affective response, and capacity to recognize reality,
communicate, and relate to others is
impaired. Psychotic disorders have psychotic symptoms as their
defining features; there are other
disorders in which psychotic symptoms may be present, but are
not necessary for the diagnosis.
Those as a feature of the diagnosisdisorders that require the
presence of psychosis defining
include schizophrenia, substance-induced (i.e., drug-induced)
psychotic disorders, schizophreniform
disorder, schizoaffective disorder, delusional disorder, brief
psychotic disorder, and psychotic
disorder due to a general medical condition ( ). Table 4-1
Disorders that may or may not have
as features include mania and depression as well as
severalpsychotic symptoms associated
cognitive disorders such as Alzheimer’s dementia ( ).Table 4-2
43. manifesting irritability and grouchiness; tending to blame others
for problems; expressing feelings of
resentment; complaining and finding fault; as well as expressing
suspicion of people. Grandiose
is exhibiting an attitude of superiority; hearing voices that
praise and extol; believingexpansiveness
one has unusual powers or is a well-known personality, or that
one has a divine mission.
In a there is conceptual disorganization, disorientation,
anddisorganized/excited psychosis
excitement. can be characterized by giving answers that are
irrelevant orConceptual disorganization
incoherent, drifting off the subject, using neologisms, or
repeating certain words or phrases.
is not knowing where one is, the season of the year, the
calendar year, or one’s ownDisorientation
age. is expressing feelings without restraint; manifesting
speech that is hurried; exhibitingExcitement
an elevated mood; an attitude of superiority;
Table 4-2 Disorders in which psychosis is an associated feature
dramatizing oneself or one’s symptoms; manifesting loud and
boisterous speech; exhibiting
overactivity or restlessness; and exhibiting excess of speech.
Depressive psychosis is characterized by psychomotor
retardation, apathy, and anxious
self-punishment and blame. and are manifested by slowed
speech;Psychomotor retardation apathy
indifference to one’s future; fixed facial expression; slowed
movements; deficiencies in recent
memory; blocking in speech; apathy toward oneself or one’s
44. problems; slovenly appearance; low or
whispered speech; and failure to answer questions. is
theAnxious self-punishment and blame
tendency to blame or condemn oneself; anxiety about specific
matters; apprehensiveness regarding
vague future events; an attitude of self-deprecation, manifesting
as a depressed mood; expressing
feelings of guilt and remorse; preoccupation with suicidal
thoughts, unwanted ideas, and specific
fears; and feeling unworthy or sinful.
This discussion of clusters of psychotic symptoms does not
constitute diagnostic criteria for any
psychotic disorder. It is given merely as a description of several
types of symptoms in psychosis to
give the reader an overview of the nature of behavioral
disturbances associated with the various
psychotic illnesses.
Schizophrenia is more than a psychosis
Although schizophrenia is the commonest and best-known
psychotic illness, it is not synonymous
with psychosis, but is just one of many causes of psychosis.
Schizophrenia affects 1% of the
population, and in the US there are over 300 000 acute
schizophrenic episodes annually. Between
25% and 50% of schizophrenia patients attempt suicide, and
10% eventually succeed, contributing to
a mortality rate eight times greater than that of the general
population. Life expectancy of a patient
with schizophrenia may be 20-30 years shorter than the general
population, not only due to suicide,
but in particular due to premature cardiovascular disease.
Accelerated mortality from premature
cardiovascular disease in patients with schizophrenia is caused
47. Figure 4-1. . The syndrome of schizophrenia consists of
aPositive and negative symptoms of schizophrenia
mixture of symptoms that are commonly divided into two major
categories, positive and negative. Positive
symptoms, such as delusions and hallucinations, reflect the
development of the symptoms of psychosis; they
can be dramatic and may reflect loss of touch with reality.
Negative symptoms reflect the loss of normal
functions and feelings, such as losing interest in things and not
being able to experience pleasure.
least five types of negative symptoms all starting with the letter
A ( ):Table 4-5
alogia - dysfunction of communication; restrictions in the
fluency and productivity of thought
and speech
affective blunting or flattening - restrictions in the range and
intensity of emotional expression
asociality - reduced social drive and interaction
anhedonia - reduced ability to experience pleasure
avolition - reduced desire, motivation or persistence;
restrictions in the initiation of
goal-directed behavior
Table 4-4 Negative symptoms of schizophrenia
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51. Figure 4-4. . The different symptom domains of schizophrenia
areLocalization of symptom domains
hypothesized to be regulated by unique brain regions. Positive
symptoms of schizophrenia are hypothetically
modulated by malfunctioning mesolimbic circuits, while
negative symptoms are hypothetically linked to
malfunctioning mesocortical circuits and may also involve
mesolimbic regions such as the nucleus accumbens,
which is part of the brain’s reward circuitry and thus plays a
role in motivation. The nucleus accumbens may also
be involved in the increased rate of substance use and abuse
seen in patients with schizophrenia. Affective
symptoms are associated with the ventromedial prefrontal
cortex, while aggressive symptoms (related to
impulse control) are associated with abnormal information
processing in the orbitofrontal cortex and amygdala.
Cognitive symptoms are associated with problematic
information processing in the dorsolateral prefrontal cortex.
Although there is overlap in function among different brain
regions, understanding which brain regions may be
predominantly involved in specific symptoms can aid in
customization of treatment to the particular symptom
profile of each individual patient with schizophrenia.
occur with positive symptoms such as delusions and
hallucinations, and be confused with positive
symptoms. Behavioral interventions may be particularly helpful
to prevent violence linked to poor
impulsivity by reducing provocations from the environment.
Certain antipsychotic drugs such as
clozapine, or very high doses of standard antipsychotic drugs,
or occasionally the use of two
antipsychotic drugs simultaneously, may also be useful for
52. aggressive symptoms and violence in
some patients.
It can also be difficult to separate the symptoms of formal
cognitive dysfunction from the symptoms of
affective dysfunction and from negative symptoms, but research
is attempting to localize the specific
areas of brain dysfunction for each symptom domain in
schizophrenia in the hope of developing
better treatments for the often-neglected negative, cognitive,
and affective symptoms of
schizophrenia. In particular, neuropsychological assessment
batteries are being developed to
quantify cognitive symptoms, in order to detect cognitive
improvement after treatment with a number
of novel psychotropic drugs currently being tested. Cognitive
symptoms of schizophrenia are
impaired attention and impaired information processing
manifested as impaired verbal fluency (ability
to produce spontaneous speech), problems with serial learning
(of a list of items or a sequence of
events), and impairment in vigilance for executive functioning
(problems with sustaining and focusing
attention, concentrating, prioritizing, and modulating behavior
based upon social cues).
Important cognitive symptoms of schizophrenia are listed in .
These do not includeTable 4-6
symptoms of dementia and memory disturbance more
characteristic of Alzheimer’s disease, but
cognitive symptoms of schizophrenia emphasize "executive
dysfunction," which includes problems
representing and maintaining goals, allocating attentional
resources, evaluating and monitoring
performance, and utilizing these skills to solve problems.
Cognitive symptoms of schizophrenia are
54. frontotemporal/Pick’s dementia, etc.) can also be
associated with cognitive dysfunctions similar to those seen in
schizophrenia.
Affective symptoms are frequently associated with
schizophrenia but this does not necessarily mean
that they fulfill the diagnostic criteria for a comorbid anxiety or
affective disorder. Nevertheless,
depressed mood, anxious mood, guilt, tension, irritability, and
worry frequently accompany
schizophrenia. These various symptoms are also prominent
features of major depressive disorder,
psychotic depression, bipolar disorder, schizoaffective disorder,
organic dementias, childhood
psychotic disorders, and treatment-resistant cases of depression,
bipolar disorder, and
schizophrenia, among others. Finally, occur in numerous
otheraggressive and hostile symptoms
disorders, especially those with problems of impulse control.
Symptoms include overt hostility, such
as verbal or physical abusiveness or assault, self-injurious
behaviors including suicide, and arson or
other property damage. Other types of impulsiveness such as
sexual acting out are also in this
category of aggressive and hostile symptoms. These same
symptoms are frequently associated with
bipolar disorder, childhood psychosis, borderline personality
disorder, antisocial personality disorder,
drug abuse, Alzheimer’s and other dementias, attention deficit
hyperactivity disorder, conduct
disorders in children, and many others.
Brain circuits and symptom dimensions in schizophrenia
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57. therapies for effective outcomes (Park & Zarate, 2019). The
purpose of this paper is to review a case study, choose the
appropriate selection utilizing research, and discuss ethical
considerations.
Case Study
A 32-year-old Hispanic American client presents to the initial
appointment with depression. Health history, along with
medical workup, appears to be unremarkable except for the
slight back and shoulder pain due to his occupation. The clinical
interview reveals past feelings of being an “outsider” and has
few friends (Laureate Education, 2016). There is a decline in
daily activities, a weight increase of 15 pounds over two
months, along with diminished sleep and the inability to fully
concentrate (Laureate Education, 2016). The results of the
depression screening administered by the psychiatric mental
health nurse practitioner (PMHNP), indicates severe depression
with a score of 51 (Montgomery & Asberg, 1979).
Decision Point One
The selections include Zoloft 25 mg orally daily, Effexor 37.5
XR mg orally daily, or Phenelzine 15 mg orally TID. As a
healthcare professional treating a client, Zoloft (sertraline) 25
mg is the first choice at decision point one. Selective serotonin
reuptake inhibitors (SSRIs) impede the reabsorption of this
neurotransmitter; thus, increasing the serotonin levels of the
nerve cells in the brain to allow for improvement in mood
(Stahl, 2013). SSRIs have been utilized as first-line therapy to
treat major depressive disorder due to efficacy, fewer side
effects, cost-effectiveness as well as a wider availability
(Masuda et al., 2017). The therapeutic dosing range is typically
50 mg-200 mg (Stahl, 2017). However, beginning at 25 mg and
gradually titrating the dose, depending on tolerability, is an
appropriate health care decision (National Alliance on Mental
Illness, 2018b). Therefore, a low dose of Zoloft appears to be
the best option in caring for this client.
Effexor (venlafaxine) is classified as a selective serotonin-
norepinephrine reuptake inhibitor (SNRI) which impedes the
58. reabsorption of the neurotransmitters serotonin and
norepinephrine changing the chemistry in the brain to regulate
mood (Stahl, 2013). Bhat and Kennedy (2017) describe
antidepressant discontinuation syndrome (ADS) as a
“medication-induced movement disorder” along with various
adverse reactions such as intense sadness and anxiety; periods
of an “electric shock” sensation; sights of flashing lights; and
dizziness upon movement (Bhat & Kennedy, 2017, p. E7).
These symptoms are often experienced a few days after sudden
discontinuation of an antidepressant with a shorter-life (3-7
hours) such as venlafaxine or paroxetine (Bhat & Kennedy,
2017; Stahl, 2017). Moreover, Stahl (2017) indicates
venlafaxine is one of the drugs with more severe withdrawal
symptoms in comparison to other antidepressants. It may take
some clients several months to taper off of this medicine;
therefore, Effexor is not the optimal selection at this time.
Phenelzine is classified as an irreversible monoamine oxidase
inhibitor (MAOI) which impedes the monoamine oxidase from
deconstructing serotonin, dopamine, as well as norepinephrine.
Thus, boosting the levels of neurotransmitters in the brain to
regulate mood (Stahl, 2017). Park and Zarate (2019) purport
the use of monoamine oxidase inhibitors have a higher risk
profile; therefore, are not typically utilized unless a newer
antidepressant is considered ineffective. Bhat and Kennedy
(2017) indicate there is a need for a long taper with MAOIs.
Further, this medication may lose effectiveness after long-term
use, and it is considered to have habit-forming qualities for
some individuals (Stahl, 2017). The initial dose for phenelzine
is taken three times a day which research suggests medication
adherence is often tricky when the administration is more than
once a day (Goette & Hammwöhner, 2016). Stahl (2017)
describes certain risk factors comprising of frequent weight
gain, interference of certain food products containing tyramine,
drug interactions (serotonin syndrome), as well as a
hypertensive crisis. When utilizing this medication for
treatment-resistant depression, the advance practitioner is aware
59. of the detrimental adverse reactions which may occur.
Therefore, phenelzine is not the safest option for this client.
The overarching goal for this male client is to reduce the
symptoms related to his major depressive disorder and to
eventually achieve remission without relapse where he can
maintain normalcy in his life. After four weeks, his depressive
symptoms decrease by 25 percent which is progress; however,
he has a new onset of erectile dysfunction (Laureate Education,
2016). Sexual dysfunction is a notable side effect of sertraline
(Stahl, 2017). Therefore, the clinician will reevaluate the plan
of care given this new information. The outcomes were to be
expected as the client was started on a low dose of sertraline,
and treatment is typically 50 mg to 200 mg. A continuation in
progress may require more time, approximately six to eight
weeks in total (Stahl, 2017).
Decision Point Two
The present selections include decrease dose to 12.5 daily
orally, continue same dose and counsel client, or augment with
Wellbutrin 150 IR in the morning. The preference for decision
point two is Wellbutrin (bupropion) 150 IR, which is considered
a norepinephrine dopamine reuptake inhibitor (SDRI). An
SDRI elevates the neurotransmitters dopamine, noradrenaline,
and norepinephrine in the brain to achieve an improvement in
depressive symptoms (Stahl, 2017). The purpose of utilizing
this agent is three-fold: (1) To boost mood (2) To treat the new
onset of sexual dysfunction (3) To aid in weight-loss.
According to the National Alliance on Mental Illness [NAMI]
(2018a), Wellbutrin is a medication administered for major
depressive disorder often in conjunction with an SSRI (NAMI,
2018a).
Further, Wellbutrin may be prescribed with an SSRI to reverse
the effects of SSRI-induced sexual dysfunction (Stahl, 2017).
Dunner (2014) purports combining antidepressants are safe and
may enhance efficacy; however, the combination of medications
may also be utilized as an approach to reduce the effects of
antidepressant pharmacotherapy. Dunner (2014) concurs that
60. bupropion is frequently used with an SSRI or SNRI to alleviate
sexual dysfunction. Stahl (2017), findings indicate the most
common side effects of bupropion consist of constipation, dry
mouth, agitation, anxiety, improved cognitive functioning, as
well as weight loss. The client in this scenario has gained 15
pounds over two months; thus, this medication may aid in his
desire to lose weight (Laureate Education, 2016). Further, this
agent typically is not sedating as it does not have
anticholinergic or antihistamine properties yet have a mild
stimulating effect (Guzman, n.d).
Decreasing the Zoloft dose from 25 mg daily to 12.5 mg would
not prove feasible as the client has reached a 25 percent
reduction in symptomology. The treatment for adults is 50 mg-
200 mg, taking an approximate six to eight weeks to see the
results in some individuals (Stahl, 2017). If the provider is
tapering the medication as part of the client's plan of care,
reducing the dose to 12.5 mg would prove beneficial. Research
finds that when taking an antidepressant, the neurons adapt to
the current level of neurotransmitters; therefore, if
discontinuing an SSRI too quickly some of the symptoms may
return (Harvard Health Publishing, 2018). Under some
circumstances, discontinuation signs may appear, such as sleep
changes, mood fluctuations, unsteady gait, numbness, or
paranoia (Harvard Health Publishing, 2018). However, the
client is experiencing slow and steady progress on his current
dose of Zoloft, so no adjustments are warranted.
At this point, positive results have been verbalized with the
current dose of Zoloft 25 mg daily, with the exception of the
onset of erectile dysfunction, which is a priority at this time.
One study finds that comorbid depression and anxiety disorders
are commonly seen in adult males with sexual dysfunction
(Rajkumar & Kumaran, 2015). An estimated 12.5 percent of
participants experienced a depressive disorder before the
diagnosis of sexual dysfunction. The author’s findings suggest a
significant increase in suicidal behaviors with this comorbidity.
Moreover, the study indicates, some men experienced a sexual
61. disorder while taking prescribed medication such as an
antidepressant (Rajkumar & Kumaran, 2015). According to Li
et al. (2018), cognitive-behavioral therapy (CBT) is a beneficial
tool utilized with clients experiencing mood disorders. The
implementation of CBT may increase the response and
remission rates of depression. However, the option of
continuing the same dose and engaging in counseling services is
not the priority at this time. It is essential to address this side
effect to enhance his current pharmacotherapy and prevent an
increase in depressive symptoms.
The continued goal of therapy is to achieve “full” remission of
this individual’s major depressive disorder and to enhance his
wellbeing. After four weeks, the client returns to the clinic
with a significant reduction in depressive symptoms along with
the dissipation of erectile dysfunction. However, he reports
feelings of “jitteriness” and on occasion “nervousness”
(Laureate Education, 2016). This course of treatment has
proven successful thus far, and the outcomes are to be expected
due to the medication trials.
Decision Point Three
The present selections are to discontinue Zoloft and continue
Wellbutrin, change Wellbutrin to XL 150 mg in the morning, or
add Ativan 0.5 mg orally TID/PRN for anxiety. The selection
for decision point three is to change the Wellbutrin from IR to
XL 150 mg in the morning. The first formulation is immediate-
release (IR) and the recommended dosing is divided beginning
at 75 mg twice daily increasing to 100 mg twice daily, then 100
mg three times a day with the maximum of 450 mg (Stahl,
2017). The second formulation is extended-release (XL),
where the administration for the initial dose is once daily taken
in the morning; the maximum is 450 mg in a single dose (Stahl,
2017). The peak level of bupropion XL is approximately five
hours; therefore, the side effects reported may subside as the
absorption rate is slower than the IR dose (U.S. Food and Drug
Administration, 2011a). The immediate-release peak level is
approximately two hours which may account for the client’s
62. notable feelings of being jittery and at times nervous (U.S. Food
and Drug Administration, 2011b). Furthermore, clients are
switched to extended-release to improve tolerance and treatment
adherence to once-daily treatment (Guzman, n.d). As a mental
health provider, caring for this client, changing the formulation
is the best decision at this point as well as to continue to
monitor side effects.
As mentioned above, Zoloft, an SSRI, can be utilized as a first-
line agent for major depressive disorder (Masuda et al., 2017).
Using Wellbutrin as an adjunct to the regimen has continued to
reduce his symptoms of depression and has alleviated one of his
primary concerns which is sexual dysfunction. Therefore,
discontinuing Zoloft and maintaining the use of Wellbutrin is
not an appropriate option at this time.
Ativan (lorazepam) is a benzodiazepine with anxiolytic, anti-
anxiety, and sedative properties. It provides short-term relief of
anxiety symptoms or insomnia (U.S. National Library of
Medicine [NLM], n.d.). Lorazepam works by enhancing the
effect of the inhibitory neurotransmitter GABA, which inhibits
the nerve signals, in doing so, reducing the “nervous excitation”
(NLM, n.d., para. 1). In some instances, a low dose, 0.5 mg,
may be administered short-term to reduce side effects from
another medication. Stahl (2017), indicates many side effects
will not improve with an augmenting drug. Common side effects
consist of confusion, weakness, sedation, nervousness, and
fatigue (Stahl, 2017). Further, Ativan has an increased risk for
abuse potential as it is known to have habit-forming properties
(Stahl, 2017). As a result, administering Ativan would not be in
the best interest of the client.
The ultimate goal is to achieve remission of his mood disorder.
The medication regimen has proven effective; thus, considering
this to be a successful plan of care. Taking both the sertraline
and bupropion can exhibit side effects of jitteriness; however,
changing to the extended-release may aid in the dissipation of
these feelings. The addition of Ativan to relieve side effects,
that are perhaps temporary, is against better judgment without
63. first making an effort to change or modify the medication
regimen (Laureate Education, 2016).
Summary with Ethical Considerations
Mood disorders affect millions of individuals in the United
States on an annual basis. The prevalence of mental illness
continues to flourish, impacting one’s quality of life. Initiating
treatment, under the guidance of a healthcare professional, is of
the utmost importance. Further, an individualized plan of care
comprising of education, therapy, medication, and support is
crucial for overall health and wellbeing.
The client is a Hispanic American male employed as a laborer
in a warehouse (Laureate Education, 2016). It is essential to
assess his financial means before prescribing medications.
Although one cannot assume the client has financial hardships,
having this knowledge will guide in the process of treatment. If
the client is without insurance and has to pay out-of-pocket,
medication adherence may not be sustainable. Therefore, as a
psychiatric nurse practitioner, providing a cost-effective means
whether, through generic prescriptions, discount pharmacies, or
prescribing a larger quantity may be a necessary option (Barker
& Guzman, 2015). Further, the partnership among clients and
practitioners is essential; to establish trust and respect as well
as understanding cultural preferences while avoiding
stereotypes is vital.