Pneumocytis Pneumonia

discussion 1 Clinical case scenario A 39-year-old homeless man presents to the emergency department for cough and fever. He says that his illness has been worsening over the past 2 weeks. He originally had dyspnea on exertion and now is short of breath at rest. On questioning, he tells you that he lives in a homeless shelter when he can, but he frequently sleeps on the streets. He has used IV drugs (primarily heroin) “on and off” for many years. He denies medical history but the only time he gets medical attention is when he comes to the emergency department for an illness or injury. On review of systems, he complains of fatigue, weight loss, and diarrhea. On examination, he is a thin, disheveled man appearing much older than his stated age. His temperature is 100.5°F (38.0°C), his blood pressure is 100/50 mm Hg, his pulse is 105 beats/min, and his respiratory rate is 24 breaths/min. His initial oxygen saturation is 89% on room air, which comes up to 94% on 4 L of oxygen by nasal cannula. Significant findings on examination include dry mucous membranes, a tachycardic but regular cardiac rhythm, a benign abdomen, and generally wastedappearing extremities. His pulmonary examination is significant for tachypnea and fine crackles bilaterally, but no visible signs of cyanosis. His chest x-ray is read by the radiologist as having diffuse, bilateral, interstitial infiltrates that look like “ground glass.” Answer the following questions 1-What is the most likely cause of this patient’s current pulmonary complaints? 2-What underlying illness does this patient most likely have? 3-What testing and treatment should be started now?

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Depression- decision tree

BACKGROUND INFORMATION The client is a 70 year-old Hispanic American male who came to the United States when he was in high school with his father. His mother died back in Mexico when he was in school. He presents today to your office for an initial appointment for complaints of depression. The client was referred by his PCP after “routine” medical work-up to rule out an organic basis for his depression. He has no other health issues with the exception of some occasional back pain and “stiff” shoulders which he attributes to his current work as a laborer in a warehouse. SUBJECTIVE During today’s clinical interview, client reports that he always felt like an outsider as he was “teased” a lot for being “black” in high school. States that he had few friends, and basically kept to himself. He describes his home life as “good.” Stating “Dad did what he could for us, there were 8 of us.” He also reports a remarkably diminished interest in engaging in usual activities, states that he has gained 15 pounds in the last 2 months. He is also troubled with insomnia which began about 6 months ago, but have been progressively getting worse. He does report poor concentration which he reports is getting in “trouble” at work. MENTAL STATUS EXAM The client is alert, oriented to person, place, time, and event. He is casually dressed. Speech is clear, but soft. He does not readily make eye contact, but when he does, it is only for a few moments. He is endorsing feelings of depression. Affect is somewhat constricted, but improves as the clinical interview progresses. He denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment and insight appear grossly intact. He is currently denying suicidal or homicidal ideation. You administer the “Montgomery- Asberg Depression Rating Scale (MADRS)” and obtained a score of 51 (indicating severe depression) . RESOURCES § Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389. For this Discussion, you will select an interactive media piece to practice decision making when treating patients with psychological disorders ( Selected above) You will recommend the most effective pharmacotherapeutic to treat the psychological disorder presented and examine potential impacts of pharmacotherapeutics on a patient’s pathophysiology. To Prepare · Review this week’s interactive media pieces and select one to focus on for this Discussion. · Reflect on the decision steps in the interactive media pieces, and consider the potential impacts from the administration of the associated pharmacotherapeutics on the patient’s pathophysiology. · Post a brief explanation of the psychological disorder presented( depression) and the decision steps you applied in completing the interactive media piece for the psychological disorder you selected ( as below) Then, explain how the administration of the associated pharmacotherapeutics you recommended may impact the patient’s pathophysiology. How might these potential impacts inform how you would suggest treatment plans for this patient? Be specific and provide examples. Decision steps taken: Decision point 1 Begin Zoloft 25mg orally daily. ( pt came back in not feeling better and c/o erectile dysfunction) Decision point 2 Decrease dose of Zoloft ( pt still feels better but still same complain) Decision point 3 d/c zoloft and start on paxil ( SSRIs should be first line of treatment while MOAIs last line of treatment for depression( from research, say why this decision will be best for this patient with three references)

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Securing the blessings of liberty

The Preamble to the U.S. Constitution asserts that the Founders were driven by a desire to “secure the blessings of liberty.” This phrase echoes the Declaration of Independence, which asserted that, “all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.–That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed.” Explain what the Framers meant by “securing the blessings of liberty” and how this idea related to their understanding of the role and structure of government. Be sure to explain how this idea was rooted both in American political history and in American political culture.

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initial discussion

read the pdf bottom of this direction and pick case and one page with intext citation and reference response Directions: There are three scenarios that will be used in this discussion posting. You are all responsible for the initial discussion posting and then responding to one posting in the remaining scenarios. For example, my last name is Combs, therefore my initial discussion posting will occur from CASE #1. I will then be responsible for responding to one post from CASE #2 and one post from CASE #3. CASE #1 (A to H); CASE #2 (I to Q); CASE #3 (R to Z) CASE #1: 30-year-old male presents to the emergency department with RLQ pain and fever. Labs reveal an elevated white blood count. The surgical intern tells the patient that appendicitis is suspected and that the plan is to proceed with surgery to remove the appendix. He explains that the surgery is to be performed to prevent complications of appendicitis, including abscess formation, sepsis or even death. He goes on to explain the risks of surgery, including bleeding, infection and damage to adjacent organs. What additional information needs to be included in this consent? Provide an evidence-based reason for your answer. Whether or not the intern would undergo the procedure in a similar circumstance. Alternative to the surgery, including receiving antibiotics and monitoring the patient. Name of the surgeon who will actually be performing the procedure. A, B and C B and C only CASE #2: 33-year-old woman is in the operating room to undergo colectomy for ulcerative colitis. Patient was given appropriate information, and consented for the procedure. During the operation, a mass is identified involving the liver. Given the previous consent, it is acceptable for the surgeon to proceed further to either biopsy or excise the lesion. Provide an evidence-based reason for your answer. True False CASE #3: 14-year-old girl presents to the emergency department, accompanied by her 10-month-old daughter and boyfriend. The boyfriend is the child’s father. Patient complains of severe lower abdominal pain, although she is afebrile, with normal laboratory values and normal vital signs. No cause of the pain is able to be delineated, and the plan is to take the girl to the operating room to perform a diagnostic laparoscopy. In this case, from whom should informed consent be obtained? Provide an evidence-based reason for your answer. Patient Patient’s parents Patient’s boyfriend Informed Consent – The Joint Commission.pdf

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Final project

The final project for this course is the creation of a marketing and communication plan. The final product represents an authentic demonstration of competency because when working in a management position at a healthcare organization, you could be involved in selecting or creating a healthcare marketing plan. The project is divided into three milestones, which will be submitted at various points throughout the course to scaffold learning and ensure quality final submissions. These milestones will be submitted in Modules Three, Five, and Seven. The final product will be submitted in Module Nine The last assignment to complete the final paper is based on marketing and communication strategies based on this proposed service: Proposed Service for Marketing The proposed service for the hospital is a new health payment plan for the uninsured. The plan will be designed to make care more affordable for the out-of-pocket payers since this is one of the most expensive care payment plans. This strategy addresses the opportunity of developing new services that will make Bellevue Hospital safer and more accessible to more people without the ability to afford insurance plans. The rubric for both assignments are attached as well as part one and part of the final paper.

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Yale Brown Obsessive Compulsive Scale

This week, as you explore assessment and diagnosis in psychotherapy, you examine assessment tools, including their psychometric properties and appropriate use. You also develop diagnoses for clients receiving psychotherapy and consider legal and ethical implications of counseling these clients. Below you will find your assigned assessment tool for this week’s discussion. Yale Brown Obsessive Compulsive Scale 1) Post an explanation of the psychometric properties of the assessment tool you were assigned (Yale Brown Obsessive Compulsive Scale) . 2) Explain when it is appropriate to use this assessment tool with clients, including whether the tool can be used to evaluate the efficacy of psychopharmacologic medications. 3) Support your approach with evidence-based literature. 4) Also develop diagnoses for clients receiving psychotherapy and consider legal and ethical implications of counseling these clients Required Readings Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company. Chapter 3, “Assessment and Diagnosis” (pp. 95–168) Chapter      4, “The Initial Contact and Maintaining the Frame” (pp. 169–224) American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Note: It is highly recommended that you use this resource as a reference guide throughout the course. You will access this text from the Walden Library databases. American Academy of Child and Adolescent Psychiatry. (1995). Practice parameters for the psychiatric assessment of children and adolescents . Washington, DC: Author. Retrieved from https://www.aacap.org/App_Themes/AACAP/docs/practice_parameters/psychiatric_assessment_practice_parameter.pdf American Psychiatric Association. (2016). Practice guidelines for the psychiatric evaluation of adults (3rd ed.). Arlington, VA: Author. Retrieved from http://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760 Walden Library. (2017). NURS 6640 week 2 discussion guide. Retrieved from http://academicguides.waldenu.edu/nurs6640week2discussion Walden University. (n.d.). Tests & measures: Home. Retrieved February 6, 2017, from http://academicguides.waldenu.edu/library/testsmeasures Note: This database may be helpful in obtaining assessment tool information for this week’s Discussion. Required Media Laureate Education (Producer). (2015a). Counseling competencies—The application of ethical guides and laws to record keeping [Video file]. Baltimore, MD: Author. Provided courtesy of the Laureate International Network of Universities. Note: The approximate length of this media piece is 23 minutes. (See Attached Transcript for the Media)

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Assignment: Asthma and Stepwise Management

Assignment: Asthma and Stepwise Management Asthma is a respiratory disorder that affects children and adults. Advanced practice nurses often provide treatment to patients with these disorders. Sometimes patients require immediate treatment, making it essential that you recognize and distinguish minor asthma symptoms from serious, life-threatening ones. Since symptoms and attacks are often induced by a trigger, advanced practice nurses must also help patients identify their triggers and recommend appropriate management options. Like many other disorders, there are various approaches to treating and managing care for asthmatic patients depending on individual patient factors. One method that supports the clinical decision making of drug therapy plans for asthmatic patients is the stepwise approach, which you explore in this Assignment. To Prepare Reflect on drugs used to treat asthmatic patients,      including long-term control and quick relief treatment options for      patients. Think about the impact these drugs might have on patients,      including adults and children. Consider how you might apply the stepwise approach to      address the health needs of a patient in your practice. Reflect on how stepwise management assists health care      providers and patients in gaining and maintaining control of the disease. Create a 5- to 6-slide PowerPoint presentation that can be used in a staff development meeting on presenting different approaches for implementing the stepwise approach for asthma treatment. Be sure to address the following: Describe long-term control and quick relief treatment      options for the asthma patient from your practice as well as the impact      these drugs might have on your patient. Explain the stepwise approach to asthma treatment and      management for your patient. Explain how stepwise management assists health care      providers and patients in gaining and maintaining control of the disease.      Be specific. Book link https://www.sendspace.com/file/llbyl3

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Checkpoint for Certification Plan

Assignment 2: Week 7 Practicum Journal: Checkpoint for Certification Plan Students will: · Evaluate progress on certification plans Report your progress on the Certification Plan completed in Week 1 and submitted in Week 4. · What have you done to prepare for your certification? · Have you completed the scheduled tasks assigned on your timeline? If not, what are your plans to stay on schedule?

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Draft a proposal of 4–5 pages for the development of an interprofessional team to address a problem in delivering safe, high-quality health care.

· Competency 1: Explain the concepts, principles, and characteristics of effective health care leadership. o Analyze the factors contributing to a problematic health care issue. · Competency 2: Explain the role of health care leaders in facilitating interprofessional collaboration. o Explain the need for interprofessional collaboration to improve the quality and safety of health care in specific instances. o Assess the effectiveness of a particular leadership approach in building and maintaining interprofessional collaborative relationships. o Develop a collaborative plan for improving the quality and safety of health care in specific instances. o Determine the leader’s role in implementing collaborative health care improvement projects. · Competency 4: Determine the influence of the practitioner-scholar role on professional practice and leadership development. o Determine how the practitioner-scholar model might be applied in resolving a particular health care issue. · Competency 5: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with applicable organizational, professional, and scholarly standards.

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7-1 Final Project – Needing revision and correction on each paper done already following rubric below!

You may want to use this as a checklist to make sure that your paper is ready for submission: Did you submit the paper through Turnitin? *** I recommend that you submit your paper through Turnitin well before it is due. Make adjustments if needed and then resubmit. You will have to submit the paper into the submission folder to run it through TII Is the Turnitin percentage 25% or less? This is the goal. It is important to look at the report to see where the citations may need to be fixed. Did you make adjustments and rerun the paper through Turnitin? Are all of the in-text citations noted correctly? Quotation marks used when needed? Author, date, and page numbers used correctly? Large quotes done correctly? Is the reference list done correctly? Titles of books and journals (and volume number) italicized? In alphabetical order? Is the format correct for each reference based on its type? If electronic sources are used is the URL included (but NOT the retrieval date)? Is the format of the paper correct? Title page? Formatted correctly Running head? 12 pt font, double spaced, 1 in. margins? Reference Page in correct format? Subtitles placed correctly? Did you look at the rubric to make sure that you covered everything that should be included? Did you reread your paper and run spell check?

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