Week 4
MidWeek Comprehension Questions
Discussion
Purpose
Information literacy is critically important for all nurses, especially APNs. APNs must be able to determine what information is needed, find the information, critique the information, provide care based on this information, and evaluate the outcomes of the process. Sound challenging? Continue to reflect upon strategies to facilitate this process. Provide a brief response (100 words or less)
Needing assistance with this assignment
I have to write a reply to each of the texts in the document attached below, they must be 200 words each and include references.
Find and review ten (10) scholarly, peer-reviewed research articles, meta-analyses, or CPGs in support of the practice change intervention. Complete the appropriate section in the worksheet for each article.
1. State the PICOT question.
2. For each article, supply the information for each of the seven headings for the appropriate article type.
3. Find and review ten (10) scholarly, peer-reviewed research articles, meta-analyses, or CPGs in support of the practice change intervention. Complete the appropriate section in the worksheet for each article.
4. State the PICOT question.
5. For each article, supply the information for each of the seven headings for the appropriate article type.
Use complete sentences to document findings.
Select the correct table for each of the ten articles and complete the information that aligns with the type of research article selected. You may do any combination of articles.
Copy and paste the tables as needed to classify your ten articles correctly.
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PICOT Statement |
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QUANTITATIVE STUDIES |
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Full reference for article (APA 7th Ed.Format) |
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DOI of article/ article link |
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Problem-related to PICOT |
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Methods |
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Sample and Participants |
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Major Findings/Conclusions |
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Relevance to Practice Issue or Proposed Intervention |
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QUALITATIVE STUDIES |
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Full reference for article (APA 7th Ed.Format) |
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DOI of article/ article link |
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Purpose and Type of Research |
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Sample |
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Data Collection Method |
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Study Findings |
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Key Findings/Themes |
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Relevance to Practice Issue or Proposed Intervention |
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Clinical Practice Guideline |
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Full reference for article (APA 7th Ed.Format) |
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DOI of article/ article link |
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Purpose and Type of Research |
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Systematic Review of Literature |
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Stakeholders and Peer Review |
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Study Findings related to PICOT |
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Strength of Recommendations |
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Relevance to Practice Issue or Proposed Intervention |
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META-ANALYSIS STUDIES |
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Full reference for article (APA 7th Ed.Format) |
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DOI of article/ article link |
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Purpose of Research Article |
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Search Selection Method |
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Meta-Analysis Model |
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Consistency/Variation of Studies |
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Summary of Findings |
The patient is a 71-year-old widowed man who is seen regularly in the clinic for health maintenance and follow-up of his chronic insomnia and anxiety. He has regular prescriptions for triazolam (Halcion) and clonazepam (Klonopin) for these problems. Recently he has been reporting frequent episodes of losing his balance and falling, and eight weeks ago was hospitalized for a hip fracture sustained during one of these falls resulting in hip surgery. On this visit, he also complains of becoming increasingly confused.
please follow all directions
Unit 9 ADHD Medications. 800w. 4 references. Due 10-26-23
Thomas Deliver, a 36-year-old male patient, enters your office for his initial appointment. According to the intake paperwork, Mr. Deliver is a computer programmer who is complaining of problems with concentration, completing tasks, and being terrible at listening during company meetings and even at home. He explains that he has difficulty starting and completing work projects and trouble being on time or keeping appointments and commitments. He has divorced 3 months ago and has joint custody of two daughters ages 6 and 10 years old. On most days, he sleeps late and he has trouble keeping a regular schedule and getting his children to their lessons and extracurricular appointments on time.
Mr. Deliver believes the lack of concentration and poor communication with his wife led to the divorce, and Mr. Deliver worries that his trouble with organization and attention may affect his custody agreement and prevent him from keeping his job.
Mr. Deliver’s employer and his family and friends have suggested to him that he should get evaluated for ADHD, but he has resisted because of concerns about the stigma of a psychiatric diagnosis and the risks of taking a psychotropic medication.
Mr. Deliver is 5'11″ and his weight is 165 lb. He takes a men’s multivitamin daily, HCTZ at 25 mg for hypertension, fish oil 1,000 mg at bedtime for hyperlipidemia, and a rescue inhaler that he keeps with him although he hasn’t had to use it for many years.
1. What screening tools can be used to affirm your initial diagnosis that Mr. Deliver meets the criteria for ADHD?
2. Further assessment determines that Mr. Deliver does meet the criteria for ADHD, inattentive type. What is the current recommendation for pharmacological treatment for Mr. Deliver?
Assume that instead of Mr. Deliver being 36-years-old, Thomas is a 13-year-old male that also meets the diagnostic criteria for ADHD, hyperactive type (Thomas is not on any medications at this age). How will your pharmacological treatment change?
Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.
Please be sure to validate your opinions and ideas with in-text citations and corresponding references in APA format.
Please review the rubric to ensure that your response meets the criteria.
1. What screening tools can be used to affirm your initial diagnosis that Mr. Deliver
meets the criteria for ADHD?
The first tool I would use to affirm that this patient meets the criteria for ADHD would be
the DSM-5. The DSM-5 lists the diagnostic criteria for ADHD as needing six or more of
the symptoms in either category 1 (inattention) or category 2 (hyperactivity and
impulsivity) that last for at least 6 months and to a degree that negatively impacts social,
academic or occupations activities. These symptoms also need to be present in two or
more settings, be present prior to age of 12 years and do not occur exclusively during
the course of schizophrenia or another psychotic disorder and are not better explained
by another mental disorder (American Psychiatric Association, 2013). There are also
many screening tools to use in addition to the DSM-5. Rating scales are used in
conjunction with the DSM-5 to help with diagnosis of ADHD. Rating scales specifically
designed for use in adults include: Brown Attention-Deficit Disorder Symptom
Assessment Scale for Adults (BADDS); Adult ADHD Clinical Diagnostic Scale (ACDS);
ADHD Rating Scale-IV With Adult Prompts (ADHD-RS-IV); and the Adult ADHD SelfReport Scale (ASRS) (Gualtieri & Johnson, 2005).
This study source was downloaded by 100000769192234 from CourseHero.com on 10-21-2023 15:58:26 GMT -05:00
https://www.coursehero.com/file/123197904/discussion-9docx/
2. Further assessment determines that Mr. Deliver does meet the criteria for ADHD,
inattentive type. What is the current recommendation for pharmacological
treatment for Mr. Deliver?
I would recommend either an amphetamine or methylphenidate. I am slightly
concerned about this patient’s history of hypertension and hyperlipidemia, as both
of these psychostimulant classes have been shown to raise blood pressure. Long
term studies have shown that stimulant use is not associated with increased risk of
heart attacks, cardiac death or stroke. Those with well-controlled hypertension have
been shown to manage ADHD symptoms effectively with amphetamines and
methylphenidates. This still does not negate the fact however, that the product
labels of stimulants state that “caution is indicated” when treating patients with preexisting hypertension (Fairman et al., 2018). I would also be sure to encourage this
patient to partake in behavioral therapy as well as using prescription medication.
3. Assume that instead of Mr. Deliver being 36-years-old, Thomas is a 13-year-old male
that also meets the diagnostic criteria for ADHD, hyperactive type (Thomas is not on
any medications at this age). How will your pharmacological treatment change?
For an adolescent patient the treatment plan is not a lot different than for adults
with ADHD. Stimulants are more effective than non-stimulants, but there can be a
risk for growth restriction. There are other non-stimulant medications that could be
tried first (atomoxetine, guanfacine, clonidine, bupropion, and modafinil). As with
adults with ADHD, I would also recommend concurrent behavioral therapy (Heldt,
2017).
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Arlington, VA: American Psychiatric Publishing
Fairman, K. A., Davis, L. E., Peckham, A. M., & Sclar, D. A. (2018). Diagnoses of
Cardiovascular Disease or Substance Addiction/Abuse in US Adults Treated for ADHD
with Stimulants or Atomoxetine: Is Use Consistent with Product Labeling? Drugs – Real
World Outcomes, 5(1), 69–79. https://doi.org/10.1007/s40801-017-0129-2
This study source was downloaded by 100000769192234 from CourseHero.com on 10-21-2023 15:58:26 GMT -05:00
https://www.coursehero.com/file/123197904/discussion-9docx/
Gualtieri, C. T., & Johnson, L. G. (2005). ADHD: Is Objective Diagnosis Possible? Psychiatry
(Edgmont (Pa. : Township)), 2(11), 44–53.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993524/
Heldt, J. P. (2017). Memorable psychopharmacology. Createspace Independent Publishing
Platform
1.What screening tools can be used to affirm your initial diagnosis that Mr. Deliver meets the criteria for ADHD?
The DSM-5 would be the first resource I would consult to confirm if this patient satisfies the requirements for ADHD. According to the DSM-5, six or more symptoms from either group—category 1 (inattention) or category 2 (hyperactivity and impulsivity)—must be present for at least six months and have a detrimental influence on a person's ability to engage in social, academic, or occupational activities. Additionally, these symptoms must appear in two or more contexts, appear before the age of twelve, not only occasionally during the course of schizophrenia or another psychotic condition, and not be better explained by another mental illness (American Psychiatric Association, 2013).The DSM-5 is just one of several screening instruments available. The DSM-5 and rating scales are combined to assist in the diagnosis of ADHD. The Brown Attention-Deficit Disorder Symptom Assessment Scale for Adults (BADDS), the Adult ADHD Clinical Diagnostic Scale (ACDS), the ADHD Rating Scale-IV With Adult Prompts (ADHD-RS-IV), and the Adult ADHD SelfReport Scale (ASRS) are among the rating scales created expressly for use in adults (Gualtieri & Johnson, 2005).
2.Further assessment determines that Mr. Deliver does meet the criteria for ADHD, inattentive type. What is the current recommendation for pharmacological treatment for Mr. Deliver?
Either an amphetamine or methylphenidate is what I would advise. The patient's history of hypertension and hyperlipidemia causes me a little anxiety because it has been demonstrated that both of these kinds of psychostimulants can increase blood pressure. Studies conducted over an extended period of time have revealed no link between stimulant usage and an increased risk of heart attacks, cardiac death, or stroke. Amphetamines and methylphenidate have been demonstrated to help people with well-controlled hypertension manage their ADHD symptoms. However, this does not change the fact that while treating patients with preexisting hypertension, caution is advised on the product labels of stimulants (Fairman et al., 2018). In addition to prescription medication, I would make sure to encourage this patient to engage in behavioral treatment.
3.Assume that instead of Mr. Deliver being 36-years-old, Thomas is a 13-year-old male that also meets the diagnostic criteria for ADHD, hyperactive type (Thomas is not on any medications at this age). How will your pharmacological treatment change?
The treatment strategy is mostly the same for adolescents and adults with ADHD. Although stimulants are more effective than non-stimulants, there is a chance that they may limit growth. There are more non-stimulant drugs that might be tried initially (atomoxetine, guanfacine, clonidine, bupropion, and modafinil). In the same way that I would advise concurrent behavioral therapy for people with ADHD (Heldt, 2017)
Step-by-step explanation
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing
Fairman, K. A., Davis, L. E., Peckham, A. M., & Sclar, D. A. (2018). Diagnoses of Cardiovascular Disease or Substance Addiction/Abuse in US Adults Treated for ADHD with Stimulants or Atomoxetine: Is Use Consistent with Product Labeling? Drugs – Real World Outcomes, 5(1), 69-79. https://doi.org/10.1007/s40801-017-0129-2
Gualtieri, C. T., & Johnson, L. G. (2005). ADHD: Is Objective Diagnosis Possible? Psychiatry (Edgmont (Pa. : Township)), 2(11), 44-53. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993524/
Heldt, J. P. (2017). Memorable psychopharmacology. Createspace Independent Publishing Platform.
this is in correspondence with the goals and objective of the previous work. the one you did,
Summary of strengths:
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Opportunities for growth:
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Now, write three to four (3–4) possible goals and objectives for this practicum experience. Ensure that they follow the SMART Strategy, as described in the Learning Resources.
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1. a. b. c. 2. a. b. c. 3. a. b. c.
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I need plagiarism minimized, good references and medical words. the paper follows correct APA format, valid references (more than 4)
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· Review your Clinical Skills Self-Assessment Form you submitted and think about areas for which you would like to gain application-level experience and/or continued growth as an advanced practice nurse. How can your experiences in the practicum help you achieve these aims?
· Review the information related to developing objectives provided in this week’s Learning Resources. Your practicum learning objectives that you want to achieve during your practicum experience must be:
· Specific
· Measurable
· Attainable
· Results-focused
· Time-bound
· Reflective of the higher-order domains of Bloom’s taxonomy (i.e., application level and above)
Note: Please make sure your objectives are individualized and outlined in your Practicum Experience Plan (PEP). While you may add previous objectives to continue to work toward. You must have 3 new objectives for each class, each quarter.
· Discuss your professional aims and your proposed practicum objectives with your Preceptor to ascertain if the necessary resources are available at your practicum site.
· Select one nursing theory and one counseling/psychotherapy theory to best guide your clinical practice. Explain why you selected these theories. Support your approach with evidence-based literature.
· Create a timeline of practicum activities that demonstrates how you plan to meet these goals and objectives based on your practicum requirements.
THE ASSIGNMENT
Record the required information in each area of the Practicum Experience Plan template, including 3–4
measurable practicum learning objectives you will use to facilitate your learning during the practicum experience.
Mark and Jacqueline have been married for 30 years. They have grown children who live in another state. Jacqueline’s mother has moved in with the couple because she has Alzheimer’s disease. Jacqueline is an only child and always promised her mother that she would care for her in her old age. Her mother is unaware of her surroundings and often calls out for her daughter Jackie when Jacqueline is in the room. Jacqueline reassures her mother that she is there to help, but to no avail.
Jacqueline is unable to visit her children on holidays because she must attend to her mother’s daily needs. She is reluctant to visit friends or even go out to a movie because of her mother’s care needs or because she is too tired. Even though she has eliminated most leisure activities with Mark, Jacqueline goes to bed at night with many of her caregiving tasks unfinished. She tries to visit with her mother during the day, but her mother rejects any contact with her daughter. Planning for the upcoming holidays seems impossible to Mark, because of his wife’s inability to focus on anything except her mother’s care.
Jacqueline has difficulty sleeping at night and is unable to discuss plans even a few days in advance. She is unable to visit friends and is reluctant to have friends visit because of the unpredictable behavior of her mother and her need to attend to the daily care.
Reflective Questions
1. How do you think this situation reflects Jacqueline’s sense of role performance?
2. How do you think that Jacqueline may be contributing to her own health?
Please provide rationales for your answers. Please provide a citation for your answers.
Your patient is a 23-year-old female. She presents with coughing and wheezing which she stated started about three weeks ago. She is currently 25 weeks pregnant. Her last prenatal visit was one month ago in another state. She has an appointment with the prenatal care provider next week, however her respiratory symptoms brought her to your office today.
History – Chickenpox as a child. Asthma as a child, diagnosed at age 8 for which she used a SABA when needed. She has not had the need to use an inhaler since she was 19. She takes only her prenatal vitamin. No other acute or chronic problems. She advises you that she is up to date on all immunizations except she has not had a flu shot (it is October).
Social – Non-smoker, no drug use. She relocated to your state two weeks ago to get away from an abusive domestic situation. She has no support network in this area and has not yet found employment. She has no medical insurance.
HPA – Non-productive cough x 3 weeks. Wheezing audible from across the room. She states it is like this all day and wakes her from sleep every night. She reports that she is fatigued even in the morning. No other complaints.
PE/ROS – Pt appears disheveled but clean. Wheezing in all lung fields. T 98, P 82 regular, R 28 no stridor. FH 130 regular. The remainder of the exam is WNL.
02 98% and FEV 70%
Directions:
1. Construct a narrative document of 4-5 pages (not including cover page or reference page)
2. Diagnose the patient based on the above findings and provide your rationale for how you arrived at the diagnosis.
3. Develop a treatment plan specifically for this patient, pharmacologic and non-pharmacologic.
4. Describe community resources (using your own community) currently available in your state/city to support this patient.
5. Provide a communication plan that you will use to ensure the patient is an active participant in the treatment plan. Refer to therapeutic communication concepts.
6. Utilize national standards, your pharm and/or patho book, and medical or advanced practice professional sources. Do not use patient-facing sources or general nursing texts.
7. Use references to support your concepts. Utilize correct APA formatting (7th edition) and mechanics of professional communication.
Before finalizing your work, you should:
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Read the Assignment description carefully (as displayed above);
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Consult the Grading Rubric (under Course Resources) to make sure you have included everything necessary.
Your writing assignment should:
· Follow the conventions of
Standard American English (correct grammar, punctuation, mechanics, etc.);
· Be
well organized, logical, and
unified, as well as
original and insightful;
· Utilize correct APA formatting, 7th edition.
· Submit to, and review results of Turnitin. Purdue University Global Student Conduct policy as it relates to plagiarism will be adhered to in this course.
Rubric Title: MN553 Unit 4 Assignment Rubric
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Assignment Criteria |
Level III |
Level II |
Level I |
Not Present |
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Criteria 1 |
Level III Max Points Points: 10 |
Level II Max Points Points: 8 |
Level I Max Points Points: 6 |
Not Present 0 Points |
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Diagnosing the patient |
· An accurate diagnosis with correct staging is provided · Rationale for arrival at the diagnosis with support from national guidelines is provided |
· An accurate diagnosis is provided with staging that may not be correct · Rationale for the diagnosis is provided without support |
· An accurate diagnosis is provided with staging that may not be correct · Rationale for the diagnosis is provided without support |
· Does not meet the criteria |
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Criteria 2 |
Level III Max Points Points: 10 |
Level II Max Points Points: 8 |
Level I Max Points Points: 6 |
Not Present 0 Points |
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Providing pharmacologic intervention |
· Correct medications are prescribed to treat the diagnosis · Rational for medications prescribed adheres to national guidelines · |
· 50% of correct medications are prescribed · Rational to support prescribed medications is provided and adheres to national guidelines |
· Less than 50% of the correct medications are prescribed · Rational to support the prescribed medications is not present or does not adhere to national guidelines |
· Does not meet the criteria |
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Criteria 3 |
Level III Max Points Points: 5 |
Level II Max Points Points: |
Level I Max Points Points: |
Not Present 0 Points |
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Providing non-pharmacologic interventions |
· Five or more non-pharmacologic interventions are provided |
· Three or four non-pharmacologic interventions are noted |
One or two non-pharmacologic interventions |
· Does not meet the criteria |
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Criteria 4 |
Level III Max Points Points: 10 |
Level II Max Points Points: 7 |
Level I Max Points Points: 0 |
Not Present 0 Points |
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Writing a communication plan |
· A communication plan which includes principles of therapeutic communication is developed |
· A communication plan that does not include principles of therapeutic communication is developed |
· Does not meet the criteria |
· Does not meet the criteria |
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Criteria 5 |
Level III Max Points Points: 10 |
Level II Max Points Points: 7 |
Level I Max Points Points: 4 |
Not Present 0 Points |
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Community Resources |
· Three or more local community resources are provided |
· Two local community resources are provided |
· One local community resource is provided or: · Resources are provided but they are not local to the community |
· Does not meet the criteria |
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Criteria 6 |
Level III Max Points Points: 10 |
Level II Max Points Points: 8 |
Level I Max Points Points: 6 |
Not Present 0 Points |
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College-level academic writing |
· Professional, peer-reviewed, advanced practice references are used · Grammar and mechanics of writing demonstrate graduate level work · Adheres to page number requirements |
· The majority of references used are professional, peer-reviewed and advanced practice · Errors in grammar or mechanics of writing are present but do not interfere with readability · Adheres to page number requirements |
· The majority of references used are professional, peer-reviewed and advanced practice · Errors in grammar or mechanics of writing are present but do not interfere with readability · Does not adhere to page number requirements |
· Does not meet the criteria |
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Maximum Total Points |
55 |
44 |
33 |
0 |
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Minimum Total Points |
45 points minimum |
34 points minimum |
1 point minimum |
0 |
