WEEK 5

This paper will have three parts addressing two important pieces of legislation related to the right of individuals to make health care decisions for themselves.

Part I

The Advance Health Care Directive 

Locate a copy of an advanced directive (AD) that complies with the laws of the state in which you work. The organization in which you work should have a copy of an advance directive that is given to patients. If not, download your state's Advance Directives here 

http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3289.Links to an external site.

Complete the advance directive for yourself.  
Do not turn in your AD with your paper. The AD is for your personal use.

In your paper, Part I:

1. Identify where you obtained the AD and explain its compliance with state law.

2. Conduct research (1-2 sources) to learn more about the AD in your state and explain how it works.   

3. Discuss how easy or difficult it was to complete the AD. Your comments should be specific and both objective and
 subjective. For example, when you state your personal feelings, you must relate them to the literature (textbook and research) that discusses this process and the difficulties that many people face when completing an advance directive.

(Cite/ reference any sources you use to explore these questions, including your texts.)

Part II

Physician Orders for Life-Sustaining Treatment (POLST) Form

1. What is a 

Physician Orders for Life-Sustaining Treatment (POLST) formLinks to an external site.
?

POLST: Portable medical orders for seriously ill or frail individuals

2. When should this form be completed?

3. Who can complete the form?

4. Who needs to sign the form to make it a legal document?

(Cite/reference any sources you use to explore these questions, including your texts.)

Part III

Tie the two first sections together by writing a summary and conclusion.

This section should address:

1. the differences between an Advance Health Care Directive and the POLST,

2. the RN's important role in assuring the patient's right to autonomy in choosing the healthcare interventions the patient does or does not want.

____________________________________________

Use current APA Style.

The paper should be between 3-5 pages in length excluding the title and reference page(s). 

Cite and reference the course text and at least two (2) additional appropriate professional sources.   

NURS_521_DE – Feild Activity Paper

NURS_521_DE – Feild Activity Paper
Criteria	Ratings	Pts
This criterion is linked to a Learning OutcomeContent	50 to >43.5 pts Meets Expectations Content is clear, thorough, and organized effectively. Main points are well supported. Meets all of the criteria of the written assignment. 43.5 to >37.5 pts Approaches Expectations Content is somewhat clear, thorough, and organized effectively. Some points are well supported. Meets most of the criteria of the written assignment. 37.5 to >29.5 pts Below Expectations Content is generally unclear, not thorough, and organized ineffectively. Main points are not well supported. Meets only a few of the criteria of the written assignment. 29.5 to >0 pts Does Not Meet Expectations Content is disconnected, unorganized, and does not meet the criteria of the written assignment.	50 pts
This criterion is linked to a Learning OutcomeClarity and Coherence	50 to >43.5 pts Meets Expectations Writing flows smoothly from one idea to another. Writer has taken pains to assist the reader in following the logic of the ideas expressed. 43.5 to >37.5 pts Approaches Expectations Sentences are mostly structured to communicate ideas clearly. Transitions between paragraphs make the writer’s points easy to follow. 37.5 to >29.5 pts Below Expectations Sentence structure and word choice sometimes interfere with clarity of content and distract the reader. 29.5 to >0 pts Does Not Meet Expectations Poor sentence structure, sentences do not make sense; no clarity evident in the paper.	50 pts
This criterion is linked to a Learning OutcomeReferences and Citations Within the Body of the Paper	12.5 to >10.88 pts Meets Expectations The required number of scholarly references is used and cited skillfully throughout the paper. 10.88 to >9.38 pts Approaches Expectations The required number of scholarly references is used but some may not be cited accurately or skillfully throughout the paper. 9.38 to >7.38 pts Below Expectations The required number of scholarly references is not used and most are not cited accurately or skillfully throughout the paper. 7.38 to >0 pts Does Not Meet Expectations References or citations are not included in the body of the paper and writing indicates none were used.	12.5 pts
This criterion is linked to a Learning OutcomeMechanics and APA	12.5 to >10.88 pts Meets Expectations The assignment consistently follows current APA format and is free from errors in formatting, citation, and references. No grammatical, spelling, or punctuation errors. All sources are cited and referenced correctly. 10.88 to >9.38 pts Approaches Expectations The assignment consistently follows current APA format with only isolated and inconsistent mistakes and/or has a few grammatical, spelling, or punctuation errors. Most sources are cited and referenced correctly. 9.38 to >7.38 pts Below Expectations The assignment generally follows current APA format with several mistakes and grammatical, spelling, or punctuation errors. Most sources are cited and referenced incorrectly. 7.38 to >0 pts Does Not Meet Expectations The assignment does not follow current APA format and/or has many grammatical, spelling, or punctuation errors. Sources are missing.	12.5 pts
Total Points: 125

 

After studying the course materials located on Module 5: Lecture Materials & Resources page, answer the following:

1. Name some very important organs that are not vital organs.
2. List the functional description of all the normal vital organs, including today’s exceptions.
3. Is it possible to live without a vital organ? Why? Example?
4. Distinction between assisting or substituting vital organs. Bioethical analysis.
5. Do the following practices assist or substitute the vital organ? Why?
   • Dialysis
   • Respirator
   • Ventilator
   • Tracheotomy
   • CPR
6. Read and summarize ERD PART FIVE Introduction.
7. Unconscious state: Definition.
8. Clinical definitions of different states of unconsciousness: Compare and contrast
9. Benefit vs Burden: bioethical analysis.

Submission Instructions:
 is to be clear and concise and students will lose points for improper grammar, punctuation, and misspelling.

• If references are used, please cite properly according to the current APA style

With the consolidation of hospitals, clinics, and healthcare providers across the United States, leadership is delivered in many forms.  The importance of understanding and mastering online leadership (often referred to as virtual or E-leadership) is imperative.

How would you establish relationships with your team on-ground and from a distance? How would you create presence in a virtual team? Provide examples.

Expectations

Initial Post:

• Due: Thursday, 11:59 pm PT
• Length: 150 – 250 Words

Peer Responses:

Advanced Psychopharmacology and Health Promotion

Unit 9 peer response. ADHD Medications. 800W. APA. 4 references due 10-30-23.

Instructions:

Please read and respond to at least two of your peers' initial postings. You may want to consider the following questions in your responses to your peers:

· Compare and contrast your initial posting with those of your peers.  

· How are they similar or how are they different?

· What information can you add that would help support the responses of your peers?

· Ask your peers a question for clarification about their post.

· What most interests you about their responses? 

Please be sure to validate your opinions and ideas with citations and references in APA format.

Mihaela

Unit 9 – ADHD Medications

1.
What screening tools can be used to affirm your initial diagnosis that Mr. Deliver meets the criteria for ADHD?

One commonly used screening tool is the Adult ADHD Self-Report Scale (ASRS). The ASRS consists of a series of questions that evaluate both inattentive and hyperactive-impulsive symptoms (Anbarasan et al., 2020). Another useful screening tool is the Conners' Adult ADHD Rating Scales (CAARS), which assesses various domains affected by ADHD, such as attention problems, hyperactivity/impulsivity, and executive functioning (Smyth et al., 2019).

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?

Once it is confirmed through further assessment that Mr. Deliver meets the criteria for ADHD, inattentive type, the current recommendation for pharmacological treatment would typically involve stimulant medications such as methylphenidate or amphetamine derivatives. These medications have consistently shown efficacy in improving attention, reducing impulsivity, and enhancing executive functions in adults with ADHD (Farhat et al., 2022). Non-stimulant options like atomoxetine or viloxazine (norepinephrine modulator) may also be considered if there are contraindications or intolerance to stimulants (Mechler et al., 2022). However, considering Mr. Deliver's concerns about stigma and psychotropic medications' risks, it may be worth discussing non-pharmacological interventions as well. Cognitive-behavioral therapy (CBT) has demonstrated efficacy in managing symptoms of adult ADHD. CBT can help Mr. Deliver develop strategies to improve organization skills, time management, and enhance his ability to focus on tasks (Young et al., 2020).

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?

In the case of Thomas, a 13-year-old boy diagnosed with ADHD hyperactive type who is not currently taking any medications, the most probable treatment approach would involve the use of stimulant medications. According to the American Academy of Pediatrics (AAP), stimulant medications like methylphenidate are recommended as first-line treatment options for children and adolescents with ADHD, as they have been shown effective in reducing symptoms and improving functioning (Shrestha et al., 2020). However it is important to monitor growth and potential side effects in pediatric patients (Vertessen et al., 2023).

References

Anbarasan, D., Kitchin, M., & Adler, L. A. (2020). Screening for adult adhd. 
Current Psychiatry Reports, 
22(12). 

https://doi.org/10.1007/s11920-020-01194-9Links to an external site.

Farhat, L. C., Flores, J. M., Behling, E., Avila-Quintero, V. J., Lombroso, A., Cortese, S., Polanczyk, G. V., & Bloch, M. H. (2022). The effects of stimulant dose and dosing strategy on treatment outcomes in attention-deficit/hyperactivity disorder in children and adolescents: A meta-analysis. 
Molecular Psychiatry, 
27(3), 1562–1572. 

https://doi.org/10.1038/s41380-021-01391-9Links to an external site.

Mechler, K., Banaschewski, T., Hohmann, S., & Häge, A. (2022). Evidence-based pharmacological treatment options for adhd in children and adolescents. 
Pharmacology & Therapeutics, 
230, 107940. 

https://doi.org/10.1016/j.pharmthera.2021.107940Links to an external site.

Shrestha, M., Lautenschleger, J., & Soares, N. (2020). Non-pharmacologic management of attention-deficit/hyperactivity disorder in children and adolescents: A review. 
Translational Pediatrics, 
9(S1), S114–S124. 

https://doi.org/10.21037/tp.2019.10.01Links to an external site.

Smyth, A. C., & Meier, S. T. (2016). Evaluating the psychometric properties of the conners adult adhd rating scales. 
Journal of Attention Disorders, 
23(10), 1111–1118. 

https://doi.org/10.1177/1087054715624230Links to an external site.

Vertessen, K., Luman, M., Swanson, J. M., Bottelier, M., Stoffelsen, R., Bet, P., Wisse, A., Twisk, J. R., & Oosterlaan, J. (2023). Methylphenidate dose–response in children with adhd: Evidence from a double-blind, randomized placebo-controlled titration trial. 
European Child & Adolescent Psychiatry. 

https://doi.org/10.1007/s00787-023-02176-xLinks to an external site.

Young, Z., Moghaddam, N., & Tickle, A. (2016). The efficacy of cognitive behavioral therapy for adults with adhd: A systematic review and meta-analysis of randomized controlled trials. 
Journal of Attention Disorders, 
24(6), 875–888. 

https://doi.org/10.1177/1087054716664413Links to an external site.

Ruth

Unit 9: Initial Discussion ADHD Medications

What screening tools can be used to affirm your initial diagnosis that Mr. Deliver meets the criteria for ADHD?

Attention-Deficit/Hyperactivity Disorder (ADHD) is the most common neuropsychiatric disorder of childhood, with impairing symptoms persisting into adulthood in approximately 70% of cases. Several screening tools are available to help providers identify and diagnose ADHD. The World Health Organization (WHO) Adult ADHD Self-Report Scale Part A is the most commonly used screening tool for ADHD cases in adults. The tool is available in national and international ADHD guidelines.  The screening tool contains six questions that cover inattentive and hyperactive-impulsive symptoms. It also includes a threshold of four or more, which is used for probable ADHD.  The score is calculated according to the number of questions that meet the criteria: sometimes endorsing/often/very often for questions 1–3 and endorsing usually/very often for questions 4–6. However, this screening, even if the patient is positive, may not have an active diagnosis of ADHD; further evaluation is required to ensure symptoms are related to ADHD diagnosis (Chamberlain et al., 2021). 

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?

According to his age and diagnosis, the current recommendation for this patient will be amphetamine 12.5 mg daily. Recommend that the patient start CBT and encourage exercise. A study showed that ADHD drugs are more effective and tolerated by children and adolescents than adults; the reason for this discrepancy is unknown. Amphetamines, methylphenidate, atomoxetine, and modafinil cause weight loss in children, adolescents, and adults. Amphetamines and atomoxetine increased blood pressure in children and adolescents, and methylphenidate increased blood pressure in adults. Methylphenidate showed better symptom control with the most minor side effects for children and adolescents, and amphetamines produced the best results for adults (Gupta, 2018). 

Reference:

Chamberlain, S. R., Cortese, S., & Grant, J. E. (2021). Screening for adult ADHD using brief rating tools: What can we conclude from a positive screen? Some caveats. 
Comprehensive Psychiatry, 
106, 152224. https://doi.org/10.1016/j.comppsych.2021.152224

Gupta, S. (2018). Best First-Line ADHD Medications for Children, Adults: Study Results. 
Attitude. https://www.additudemag.com/adhd-drugs-methylphenidate-vs-amphetamine-treatment/

Mayo Clinic. (2023). Amphetamine (Oral Route). 

https://www.mayoclinic.org/drugs-supplements/amphetamine-oral-route/proper-use/drg-20150941Links to an external site.