Richard is a 62-year-old single man who says that his substance dependence and his bipolar disorder both emerged in his late teens.  He says that he started to drink to “feel better” when his episodes of depression made it hard for him to interact with his peers.  He also states that alcohol and cocaine are a natural part of his manic episodes.  He also notes that coming off the cocaine and binge drinking contribute to low mood, but he has not responded well to referrals to AA and past inpatient stays have led to only temporary abstinence.  Yet, Richard is now trying to forge a closer relationship with his adult children, and he says he is especially motivated to get a better handle on both his bipolar disorder and his substance use.  He has been more compliant with his mood stabilizing and antidepressant medication, and his psychiatric provider would like his dual diagnoses addressed with psychotherapy. What diagnostic information would be most critical to collect in the first visit? Which diagnostic measures are recommended by the US clinical guidelines for the treatment of this patient’s family problem? Which evidence based harm reduction strategies would you recommend to treat this patient? Identify your city. Then refer this patient to three agencies near you that would support positive health outcomes for this patient.  (These agencies must not have been used in past discussion posts). What was your rationale for choosing these three agencies?

Case Study: Bobby, a 13-year-old male, was hospitalized following a perforated appendix that required surgery. Bobby has an open wound requiring dressing changes twice daily. He is currently on contact precautions for a methicillin resistant staphylococcus aureus (MRSA) infection. The estimated date of discharge is five-to-ten-days post-op and will include long-term antibiotics and wound care.

The nurse notes on the assessment- Previously Bobby was talkative and related his enthusiasm for school and upcoming science competitions. However, today, he was withdrawn and stated, “I’m just tired”.

• What are the impacts when an adolescent is separated from their peer group?
• How should the nurse arrange for visitation and playtime during Bobby’s hospitalization and isolation?
• What concerns with body image would the nurse anticipate?
• Why is “play” an important part of childhood?

As an advanced practice nurse, you will likely experience patient encounters with complex comorbidities. For example, consider a female patient who is pregnant who also presents with hypertension, diabetes, and has a recent tuberculosis infection. How might the underlying pathophysiology of these conditions affect the pharmacotherapeutics you might recommend to help address your patient’s health needs? What education strategies might you recommend for ensuring positive patient health outcomes?

For this Discussion, you will be assigned a patient case study and will consider how to address the patient’s current drug therapy plans. You will then suggest recommendations on how to revise these drug therapy plans to ensure effective, safe, and quality patient care for positive patient health outcomes.

Post a brief description of your patient’s health needs from the patient case study you assigned. Be specific. Then, explain the type of treatment regimen you would recommend for treating your patient, including the choice or pharmacotherapeutics you would recommend and explain why. Be sure to justify your response. Explain a patient education strategy you might recommend for assisting your patient with the management of their health needs. Be specific and provide examples.

To Prepare:

• Review the Resources for this module and reflect on the different health needs and body systems presented.
• Your Instructor will assign you a complex case study to focus on for this Discussion.
• Consider how you will practice critical decision making for prescribing appropriate drugs and treatment to address the complex patient health needs in the patient case study you selected.

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Private, nongovernmental healthcare organizations may be either for profit (FP) or not for profit (NFP).

• Discuss the difference between not-for-profit and for-profit organizations.
• What happens if an NFP organization makes a profit?
• What are the advantages and disadvantages of each type of organization?
• Describe two specific examples of how risk management has influenced nursing documentation.

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.