Each student will individually write a paper over a relevant maternal-infant nursing topic that is addressed by a Healthy People 2030 objective. Healthy People 2030 objectives are available at 

https://health.gov/healthypeople/objectives-and-data/browse-objectives
 .The concept chosen must be appropriate and relevant to maternal-infant nursing. The purpose of this assignment is three-fold:  to thoroughly research a topic of interest relating to maternal-infant nursing; to synthesize the information found; and to then draw inferences about the concept. 

This paper is expected to be short, succinct, focused, and developed on the chosen topic. The student can adequately address the criteria in 
3-5 pages, excluding the title and reference pages. All papers must be typed and in APA 7 format.  I encourage you to meet with Megan Hasler, the School of Nursing's librarian if needed for APA guidance or search questions, etc. 

Students are strongly encouraged to send papers to the Writing Center prior to submission.
  References must include a minimum of three (3) journal articles, and you may also include an appropriate medical/nursing dictionary or encyclopedia, the course textbook, the state department of health website for vital statistics, the CDC, etc. See evaluation criteria below for specific guidelines, and PDF attachment for a template.  
Due by Sunday, November 5, at 23:59pm. In the box below you will find examples of topics that have an associated Healthy People 2030 objective. Topic must be approved.

NO MORE THAN ONE QUOTE IN THE PAPER!

Maternal-Infant Concept Paper Evaluation Rubric

CRITERION	POINTS POSSIBLE
Topic is defined adequately	5
How is evidence-based practice being utilized regarding the topic chosen?	5
How does this relate to nursing practice? What are some nursing considerations?	10
Choose and identify one Healthy People 2030 objective related to your chosen topic and research how your state/region/county/city compares to the goal.	10
What effect does this topic have on the client?  What cultural barriers may exist to complicate care? Other cultural considerations?	10
APA Style/Format correct (references, citations, title page, etc.)	5
Grammar (spelling, punctuation) and Content (clear, appropriate word usage, complete sentences, paragraphs, etc.)	5
TOTAL	50

Aron Ralston, an avid outdoorsman, was hiking in a narrow canyon in Southern Utah when he upset a large boulder that rolled down the canyon after him. As it fell, the boulder relodged itself between the narrow canyon walls and in the process pinned Aron’s right wrist between the boulder and the canyon wall. Aron was alone and was unable to free himself from the situation. After being trapped for five days, with no help arriving, Aron eventually made the decision to free himself by breaking the bones in his forearm with the weight of his body and amputating his hand with a dull pocketknife. After freeing himself, he hiked an additional seven miles before the search and rescue crews found him. His arm required further surgery to repair it. After the surgery, the nurses would ask Aron, “On a scale of 0-10, what is your pain level with 0 being no pain and 10 being the most pain you have ever experienced?”. Aron would reply, “0.25”. When asked about giving such an odd answer, he stated that even though he was in pain after the surgery, it was minimal compared to the pain he experienced when he cut through his ulnar nerve to free himself from being trapped by the boulder.

1. As you reflect on this story, how does it help you understand that pain is a subjective experience for your client? What types of questions will you ask your client to adequately assess their pain level?

2. Why is it important to understand that not all clients experience pain the same?

3. What objective data may be noted when a client is in pain?

4. How might pain be manifested in vital sign measurements?

5. What effects might chronic pain have on the general health of a client?

THE ASSIGNMENT: 5 PAGES

Examine 
Case Study: A Puerto Rican Woman With Comorbid Addiction. 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, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction 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.

BACKGROUND

Mrs. Maria Perez is a 53 year old Puerto Rican female who presents today due to a rather “embarrassing problem.”

SUBJECTIVE

Mrs. Perez admits that she has had “problems” with alcohol since her father died in her late teens. She reports that she has struggled with alcohol since her 20’s and has been involved with Alcoholics Anonymous “on and off” for the past 25 years. She states that for the past 2 years, she has been having more and more difficulty maintaining her sobriety since the opening of the new “Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during its grand opening at which point she was “hooked.” She states that she gets “such a high” when she is gambling. While gambling, she “enjoys a drink or two” to help calm her during high-stakes games. She states that this often gives way to more drinking and more reckless gambling. She also reports that her cigarette smoking has increased over the past 2 years and she is concerned about the negative effects of the cigarette smoking on her health.

She states that she attempts to abstain from drinking but she gets such a “high” from the act of gambling that she needs a few drinks to “even out.” She also notices that when she drinks, she doesn’t smoke “as much,” but she enjoys smoking when she is playing at the slot machines. She also reports that she has gained weight from drinking so much. She currently weights 122 lbs., which represents a 7 lb. weight gain from her usual 115 lb. weight.

Mrs. Perez is quite concerned today because she borrowed over $50,000 from her retirement account to pay off her gambling debts, and her husband does not know.

MENTAL STATUS EXAM

The client is a 53 year old Puerto Rican female who is alert and oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. Her speech is clear, coherent, and goal directed. Her eye contact is somewhat avoidant during the clinical interview. When you make eye contact with her, she looks away or looks down. She demonstrates no noteworthy mannerisms, gestures, or tics. Her self-reported mood is “sad.” Affect is appropriate to content of conversation and self-reported mood. She denies visual or auditory hallucinations, and no delusional or paranoid thought processes are readily appreciated. Insight and judgment are grossly intact; however, impulse control is impaired. She is currently denying suicidal or homicidal ideation.

Diagnosis: Gambling disorder, alcohol use disorder

Decision Point One

Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks

RESULTS OF DECISION POINT ONE

·
 Client returns to clinic in four weeks

·
 Mrs. Perez says she feels “wonderful” as she has not “touched a drop” of alcohol since receiving the injection

·
 Client reports that she has not been going to the casino, as frequently, but when she does go she “drops a bundle” (meaning, spends a lot of money gambling)

·
 Client She is also still smoking, which has her concerned. She is also reporting some problems with anxiety, which also has her concerned

Decision Point Two

Add on Valium (diazepam) 5 mg orally TID/PRN/anxiety

RESULTS OF DECISION POINT TWO

·
 Client returns to clinic in four weeks

·
 Mrs. Perez reports that when she first received the Valium, it helped her tremendously. She states “I was like a new person. This is a miracle drug!” However, she reports that she has trouble “waiting” between drug administration times and sometimes takes her Valium early

·
 She is asking today for an increase the Valium dose or frequency

Decision Point Three

Continue current dose of Vivitrol, increase Valium to 10 mg orally TID/PRN/anxiety. Refer to counseling for her ongoing gambling issue

Guidance to Student

Anxiety is a common side effect of Vivitrol. Mrs. Perez reports that she is doing well with this medication, and like other side effects, the anxiety associated with this medication may be transient. The psychiatric mental health nurse practitioner should never initiate benzodiazepines in a client who already has issues with alcohol, or other substance dependencies. Additionally, benzodiazepines are not to be used long-term. Problems associated with long-term benzodiazepine use include the need to increase the dose in order to achieve the same therapeutic effect. This is what we are seeing in Mrs. Perez’s case.

The most appropriate course of action in this case would be to continue the current dose of Vivitrol, while decreasing the Valium with the goal of discontinuation of the drug within the next two weeks. At that point, you would need to evaluate whether or not the side effect of anxiety associated with Vivitrol persists.

Increasing the dose of Valium would not be appropriate, neither would maintaining her on the current dose of Valium. Additionally, the client should be referred for counseling to help with her gambling addiction, as there are no FDA approved medications gambling disorder.

Medication should never be added treat side effect of another medication, unless that side effect is known to be transient (for instance, benzodiazepines are sometimes prescribed to overcome the initial problem of “activation” associated with initiation of SSRI, or SNRI therapy). However, in a client with multiple addictive disorders, benzodiazepines should never be used (unless they are only being used for a limited duration of therapy such as acute alcohol detoxification to prevent seizures).

Additionally, it should be noted that Mrs. Perez continues to engage in problematic gambling, at considerable personal financial cost. Mrs. Perez needs to be referred to a counselor who specializes in the treatment of gambling disorder, and should also be encouraged to establish herself with a local chapter of gamblers anonymous.

You need to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions, and to enhance her overall health.

 

 Covid-19 and the Need for Health Care Reform (King, 2020)  NEJM . 

Identify 1 flaw in the US healthcare system that was made evident during the pandemic, and 1 innovation duirng the pandemic that improved health care.

Please read the article above and answer the question in not more than two pages.

Clinical Decision-Making NU671. Unit 2New Patient Encounter. Due 11-8-2. 800w.4 references.

Initial Response

Instructions:

Consider the following questions in your initial discussion post:

· Review the SOAP note accessed through this link.  For purposes of the assignment, the patient is a ‘new patient’ in the practice.

·

New Patient SOAP Note

Download New Patient SOAP Note
Download New Patient SOAP Note

Initial Post

Use your lecture materials to determine what CPT E&M Code to utilize for this ‘new patient’ encounter.

You may choose to assign the code based on the anticipated/guestimate amount of time the provider would spend with the patient in the encounter or you may choose to utilize the Medical Decision Making (MDM) approach. If you choose the MDM include the following information in your discussion:

1. the level of history taking achieved – identify the history elements present

2. the type of exam performed – identify the number of systems and bulleted points in the note

3. the level of medical complexity encompassed – include # of points for a) diagnoses/management options, b) amount/complexity of data reviewed, and c) level of risk for complications, morbidity, mortality

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

SOAP notes provided by the instructor for this assignment

Chief Complaint:

“I don’t know how much longer I can go on like this. I’ve been down in the dumps for years and it isn’t getting any better.”

History of Present Illness:

75-year-old white male present to clinic with above complaint. Lost his first, the “love of his life” wife 19 years ago. Remarried 2 years after her death and states he probably married again too soon reporting his current wife is difficult. He describes an instance, when he was at work, the second wife would not let his son, daughter-in-law and new grandbaby into his house to visit until he got home from work. The second wife also insisted that he no longer visit with his deceased wife’s family telling him ‘when you married me, you divorced that whole family’. Conversations with his wife about his concerns resulted in only short-term changes in her approaches and behaviors. Now his wife insists they sell the house he has lived in for 46 years. He reports that his memory and ability to make simple decisions have been deteriorating significantly over the last several months. His wife suggested he probably has Alzheimer’s and should go see his primary care provider about his memory issues. He reports that he engages with modest exercise daily, eats well but is waking up numerous times at night and is usually “up for good” by 5am. He blames his disrupted sleep pattern on his feeling of fatigue starting around 9am. He reports all these circumstances as contributing to his increased depression and his desire to “give up the fight”.

PMH:

reports usual childhood illnesses inclusive of measles, mumps and chickenpox

traumatic injury, likely secondary to ‘blast’ effect, sustained during the bombing of Pearl Harbor where he was stationed as a cook; he suffered a hearing loss for six months after the bombing and was diagnosed at 54 with a rare eyes disorder resulting in poor peripheral vision that is thought to be secondary to this trauma

Family Hx:

Father died at 67 secondary to colon cancer; mother died at 24 secondary to influenza during an epidemic (he was 2 years old at that time)

No know family history of depression or other mental illness

Social Hx:

HS graduate, married to HS sweetheart for 27 years then widowed

Current marriage of 17 years

Retired after 25-year banking career

Attends Catholic mass regularly

Drinks 1-2 beers several times a week, denies episode of intoxication; never smoked or used illicit drugs

Drinks hot tea, reporting coffee causes too much GI distress

Never driven a motor vehicle secondary to poor peripheral vision

ROS:

Denies HA, body aches, dizziness, fainting spells, tinnitus, ear pain, ear discharge, nasal congestion, diarrhea, constipation, change in appetite skin abnormalities, or genitourinary symptoms

Denies periods of extreme irritability or elation associated with periods of sadness; denies feeling more depressed during the winter months than other seasons

Reports fatigued most of the time, often feels stiffness in his neck and shoulders

Denies homicidal ideations, hallucinations, paranoia or delusions

Reports suicidal thoughts, has a 22-caliber rifle at home and has considered using to end his life

SIGECAPS:

Reports – poor sleep maintenance, loss of pleasure, he feels as though he remarried too soon, he is experiencing fatigue, he is experiencing memory disturbances, eating well, no problems maintaining exercise regimen, is having suicidal ideations

Medications:

No routine medications

Allergies:

None

Physical Examination:

Constitutional – BP 118/73, P 83, RR 16, T 98.8, Ht 71 in, Wt 174 lbs, BMI 24

Integument – skin, hair and nails unremarkable

HEENT – PERRLA, EOMs intact, nares patent without discharge noted, TMs gray and shiny bilateral, numerous silver amalgams noted

Neck – supple without adenopathy, no thyromegaly

Lungs – CTA

Heart – RRR without murmur/gallop

Abdomen – soft, non-distended, active bowel sounds, non-tender, no organomegaly

Genitalia/Rectum – deferred

Musculoskeletal – no gross abnormalities or major limitations of ROM noted

Neurologic – CNs II-XII intact, finger-to-nose test negative, DTRs 2+ and equal bilateral, sensory capacity intact upper and lower extremities intact bilateral

Mental status – PHQ 9 score is 19

Diagnostics – Na 138 meq/L, K 4.2 meq/L, Cl 102 meq/L, HCO3 27 meq/L, Bun 11 mg/dL, Cr 0.9 mg/dL, fasting Glu 106 mg/dL, Ca 9.5 mg/dL, Mg 1.8 mg/dL, AST 34 IU/L, ALT 42 IU/L, GGT 38 IU/L, Alb 4.4 g/dL,

TSH 2.8, Vit B12 98 pg/mL, Folic acid 333 ng/mL, PSA 4.9 ng/mL, Hgb 14.3 g/dL, HCT 41.4 %

Urine dipstick – 5.8 pH, SG 1.016, all other parameters negative

Assessment:

1. F32.1 Major depressive disorder, single episode, moderate

2. R45.851 Suicidal ideations/thoughts

3. R73.03 Prediabetes

4. E53.9 Vitamin B deficiency

Plan:

1. Major depressive disorder

a. Diagnostic – none

b. Therapeutic – citalopram 20mg take 1 by mouth daily dispense #30 with 2 refills

c. Educational – effects of citalopram may not be fully evident for up to 3 or 4 weeks; if you note fatigue exacerbated from the citalopram take it at bedtime; RTC in 1 month for follow up

d. Consultation/Collaboration – none

2. Suicidal ideations/thoughts

a. Diagnostic – none

b. Therapeutic – same as diagnosis #1

c. Educational – same as diagnosis #1; educate on the potential negative impact of his current intake of beer – educate on how to safely reduce this consumption and to avoid abrupt cessation; educate on need to remove the 22-caliber rifle from his home; provide information on suicide hot lines

d. Consultation/Collaboration – referral for counseling

3. Prediabetes

a. Diagnostic – none

b. Therapeutic – none

c. Educational – nutrition education aimed at making dietary lifestyle choices of low glycemic index foods (<55 GI) that aid in development and maintenance of stable insulin and glucose levels

d. Consultation/Collaboration – none

4. Vitamin B deficiency

a. Diagnostic – none

b. Therapeutic – hydroxocobalamin 1000 mcg IM during this OV; start on 2mg oral B-12 daily; recheck Vitamin B-12 level in 2 to 3 months

c. Educational – nutrition education on foods high in B-12

d. Consultation/Collaboration – none

Sample assignments

New Patient Encounter

SOAP Note Review

This type of note is used in medical or psychological sectors by professionals while

working with clients or patients. In the note provided, the patient presents a persistent rash as the

chief complaint .The rash was first in the chest but has recently spread to the arms, and it is not

itchy and painful. He has had Hypoglycemia in 2010 and an allergy to NKDA. He has no

frequent medications and occasionally uses OTC NSAIDS if he has minor pain .The new patient

is married and smokes a packet per day, six-pack beer daily, and denies any chemical drugs use.

His history indicates his father and mother, are deceased due to cardiac issues. His paternal

grandmother had Cardiac died at 78, and his grandfather also had a Stroke. His maternal

grandmother had diabetes type 2 and is 75. The review of systems reveals that has no issues with

the targeted aspects.

His physical examination indicates a weight of 197, height 74.5 in, BMI 25.05 blood

pressure 130/86, and temperature at 98.9 PR 70 RR 18. The patient is alert and has

hyperpigmented muscles on both arms. The head, eyes, ears, nose, and throat (HEENT)

examination show normality in every aspect .The chest cavity, GU, lungs, abdomen, and other

diagnostics do not indicate any abnormalities. He is diagnosed with Tinea Versicolor at B36.0

and alcohol abuse at F10.10. His treatment plan involves Tinea versicolor Therapeutics in which

he is to apply Ketoconazole 2% external shampoo on the affected skin for three days. The patient

is enlightened about using the medication as prescribed and asked to report if the symptoms

persist or worsen. The are no diagnostics for alcohol abuse, but he was educated on the risks of

taking alcohol while on medication and its effects on the liver and advised not to quit cold

Turkey.

Selection of CPT E&M Code

The CPT E&M code to utilize in this scenario is 99201 since the encounter is with a new

patient and is likely to take 45 minutes (Babac, et al., 2019).This code is best since it covers the

entire patient history and examination and moderates the medical decision-making process

(Cohen, et al., 2020).Various diagnoses will be undertaken, and management options and the

complexity of data involved is moderate, and the risk of complications is medium.

This study source was downloaded by 100000769192234 from CourseHero.com on 11-07-2023 10:51:09 GMT -06:00

https://www

.

References

Babac, A., Von Friedrichs, V., Litzkendorf, S., Zeidler, J., Damm, K., & Graf von der

Schulenburg, J. (2019). Integrating patient perspectives in medical decision-making: A

qualitative interview study examining potentials within the rare disease information

exchange process in practice. BMC Medical Informatics and Decision

Making, 19(1). https://doi.org/10.1186/s12911-019-0911-z

Cohen, B. H., Busis, N. A., Villanueva, R., & Ciccarelli, L. (2020). Evaluation and Management

Codes for Outpatient Neurology Services in 2021: Changes to 99202-99215. Continuum:

Lifelong Learning in Neurology, 26(6), 1686-1697.

This study source was downloaded by 100000769192234 from CourseHero.com on 11-07-2023 10:51:09 GMT -06:00

https://www.coursehero.com/file/104575109/NEW-PATIENT-ENCOUNTERdocx/

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New Patient Encounter

The comprehensive assessment and examination of patients with mental disorders differ

greatly from the comprehensive assessment and examination of patients who are suffering from

physical disorders. Mentally ill patients require extensive evaluation, detection of severity of

symptoms, in-depth analysis of thought process, ideologies and perceptions. The implementation

of tools, interview questions and evaluation of results are time consuming. All these components

demand adequate time investment of psychiatrist and if the patient is new then the analysis and

evaluation takes more time as compared to those patients who came with established complains.

Considering these facts, the CPT E&M code for this new patient is 99205. The provided reading

resources for this module also indicated that the total time spent with a new patient should be 60

to 74+ and therefore the designated code should be 99205. I have not selected other codes

associated with new patient encounter (that is, 99202, 99203 and 99204) because the presented

case study is a complicated case that requires evaluation of depressive symptoms, their severity

and severity of suicidal thoughts and ideation (Melnyk, 2020).

The patient also reported that he desires to “give up the fight” which indicates that he

possesses thought processes related to suicides as he mentioned the presence of 22-caliber rifle at

home and shared his feelings to end his life by using that rifle. Furthermore, patient is also

suffering from physical disorders like prediabetes, sleep issues, fatigue and loss of appetite. All

of these symptoms indicate that the patient requires extensive evaluation and monitoring.

Although, he is a new patient but the follow visits would also require the implementation of code

99204 in order to continuously monitor improvement in symptoms and progress of disorder and

treatment. If the follow up visits for this patient requires implementation of 99204 code then it is

mandatory to implement the code of 99205 to his first visit (Modrek, Hamad & Cullen, 2015).
References

Melnyk, B. M. (2020). Reducing healthcare costs for mental health hospitalizations with the

evidence-based COPE program for child and adolescent depression and anxiety: A cost

analysis.
Journal of Pediatric Health Care,
34(2), 117-121.

Modrek, S., Hamad, R., & Cullen, M. R. (2015). Psychological well-being during the great

recession: Changes in mental health care utilization in an occupational cohort.
American

Journal of Public Health,
105(2), 304-310.

Response 1

Hello Brittney,

Each year, in the United States, healthcare insurers process over 5 billion claims for

payment. To ensure that healthcare data are captured accurately and consistently and that health

claims are processed properly for Medicare, Medicaid, and other health programs, a standardized

coding system for medical services and procedures is essential. The Current Procedural

Terminology (CPT) system, developed by the American Medical Association (AMA), is used for

just these purposes. The AMA system provides a standard language and numerical coding

methodology to accurately communicate across many stakeholders, including patients, the

medical, surgical, diagnostic, and therapeutic services provided. The CPT descriptive

terminology and associated code numbers provide the most widely accepted medical

nomenclature used to report medical procedures and services for processing claims, conducting

research, evaluating healthcare utilization, and developing medical guidelines and other forms of

healthcare documentation (Pelech & Hayford, 2019).

Reference Pelech, D., & Hayford, T. (2019). Medicare advantage and commercial prices for mental health

services.
Health Affairs,
38(2), 262-267.

Response 2

Hello Lorilee,

The Current Procedural Terminology (CPT) code set describes tests, evaluations,

treatments, and other medical procedures used in the spectrum of healthcare. The set contains

over 8,000 codes and is published and updated annually by the American Medical Association. It

was created to track healthcare trends and issues as well to use in the claims submission process.

The codes communicate to payers what procedures should need to be reimbursed for as a

provider. The codes related to mental health (codes 90785-90899) are found in the Psychiatry

section of the CPT code set and cover services provided by medical professionals, such as

psychiatrists, as well as services that can be delivered by non-medical professionals such as

licensed clinical psychologists, licensed professional counselors, licensed marriage and family

therapists, and licensed clinical social workers (Powell, Torous, Firth & Kaufman, 2020).

Reference

Powell, A. C., Torous, J. B., Firth, J., & Kaufman, K. R. (2020). Generating value with mental

health apps.
BJPsych Open,
6(2).