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Presentation

Ch. 15 The Future: Transformation of Nursing Practice through Leadership. Critical Thinking Questions: -What is the nursing professional practice model? Describe one type of model. – Visit YouTube on the internet. Search for “nursing” or “nurses.” What do you find? View one of the selections and critique the image portrayed. Discuss in a team with […]

Duscussion Week Two Epidemiology

Discussion Question When reviewing the goals of Healthy People 2020 (HP2020) on its website, it becomes apparent there are implications of the use of epidemiological data when designing policies and measuring success in achieving public health goals. Evaluate the following overarching HP2020 goals: Attain high-quality, longer lives free of preventable disease, disability, injury, and premature […]

Discussion 4b

Did you know that the United States has a higher rate of infant mortality than Japan (CIA, n.d.)? Or, as Dr. Beilenson states in this week’s media presentation, that “your zip code that you live in makes more difference in your health and well-being than the genetic code that you’re born with?” What causes these […]

Discussion Board Question 4

Post a 260- to 350-word response to the following questions as a New Message into the discussion area under this assignment: How does the Veterans Health Administration’s philosophy of care differ from private health care in regards to rationing health care, discretionary medical procedures, integrated health care of the payor, and plan and provider under […]

DQ 1 Week 5

The theoretical foundations of qualitative and quantitative methods are very different, but many researchers believe both methods should be used in the research study to increase validity and reliability. What advantages or disadvantages do you see in using both types of methods in a nursing study? Support your answer with current evidence-based literature.

Week 7 Assignment 1 Captain of the Ship Obsessive Compulsive Kamp University Nurs 4582: PMHNP Role II Dr. Hohn Doe March 18, 2016 Obsessive Compulsive Disorder (OCD) is represented by a diverse group of symptoms that include intrusive thoughts, rituals, preoccupations, and compulsions (Sadock, Sadock, & Ruiz, 2014). These recurring obsessions or compulsions cause severe distress to the person. An obsession is a recurrent and intrusive thought while a compulsion is a conscious, standardized, recurrent behavior. The purpose of this paper is to explore management strategies of OCD in adult clients. As the PMHNP, I will discuss a case and recommend treatment modalities, medical management, follow-up plan and collaboration in the care of a client with OCD. History of present illness (HPI) and Clinical Impression HPI: K. K. a 22 yo CF referred for a psychiatric evaluation by her PCP. Karen reports a complaint of “I need help, I can’t keep a job because of these rituals I have.” She reports that she cannot maintain a job because of her rituals of checking locks. Karen has recurrent thoughts that she had left the door of her apartment and car unlocked. She reports leaving work several times daily to check the locks on both her car and apartment. Additionally, because she often had the thought that she had not locked the door to the car, it was difficult for her to leave the car or apartment until she had repeatedly checked that it was secured causing her to be late for work. She has been fired several times for tardiness and poor attendance however checking the locks decreases her anxiety about security. Karen denies any medical issues and is not currently taking any medications. She also denies the use of any alcohol, tobacco or illicit drugs. Reports a family history of depression in both maternal and paternal grandmothers. Karen recognizes that she is needs help and is eager to begin treatment. Assessment: A healthy, well-groomed 22yo CF in no acute distress. A, A&Ox4, pleasant and appropriately dressed. Makes good eye contact however mood is depressed with a flat affect; recent and remoter memory are intact. Karen’s thoughts are circumstantial and preoccupied with obsessions and compulsions. Her insight and judgment are fair. Denies SI/HI/AVH. Clinical Impression: Based on the diagnostic criteria in APA (2013), a diagnosis of OCD is made. Psychopharmacology If the patient’s symptoms cause a significant impairment in function or distress, treatment is recommended (Fenske and Petersen, 2015). Based on Karen’s report of losing several jobs because of tardiness and attendance, there is a significant impairment in social and home functionality. Karen also reports that her rituals cause her significant distress. The standard approach is to start treatment with an SSRI or clomipramine and then move to other pharmacological strategies if the SSRI is not effective (Sadock, Sadock, & Ruiz, 2014). I will initiate Prozac 40mg oral daily as it is Food and Drug Administration (FDA) approved for treatment of OCD (Stahl, 2014). I will have the patient return to clinic in week to assess for tolerability and increase to the suggested 80mg oral daily. Higher dosages have often been necessary for a beneficial effect (Stahl, 2014). I prefer to initiate with an SSRI (Prozac) as opposed to tricyclic (Clomipramine) for the less troubling adverse effects associated with Clomipramine. Karen will be informed that she might experience sleep disturbances, nausea, diarrhea, headache and anxiety which are all adverse effects of SSRIs. The desired outcome of pharmacotherapy is to reduce the patient’s intrusive thoughts that cause the compulsions that interfere with her home and work life. Well controlled studies have found that pharmacotherapy, behavior therapy, or combination of both is effective in significantly reducing the symptoms of patients with OCD (Fenske and Petersen, 2015). Psychotherapy Some studies indicate that behavior therapy is as effective as pharmacotherapies in OCD and some indicate that the beneficial effects are longer lasting with behavior therapy (Sadock, Sadock, & Ruiz, 2014). Many clinicians consider behavior therapy the treatment of choice for OCD and also because it can be conducted in both outpatient and inpatient settings. With the prinicpal behavioral approaches being exposure and response prevention, patients must be committed to improvement as Karen is. Behavior therapy will be initiated the same week as pharmacotherapy. The goal of therapy is to change the client’s behavior to reduce dysfunction and to improve her quality of life. A psychotherapist will be consulted to intiate and manage therapy sessions. Medical Management I will consult with Karen’s PCP for updates and additional concerns. Since she has been with her PCP for more than 5 years, he has good insight into her life. We will discuss baseline labs such as CBC, CMP, TSH, hepatic panel. Since with SSRIs, nausea, headache dry mouth and diarrhea are common side effects, monitoring the patient’s electrolytes is important. I would also recommend an EKG for baseline and follow up after medication initiation as SSRIs can lengthen the OT interval in otherwise health people (Sadock, Sadock, & Ruiz, 2014). Community resources such as the local chapter of the OCD Foundation will be provided to Karen for support services. Follow -up Plan and Collaboration Karen was instructed to follow up in 1 week to monitor tolerability and compliance of medicaiton and dose adjustment. Subsequently, she will return every 4 weeks for medication management. She is also instructed to begin behavior therapy the same week as medication are initiated and to follow up weekly for therapy sessions. I will consult with the therapist weekly for updates and any concerns or questions. I will reiterate and reinforce to both the PCP and therapist the importance of monitoring for suicidal ideations as the patient is taking an antidepressant and abuptly stopping will increase risk of suicide. About one-third of patients with OCD have major depressive disorder, and suicide is a risk for all patients with OCD (Sadock, Sadock, & Ruiz, 2014). Conclusion A poor prognosis is indicated by Karen yielding to rather than resisting compulsion or the need for hospitalization. A good prognosis for Karen is indicated by good home, social and occupational adjustment. The importance of an interdisciplinary team including PCP, therapist and other ancillaries will benefit the client for a better quality of life. References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Fenske, N. & Petersen, K. (2015). Obsessive-Compulsive Disorder: Diagnosis and Management. American Family Physician, 92(10): 896-903. Retrieved from http://www.aafp.org.afp /2015/1115/p896.html Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer Stahl, S.M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

Post a philosophy statement for Mountain View Health Center, at least one goal, and at least one related objective. Offer insights you have gained about the process of developing a philosophy statement, as well as the significance of and distinctions between organizational goals and objectives. Week 3: Philosophy, Goals, and Objectives Being clear about “why […]

Treatment Rubric

Treatment Paper Chapter 18, Treating Drug Dependence, describes what we know is effective drug treatment. The purpose of this treatment paper is to show an understanding of the treatment needs of persons who have addiction, dependency, substance abuse disorder problems. What can a person do if they experience loss of control of their substance use […]

For Reseacher_D

Paper details Instructions Complete a full draft of your research paper. This should have all the sections of the final paper including: 1-Hypothesis (research questionor statement), introduction and quality of literature (references) 30% 2-Method of study and body of paper 30% 3-Discussion / conclusion, abstract 30% 4-AMA format, spelling/grammar, structure 10% ((Attached is a copy […]

CT 6 Healthcare Policy

Health Care Payment and Delivery Reform in Minnesota Medicaid Assignment Required Reading: http://www.commonwealthfund.org/~/media/files/publications/case-study/2013/mar/1667_edwards_medicaid_minnesota_case_study_final_v2.pdf Review the case study by clicking on the link. Prepare a paper that answers the following questions. What are accountable care organizations (ACOs)? What makes Minnesota unique in terms of a model for health system reform? Why are states experimenting with different […]