Category: Nursing

NRNP-6665 Week 4: Assignment – ASSESSING, DIAGNOSING, AND TREATING ADULTS WITH MOOD DISORDERS

It is important for the PMHNP to have a comprehensive understanding of mood disorders in order to assess and accurately formulate a diagnosis and treatment plan for patients presenting with these disorders. Mood disorders may be diagnosed when a patient’s emotional state meets the diagnostic criteria for severity, functional impact, and length of time. Those with a mood disorder may find that their emotions interfere with work, relationships, or other parts of their lives that impact daily functioning. Mood disorders may also lead to substance abuse or suicidal thoughts or behaviors, and although they are not likely to go away on their own, they can be managed with an effective treatment plan and understanding of how to manage symptoms.

In this
Assignment
you will assess, diagnose, and devise a treatment plan for a patient in a case study who is presenting with a mood disorder.

RESOURCES

 

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

NRNP-6665 Week 4: Assignment WEEKLY RESOURCES

TO PREPARE

Review this week’s Learning Resources. Consider the insights they provide about assessing, diagnosing, and treating mood disorders.

Review the Focused SOAP Note template, which you will use to complete this Assignment. There is also a Focused SOAP Note Exemplar provided as a guide for Assignment expectations.

Review the video, 
Case Study: Petunia Park
. You will use this case as the basis of this Assignment. In this video, a Walden faculty member is assessing a mock patient. The patient will be represented onscreen as an avatar.

Consider what history would be necessary to collect from this patient.

Consider what interview questions you would need to ask this patient.

Consider patient diagnostics missing from the video:
Provider Review outside of interview:

Temp 
98.2
  Pulse  
90
 Respiration 
18
  B/P  
138/88

Laboratory Data Available
: Urine drug and alcohol screen negative.  CBC within normal ranges, CMP within normal ranges. Lipid panel within normal ranges. Prolactin Level 8; TSH 6.3 (H)

THE ASSIGNMENT

Develop a Focused SOAP Note, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into your responses in the template:

Subjective: 
What details did the patient provide regarding their chief complaint and symptomatology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?

Objective: 
What observations did you make during the psychiatric assessment?

Assessment:
 Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest to lowest priority. Compare the 
DSM-5-TR
 diagnostic criteria for each differential diagnosis and explain what 
DSM-5
 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.

Plan:
 What is your plan for psychotherapy? What is your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan. Also incorporate one health promotion activity and one patient education strategy.

Reflection notes:
 Reflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), social determinates of health, health promotion, and disease prevention that takes into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

BY DAY 7 OF WEEK 4

Submit
 your Focused SOAP Note.

SUBMISSION INFORMATION

Before submitting your
final assignment
, you can check your draft for authenticity. To check your draft, access the 
Turnitin Drafts
 from the 
Start Here
 area.

To submit your completed NRNP-6665 Week 4: Assignment, save your Assignment as
WK1Assgn+last name+first initial.

Then, click on 
Start Assignment
 near the top of the page.

Next, click on 
Upload File
 and select 
Submit Assignment
 for review.

Rubric

NRNP_6665_Week4_Assignment_Rubric

NRNP_6665_Week4_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning Outcome
Create documentation in the
Focused SOAP Note Template
about the patient in the case study. In the Subjective section, provide: • Chief complaint• History of present illness (HPI)• Past psychiatric history• Medication trials and current medications• Psychotherapy or previous psychiatric diagnosis• Pertinent substance use, family psychiatric/substance use, social, and medical history• Allergies• ROS

15
 
to >
13.0
 pts

Excellent

The response throughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.

13
 
to >
11.0
 pts

Good

The response accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.

11
 
to >
10.0
 pts

Fair

The response describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis but is somewhat vague or contains minor innacuracies.

10
 
to >
0
 pts

Poor

The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Or the subjective documentation is missing.

15
 pts

This criterion is linked to a Learning Outcome
In the Objective section, provide:• Review of Systems (ROS) documentation and relate if pertinent to the chief complaint, HPI, and history• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses

15
 
to >
13.0
 pts

Excellent

The response thoroughly and accurately documents the patient’s ROS for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.

13
 
to >
11.0
 pts

Good

The response accurately documents the patient’s ROS for pertinent systems. Diagnostic tests and their results are accurately documented.

11
 
to >
10.0
 pts

Fair

Documentation of the patient’s ROS is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor inaccuracies.

10
 
to >
0
 pts

Poor

The response provides incomplete or inaccurate documentation of the patient’s ROS. Systems may have been unnecessarily reviewed. Or the objective documentation is missing.

15
 pts

This criterion is linked to a Learning Outcome
In the Assessment section, provide:• Results of the mental status examination, presented in paragraph form• At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.

20
 
to >
17.0
 pts

Excellent

The response thoroughly and accurately documents the results of the mental status exam. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.

17
 
to >
15.0
 pts

Good

The response accurately documents the results of the mental status exam. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected.

15
 
to >
13.0
 pts

Fair

The response documents the results of the mental status exam with some vagueness or innacuracy. Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vagueness or innacuracy.

13
 
to >
0
 pts

Poor

The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or the assessment documentation is missing. NRNP-6665 Week 4: Assignment

20
 pts

This criterion is linked to a Learning Outcome
In the Plan section, provide:• Your plan for psychotherapy• Your plan for treatment and management, including alternative therapies. Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan. • Incorporate one health promotion activity and one patient education strategy.

25
 
to >
22.0
 pts

Excellent

The response provides an evidence-based, detailed, and appropriate plan for psychotherapy for the patient. The response provides an evidence-based, detailed, and appropriate plan for treatment and management, including pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters. A strong rationale for the plan is provided that demonstrates critical thinking and content understanding. … The response includes at least one evidence-based health promotion activity and one evidence-based patient education strategy.

22
 
to >
19.0
 pts

Good

The response provides an evidence-based and appropriate plan for psychotherapy for the patient. The response provides an evidence-based and appropriate plan for treatment and management, including pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters. An adequate rationale for the plan is provided. … The response includes at least one health promotion activity and one patient education strategy.

19
 
to >
17.0
 pts

Fair

The response provides a somewhat vague or inaccurate plan for psychotherapy for the patient. The response provides a somewhat vague or inaccurate plan for treatment and management, including pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters. The rationale for the plan is weak or general. … The response includes one health promotion activity and one patient education strategy, but it may contain some vagueness or innacuracy.

17
 
to >
0
 pts

Poor

The response provides an incomplete or inaccurate plan for psychotherapy for the patient. The response provides an incomplete or inaccurate plan for treatment and management, including pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters. The rationale for the plan is inaccurate or missing. … The health promotion and patient education strategies are incomplete or missing.

25
 pts

This criterion is linked to a Learning Outcome
• Reflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), social determinates of health, health promotion, and disease prevention that takes into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

5
 
to >
4.0
 pts

Excellent

Reflections are thorough, thoughtful, and demonstrate critical thinking.

4
 
to >
3.5
 pts

Good

Reflections demonstrate critical thinking.

3.5
 
to >
3.0
 pts

Fair

Reflections are somewhat general or do not demonstrate critical thinking.

3
 
to >
0
 pts

Poor

Reflections are incomplete, inaccurate, or missing.

5
 pts

This criterion is linked to a Learning Outcome
Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).

10
 
to >
8.0
 pts

Excellent

The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making.

8
 
to >
7.0
 pts

Good

The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study.

7
 
to >
6.0
 pts

Fair

Three evidence-based resources are provided to support the assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification.

6
 
to >
0
 pts

Poor

Two or fewer resources are provided to support the assessment and diagnosis decisions. The resources may not be current or evidence based.

10
 pts

This criterion is linked to a Learning Outcome
Written Expression and Formatting – The paper follows correct APA format for parenthetical/in-text citations and reference list.

5
 
to >
4.0
 pts

Excellent

Uses correct APA format with no errors

4
 
to >
3.5
 pts

Good

Contains a few (one or two) APA format errors

3.5
 
to >
3.0
 pts

Fair

Contains several (three or four) APA format errors

3
 
to >
0
 pts

Poor

Contains many (five or more) APA format errors

5
 pts

This criterion is linked to a Learning Outcome
Written Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and punctuation

5
 
to >
4.0
 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors

4
 
to >
3.5
 pts

Good

Contains a few (one or two) grammar, spelling, and punctuation errors

3.5
 
to >
3.0
 pts

Fair

Contains several (three or four) grammar, spelling, and punctuation errors

3
 
to >
0
 pts

Poor

Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding

5
 pts

Total Points: 
100 NRNP-6665 Week 4: Assignment

 

Assessing, Diagnosing, and Treating Adults with Mood Disorders: Petunia Park

Subjective:

CC
(chief complaint): The patient complains of noncompliance with prescriptions, getting frequent agitation, and having alternating mood swings of “being joyful and being depressed.”

HPI
: The patient is a 25-year-old female with a previous history of mental illness. The onset of her current symptoms was about seven days ago. She describes her symptoms as being “squashed” some of the time and believes that it is her hard work ethic that is making her mentally unstable. Symptoms are intermittent in duration but can last for up to seven consecutive days. Symptom characteristics include being severe, unrelenting, and recalcitrant. They are aggravated by being wakeful and somewhat relieved by sleep and medications. The timing of her symptoms is anytime day or night. She rates their severity at 6/10.

Substance Current Use:
She is a tobacco smoker and consumes a pack a day. She denies use of any other drugs or substances.

Medical History:
She suffers from polycystic ovarian syndrome or PCOS as well as hypothyroidism.

Current Medications
:

Levothyroxine 100 mcg by mouth every day (for hypothyroidism).

Allergies
: NKDA.

Reproductive Hx
: She describes herself as a heterosexual female currently in a relationship. She has n children and her LMP was 05/29/2024.

Review of Systems or ROS
:

GENERAL: Denies fever, chills, fatigue, weight loss, or malaise.

HEENT: Negative for headaches, light sensitivity, ear discharge, ear pain, rhinorrhea, sore throat or difficulty swallowing.

SKIN: Negative for itching, eczema, or rashes.

CARDIOVASCULAR: Denies chest pain, palpitations, or peripheral edema.

RESPIRATORY: Denies coughing, dyspnea, wheezing, or producing sputum.

GASTROINTESTINAL: Denies N/V/D as well as changes in bowel movements.

GENITOURINARY: Negative for dysuria, cloudy urine, or abnormal vaginal discharge.

NEUROLOGICAL: Denies dizziness, syncope, ataxia, paresis, paralysis, pins and needles, or loss of bowel and/ or bladder control. NRNP-6665 Week 4: Assignment

MUSCULOSKELETAL: Denies muscle pain, back pain, or joint pain.

HEMATOLOGIC: Negative for a history of blood and/or clotting disorders.

LYMPHATICS: Denies lymphadenopathy or having had a splenectomy before.

ENDOCRINOLOGIC: Negative for excessive thirst, excessive drinking of water, excessive eating, excessive sweating, heat/ cold intolerance, or a history of hormonal therapy/ treatment.

Objective:

Vitals:
T 98.2; P 90 ; R 18 ; B/P  138/88

Diagnostic Lab Results
: Urine drug tests, CMP, and full blood count were unremarkable. TSH was elevated at 6.3 on testing.

Psychometric test:
Young Mania Rating Scale or YMRS tool.

Assessment:

Mental Status Examination
: The patient is a 25-year-old female who is well-groomed for the occasion, time of the day, and the weather. She has normal appearance and gait with no obvious physical abnormalities. She is concious and aware of the place, time, space, person, and event. She is cooperative and maintains good eye contact throughout. Her speech is clear, coherent, and goal-oriented although pressured in rate. She displays no obvious mannerisms or tics. Her self-reported mood is “happy” and the observed affect is euphoric hence mood-congruent. She denies having suicidal or homicidal thoughts. She also denies getting hallucinations or delusions. Her immediate, short-term, and long-term memory is good. Her abstraction is also good as she can make sense of idioms. Her insight and judgment are somewhat impaired. Impression: Bipolar I disorder (APA, 2022; Boland et al., 2021; Stahl, 2021).

Diagnosis and Differential Diagnoses

Bipolar I Disorder: 296.42 (F31.12)

The euphoria and “happiness” described in the MSE means that this patient is in the manic phase of bipolar I disease. In her CC she stated that she usually has alternating depressive feelings and elation. She thus meets the diagnostic criteria for BD I as one requirement is that the patient must have had at least one manic episode (APA, 2022; Boland et al., 2021). According to the DSM-5-TR, the diagnostic criteria also include insomnia, excessive excitement, abnormally high self-esteem, talkativeness, distractibility, and excessive energy amongst others.

Major Depressive Disorder (MDD):
296.22 (F32.1)

One of the poles of BD I is depression. This patient can thus be mistakenly diagnosed with MDD when she is on the depression pole (APA, 2022). However, this cannot be true as she has also experienced mania making this BD instead.

Attention-Deficit/ Hyperactivity Disorder or ADHD: 314.01 (F90.2)

ADHD is a distant possibility but still plausible since it usually starts in childhood but goes up to adulthood. The irritability, distractibility, insomnia, social isolation (from peers), and inattentiveness amongst others may lead to a wrong diagnosis of ADHD. However, it may also be comorbid with the BD I. NRNP-6665 Week 4: Assignment

Case Formulation and Treatment Plan:

Cognitive behavioral treatment (CBT) brief therapy 45/ session x 8 weeks (Corey, 2023).

Lithium (Eskalith) 300 mg orally BID (Stahl, 2020).

Regular physical activity and a diet rich in fresh fruits and vegetables.

Reflection

I did everything according to the book for the patient (Carlat, 2023). I also observed all ethical principles including autonomy, fidelity, justice, beneficence, and nonmaleficence (Haswell, 2019). Social determinants of health applicable to the client included low educational achievement and poor access to quality mental health care. I tailored health education for her according to these and then gave her a return date for follow up after 4 weeks.

 

 
References

American Psychiatric Association [APA] (2022).
Diagnostic and Statistical Manual of Mental Disorders-Text Revision (DSM-5-TR), 5
th
ed
. Author.

Boland, R., Verdiun, M., & Ruiz, P. (Eds) (2021).
Kaplan and Sadock’s synopsis of psychiatry, 12
th
ed
. Wolters Kluwer.

Carlat, D.J. (2023).
The psychiatric interview, 5
th
ed
. Wolters Kluwer.

Corey, G. (2023).
Theory and practice of counselling and psychotherapy, 11
th
ed
. Cengage Learning.

Haswell, N. (2019). The four ethical principles and their application in aesthetic practice.
Journal of Aesthetic Nursing
, 8(4), 177-179.
https://doi.org/10.12968/joan.2019.8.4.177

Stahl, S. M. (2021).
Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications, 5
th
ed
. Cambridge University Press.

Stahl, S.M. (2020).
Stahl’s essential psychopharmacology: Prescriber’s guide, 7
th
ed
. Cambridge University Press. NRNP-6665 Week 4: Assignment

Petunia Park Focused SOAP Note template – Assessing, Diagnosing, and Treating Adults with Mood Disorders

Subjective

CC (chief complaint):
“I have a history of taking medications and then stopping them. I do not think I need them. I feel like the medication squashes who I am.”

HPI:
Petunia Park, 28, is a Caucasian bipolar disorder medication follow-up patient. Sleep deprivation led to her being caught outside inadequately dressed and disoriented three months ago, which got her hospitalized. Her pharmaceutical nonadherence is due to the belief that they “squash her creativity.” She experiences weekly bouts of depression that leave her exhausted, unmotivated, unable to get out of bed, overeating, and losing her creativity and self-esteem. This frequently occurs after one week of “high, high, high” mood, rushed speech, rushing thoughts, and impulsivity. When she has “lots of energy to do many things,” she sleeps 2-3 hours per night and feels rested (American Psychiatric Association, 2022). She obsesses about writing her autobiography, drawing, and producing music, believing she is talented enough to become renowned. Hypersexual, she seeks new partners due to increased libido. She denies suicidal/homicidal ideation but cites a 2017 overdose suicide attempt. She denies any manic or hypomanic episodes in the past three months while using lurasidone but says it made her feel different (Boland et al., 2022).

Substance Current Use

Nicotine: 1 pp. Not interested in quitting

Alcohol: None since age 19, when she realized it worsened her symptoms

Illicit drugs: Denies current use; tried cannabis once but became paranoid; denies any other lifetime use

BUY A PLAGIARISM-FREE PAPER HERE

Past Psychiatric History

Bipolar I disorder with prior episodes of mania and psychosis, diagnosed in late adolescence.

Generalized anxiety disorder

ADHD

Multiple prior hospitalizations for mania with psychosis and one for suicidal gesture (overdose) in 2017

No history of suicide attempts or self-injurious behavior outside of overdose

No history of substance use treatment

Petunia Park Focused SOAP Note template

Family Psychiatric History

 

Mother with bipolar I disorder

Father with substance use disorder, currently incarcerated

Brother with likely schizophrenia but undiagnosed

Medical History

Hypothyroidism

Polycystic ovary syndrome

Current Medications

Levothyroxine 100mcg PO daily

Oral contraceptive pill (OCP)

Lurasidone 40mg PO BID (recently self-discontinued)

Allergies: NKDA

Reproductive Hx:

LMP last month

Sexually active with inconsistent condom use

Denies current STI symptoms or history of STIs

No history of pregnancy or abortion

ROS:

GENERAL: No weight loss, fever, chills, weakness or fatigue. Appetite increased with depression and decreased with mania.

HEENT: Denies visual changes, hearing loss, rhinorrhea, and sore throat.

SKIN: No rash or pruritis.

CARDIOVASCULAR: No chest pain, palpitations or edema.

RESPIRATORY: Denies cough, dyspnea, wheezing.

GASTROINTESTINAL: No nausea, vomiting, diarrhea, constipation, abdominal pain. Appetite increases significantly during depressive episodes, leading to weight gain.

GENITOURINARY: Denies dysuria, hematuria, and discharge. Reports increased libido during manic episodes leading to risky sexual encounters.

NEUROLOGICAL: No syncope, seizures, or focal neurological deficits. Denies current AH/VH. Prior episodes of grandiose auditory hallucinations when manic and sleep deprived, telling her she is “great and wonderfully talented.”

MUSCULOSKELETAL: Denies arthralgias, myalgias, joint swelling.

HEMATOLOGIC: Denies anemia, easy bruising, and bleeding. Has no known history of clotting disorders.

LYMPHATICS: No adenopathy.

ENDOCRINOLOGIC: Reports 5-10lb weight gain when depressed. Denies polyuria, polydipsia, and heat/cold intolerance.

Objective

VS: Sitting BP 138/88  | Pulse 90 | Temp 98.2 °F (36.8 °C) | Resp 18 | Wt. 160 lbs | BMI 27.1 | SpO2 100% RA

Labs: CBC, CMP WNL; TSH 6.3 mIU/L (H); Urine hCG negative; Urine drug screen negative

Physical Exam

General: Well-developed, well-nourished female dressed appropriately with good hygiene. No acute distress.

HEENT: Normocephalic/atraumatic, EOMI, PERRLA, notable mydriasis. Moist mucous membranes. No pharyngeal erythema or tonsillar exudates.

Neck: No JVD, lymphadenopathy, or thyromegaly.

Cardiovascular: Tachycardic rate, regular rhythm, no murmurs/rubs/gallops. Pulmonary: CTAB. No accessory muscle use.

Abdomen: Normoactive BS, soft, nontender, nondistended. No palpable hepatosplenomegaly.

GU: Deferred. Rectal: Deferred. MSK: No clubbing, cyanosis, or edema. Full ROM. 5/5 strength in upper and lower extremities.

Neuro: AOx3, no asterixis. Gait with a standard base.

Mental Status Examination

28-year-old cooperative, eye-contact-making woman. She is friendly and willing to talk about her art. Frequently gesticulating increases psychomotor activity. Speech is rushed but clear. Fluent, medium loudness, and prosody. The mood is “pretty good, a lot better than last week.” Bright, expansive affect, but impatient when probed about family history. The mental process is straight and goal-oriented with some circumstantiality. No conceptual drift or vague linkages. Grandiose fantasies about creative ability and renown. Denies auditory or visual hallucinations but says they can occur when manic and sleepless—denial of paranoia. Refuses suicide or homicidal thoughts; one low-lethality attempt with no present plan. Knowledge, attention, and abstraction-based cognition are intact. However, the severity of the condition and the need for treatment seem unclear. Hypersexuality lowered impulse control (Boland et al., 2022).

Differential diagnoses

Bipolar I disorder, severe manic episode with psychotic characteristics.

Substance/medication-induced bipolar and related disorder, with onset during withdrawal

Bipolar II disorder

Cyclothymic disorder

Borderline personality disorder

Bipolar I disorder fits the patient’s symptoms. She has alternating manic and depressed episodes lasting about a week. Her severe manic symptoms include decreased sleep, goal-directed activity, pressurized speech, idea flight, distractibility, grandiose delusions, and psychosis (American Psychiatric Association, 2022). These crises severely impair social and occupational performance. Manic episodes exclude bipolar II and cyclothymia, which constitute hypomania rather than mania (Yatham et al., 2018). Borderline personality disorder can cause emotional lability, impulsivity, and unstable relationships, but its symptoms are episodic and psychotic (Boland et al., 2022). Despite her negative urine drug test, quick lurasidone termination could cause withdrawal mania. Before lurasidone, she had many manic episodes, supporting the diagnosis of bipolar I disorder (American Psychiatric Association, 2022). Petunia Park Focused SOAP Note template

Reflections

This patient shows how difficult bipolar I disorder management is, especially for a patient with poor insight. Her hypersexuality and impulsivity put her in danger of unexpected pregnancy and STIs. Therefore, she needs safe sex practices and dependable contraception. Harmonizing her autonomy with the need to protect herself and others is ethical. If her manic symptoms develop, she may need involuntary hospitalization for stabilization (Goodwin et al., 2016). With consent, her family and support system could share collateral information and encourage drug adherence. Her brother’s untreated symptoms are likewise troubling and need evaluation.

Sociocultural, her creative endeavors define her; therefore, it is important to validate them while informing her about untreated mania. Exploring her medication attitudes and resolving adherence hurdles such as cognitive dulling anxiety may avoid relapses (Geddes & Miklowitz, 2013). Her mother’s bipolar condition may offer psychoeducation and therapy models. Avoiding medical depression requires monitoring and treating her hypothyroidism.

Case Formulation and Treatment Plan

Bipolar I condition causes manic and depressed episodes with remission. However, this patient cycles faster and has more mood episodes (Boland et al., 2022). Her late adolescent onset is usual, and her family history of bipolar disorder and other psychiatric diseases suggests hereditary loading. She may be grandiose when manic, but her creativity gives her purpose and self-esteem. Though she may have been euthymic on lurasidone before, its abrupt cessation certainly caused her manic episode.

Stabilizing mood and preventing relapse are treatment goals. Lithium is the first-line treatment for bipolar I illness and reduces suicidal behavior (Yatham et al., 2018). Given her impulsivity and questionable adherence, a long-acting injectable (LAI) antipsychotic may be better for quick stabilization. Risperidone LAI prevents manic relapse and maintains therapeutic levels even if she misses an injection (Fountoulakis et al., 2016). Start with 25mg IM q2 weeks and titrate as needed. Monthly doses of aripiprazole monohydrate are another option. If LAI monotherapy fails, lithium may be added (Goodwin et al., 2016).

When euthymic, psychotherapy is needed. Cognitive-behavioral and interpersonal therapy can challenge medication misperceptions, increase coping skills, regulate sleep/activity, and strengthen therapeutic alliances (Geddes & Miklowitz, 2013). If her support system participates, family-focused therapy may lower relapse risk. Psychoeducation on bipolar disease can help patients understand their illness, recognize relapse signs, and create a crisis plan. To track symptoms and overcome adherence hurdles, frequent follow-up is necessary.

Optimizing her thyroid function is medically necessary to prevent depression. If these drugs are started, lithium and valproate levels must be checked (Yatham et al., 2018). Given her sexual behaviors, mood stabilizer teratogenicity education and dependable contraception are essential. STI screening and safer sex counseling should be routine. Finally, fostering healthy habits like exercise, stress management, and drug abstinence can boost resilience and wellness. Evidence-based medication plus a thorough psychosocial approach may improve symptoms and functioning. Bipolar I disorder is chronic and recurring. Therefore, constant care and vigilance are necessary to preserve stability and quality of life.

References

American Psychiatric Association. (2022). Bipolar and related disorders. In Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787.x03_Bipolar_and_Related_Disorders

Boland, R. Verdiun, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.

Fountoulakis, K. N., Yatham, L., Grunze, H., Vieta, E., Young, A., Blier, P., Moeller, H. J., & Kasper, S. (2016). The International College of Neuro-Psychopharmacology (CINP) treatment guidelines for bipolar disorder in adults (CINP-BD-2017), part 2: Review, grading of the evidence, and a precise algorithm. International Journal of Neuropsychopharmacology, 20(2), 121-179. https://doi.org/10.1093/ijnp/pyw100 Petunia Park Focused SOAP Note template

Geddes, J. R., & Miklowitz, D. J. (2013). Treatment of bipolar disorder. The Lancet, 381(9878), 1672-1682. https://doi.org/10.1016/s0140-6736(13)60857-0

Goodwin, G. M., Haddad, P. M., Ferrier, I. N., Aronson, J. K., Barnes, T. R. H., Cipriani, A., Coghill, D. R., Fazel, S., Geddes, J. R., Grunze, H., Holmes, E. A., Howes, O., Hudson, S., Hunt, N., Jones, I., Macmillan, I. C., McAllister-Williams, H., Miklowitz, D. M., Morriss, R., Munafò, M., … Young, A. H. (2016). Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology, 30(6), 495–553. https://doi.org/10.1177/0269881116636545

Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Bond, D. J., Frey, B. N., Sharma, V., Goldstein, B. I., Rej, S., Beaulieu, S., Alda, M., MacQueen, G., Milev, R. V., Ravindran, A., O’Donovan, C., McIntosh, D., Lam, R. W., Vazquez, G., Kapczinski, F., McIntyre, R. S., … Berk, M. (2018). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disorders, 20(2), 97–170. https://doi.org/10.1111/bdi.12609

Mary Breckinridge Essay

Key Historical Figures in Community and Public Health Nursing (Mary Breckinridge)

Through their expertise, role, and work, different figures have shaped the public and community health nursing field. Still, few have had lasting and significant impact, such as Mary Breckinridge, whose work and innovative approach regarding rural healthcare continue to influence nursing practices today.

Through her work in rural healthcare, Mary Breckinridge had and continues to have a profound impact on present-day public and community health nursing. She founded the Frontier Nursing Service (FNS) in 1925 (Gulley, 2022). The establishment successfully extended nurse-midwifery, among other essential medical care services, to remote and underserved areas. Mary’s care delivery model integrates community-based nursing, public health principles, and midwifery to set the foundation for modern community health nursing practices (Gulley, 2022) Mary Breckinridge Essay.

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Her approach and ideology to community health emphasized preventive care, continuity of care to patients and their families, and home visits with a key focus on mothers and infants. According to Gulley (2022), Mary understood that. Effective healthcare is needed to address target populations’ economic, social and geographical barriers, which remains crucial in today’s public health initiatives. Additionally, she introduced professionals trained in public health to integrate nurse-midwives expertise. Mary Breckinridge Essay. She turned out to be a revolutionary move at a time when physicians in urban areas solely managed childbirth.

Mary’s model denoted and recognized the power and value of involving a community in healthcare, which led to increased emphasis on culturally competent care. According to Gulley (2022), the framework provided the foundation for modern-day community health interventions emphasizing education, access to care, and holistic wellness of patients, which have remained integral facets of public health nursing today over the years.

Reference

Gulley T. (2022). Review of: 
Wide Neighborhoods: A Story of the Frontier Nursing Service
. 
Journal of Appalachian Health
, 
4
(1), 61–64.
https://doi.org/10.13023/jah.0401.07
 Mary Breckinridge Essay

The progressive era essay

The progressive era was a time in American history where groups of activists and reformers from varying backgrounds began causes and movements to fight to achieve their idea of an improved America (Corbett, 2023). The progressive era brought help and achieved reform for multiple minority groups, including women and children.

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The progressive era brought reform for women with the right to vote in 1920 (McNeese, 2019). In the face of the war, many progressive movements were put on hold except for that of the Women’s suffrage movement which continued to fight for women’s right to vote (McNeese, 2019). The war was a huge aide in helping the women’s suffrage cause to give them the right to vote due to their support during the war by taking industrial jobs and volunteering as nurses; their sacrifices and support won over President Wilson and eventually led to the law giving them the right to vote in 1920 ( McNeese, 2019).

Many children suffered in the industrial sector due to low wages and poor work conditions which led to the formation of The National Child labor Committee, who fought the government to pass a law to put a stop to child labor (Corbett, 2023). The NCLC used the help of photographers to capture the injustices of child labors and eventually led to the Fair Labor Act being passed in 1938, which made it illegal to sell products made by children under sixteen (Corbett, 2023).

I feel the progressive movement forced the government to take action by putting laws in place that benefited both children and women. Allowing women to vote gave them a say in their county and how it is run, which was a huge accomplishment for women. The passing of the Fair Labor Act protected children from being mistreated and forced to work in unsafe conditions and without fair pay. The progressive era essay.

Federal and state mandates concept map on nursing profession

Directions

You will develop a concept map that illustrates your understanding of Federal and State Regulatory Standards (TBA) related to your new professional role as an Advanced Nurse Practitioner. Your concept map should include main themes, subthemes, key concepts, and their interconnections. This assignment allows you to showcase your critical thinking, analytical skills, and ability to organize complex information visually. Your concept map should include:

Federal/State Mandates for the Profession

Credentialing Requirements

Competencies

Ethical Bounds

Future Professional Possibilities for APNs.

Conduct Research:

Conduct thorough research using scholarly sources, course materials, and relevant literature.

Take detailed notes and identify key concepts, theories, and relationships.

Organize Your Information:

Identify the main themes and subthemes related to your topic.

Determine how these themes and subthemes are interconnected.

Create the Concept Map:

Begin with a central node representing your main topic.

Branch out into main themes, subthemes, and specific concepts.

Use colors, symbols, and shapes to enhance the visual appeal and clarity.

Ensure all connections are logical and accurately represent relationships between concepts.

Include Critical Analysis:

Integrate your own analysis and insights into the concept map.

Highlight connections between different concepts and themes.

Provide a critical evaluation of the relationships and their significance to the overall topic.

Technical Requirements:

You may create your concept map using digital tools (e.g., CmapTools, Lucidchart, Canva) or draw it by hand and scan it.

Ensure the final submission is clear and legible.

If using a digital tool, save and submit your concept map in PDF format.

 

Federal and state mandates concept map on the nursing profession

Introduction

This concept map shows the APN’s legal requirements, including federal and state authorities and mandates, credentialing, competencies, ethics, and future career options. That is how these regulations define APNs’ practice, their credentialing, and how they address their professional roles and responsibilities. All these themes are connected on the concept map to provide an overall understanding of the regulation factors that define APN roles. This map connects the regulatory standards and the practical implications for practice and career destinations.

 

Figure 1: Concept Map of Federal and State Regulatory Standards for Advanced Nurse Practitioners

Theme Selection

Those that constitute the core of the definition and description of the APN practice scope and responsibilities include Federal/State mandates, Credentialing Requirements, Competency, Ethical Practice Boundaries, and Future Roles. Federal and state mandates offer the legal framework in which APNs practice. For instance, laws of individual states define what activities are allowable for APNs with or without collaboration with medical doctors. Other federal legal requirements, such as the HIPAA, set some level of patient privacy that all APNs must observe.

Credentialing standards of education, certification and licensure ensure that APNs are well-prepared to practice at an advanced level (Spies et al., 2024). This theme is essential as it relates to state requirements and professional practice standards. On the state and national levels, there are controls of the educational and certification processes, and the requirements for APN licensure differ from state to state. For example, there are states where nurse practitioners have complete practice independence; certain restrictions are placed in other states.

Competencies refer to the identified clinical practice skills and content knowledge that APNs must exhibit, such as clinical judgment, diagnostic thinking and patient care. These competencies are essential to keep licensure and certification, thus relating to credentialing. Ethical considerations involve respect for the patient’s self-determination, promoting the patient’s values, and harming the patient minimized or when benefited (Varkey et al., 2021). These ethical principles are not just personal codes of behavior but legal requirements, most so when implemented at the federal level, such as HIPAA.

Future professional possibilities discuss how rule-setting develops possibilities for APNs to career progress into leadership, policy, and speciation. These opportunities become even more critical as healthcare advances and more states grant full practice authority to APNs. This theme is relevant in explaining how regulatory contexts open or constrain professional practice for APNs.

Organization

The concept map’s central node is Federal and State Regulatory Standards for Advanced Nurse Practitioners, and five primary concepts branch out from the center. Each branch is related to pertinent subtopics such as the branch of practice, certification, clinical competencies, the roles of patients in self-management, and leadership.

Coloring (blue for the themes and red for the central node) and using arrows to show the relationships between the themes make the explanation easier. For example, arrows were drawn between Federal/State Mandates and credentialing Requirements to illustrate that APN licensure is governed by state laws and another connecting Competencies and ethical Bounds to highlight that competencies cannot be exercised outside recognized ethical standards.

All these themes are separated into their subthemes. For example, Credentialing Requirements connect ‘education,’ ‘certification,’ and ‘licensure’ with them; Ethical Bounds connect with the principles of ‘patient self-determination’ and ‘beneficence.’ I have used the map to show how each theme connects to the regulations of practice and how these regulations affect APN practice in general.

Critical Insights

It becomes clear from the concept map indicated below that there are several connections between the themes. One of them is how federal and state mandates impact credentialing with little doubt. Federally and by state statutes, APNs can only work with the required education, certification, and licensure. APNs are more independent in states that grant full practice authority than in states with restricted practice rights that require the APNs to practice under the supervision of physicians. These regulatory differences significantly affect credentialing because APNs in limited states may require extra clearances or partnerships to satisfy licensure requirements.

One of the other meaningful relationships is between competencies and credentialing. The map shows that competencies are needed to continue practice and provide the best care possible. Professional education is required so APNs can perform the clinical tasks necessary for credentialing.

Ethical standards also cross over with other themes, particularly federal requirements. For example, HIPAA regulations of ethical requirements and rules prohibit the disclosure of patient information and patient self-determination (Zhang et al., 2021). It is clear from the concept map that ethical practice is not just an idea to guide the practice of APNs but a reality governed by regulations.

For example, the theme of future professional possibilities demonstrates how the rules and guidelines may open or close career opportunities. The states that grant full practice authority to the APNs enable them to lead the organization, lobby for changes and work in different fields (Schmidt et al., 2021). On the other hand, restrictive policies may act to negate such possibilities, which is why the work for further advancement of APN practice scopes continues.

Conclusion

The concept map created here provides a cleaner map of the regulatory requirements related to Advanced Nurse Practitioners. The map shows how these themes relate to Federal/State Mandates, Credentialing Requirements, Competencies, Ethical Bounds, and Future Professional Possibilities. The APNs need to understand these relationships while performing their professional roles and considering their careers (Chau et al., 2022). Because the healthcare industry is evolving, federal and state laws are essential for APNs to understand in order to maintain compliance, practice ethically and competently, and prepare for future careers.

References

Chau, J. P., Lo, S. H., Lam, S. K., Saran, R., & Thompson, D. R. (2022). Critical elements in nursing graduates’ transition to advanced practice roles and their perceived impact on patient care: an exploratory, descriptive study of graduates’ and their managers’ perceptions. 
BMC nursing
, 
21
(1), 122.
https://link.springer.com/article/10.1186/s12912-022-00907-0

Schmidt, J. E. (2021). 
Registered Nurses and Advanced Practice Nurses Knowledge of Their Role in Health Care Policy Development
 (Doctoral dissertation, Capella University).
https://search.proquest.com/openview/5de015fffdb64df2c3391e753b1184a8/1?pq-origsite=gscholar&cbl=18750&diss=y

Spies, L. A., Miller, M. K., Chair, S. Y., & Fox-McCloy, H. (2024). Global Advanced Practice Nurses’ Clinical Practice. In 
Advanced Practice Nurse Networking to Enhance Global Health
 (pp. 85-103). Cham: Springer International Publishing.
https://link.springer.com/chapter/10.1007/978-3-031-39740-0_5

Varkey, B. (2021). Principles of clinical ethics and their application to practice. 
Medical Principles and Practice
, 
30
(1), 17-28.
https://karger.com/mpp/article-abstract/30/1/17/204816

Zhang, H., Zhang, H., Zhang, Z., & Wang, Y. (2021). Patient privacy and autonomy: a comparative analysis of cases of ethical dilemmas in China and the United States. 
BMC Medical Ethics
, 
22
, 1-8.
https://link.springer.com/article/10.1186/s12910-021-00579-6

Amina Johnson iHuman case study

Key Findings

Sore throat

Fever, temperature 101.5° F

Headache

Pharyngeal erythema and tonsillar exudate

Swollen glands, tender cervical lymphadenopathy

Infectious contact per history

Infectious mononucleosis at age 15

Lack of cough

Lack of influenza immunization

Additional PMH: No change

Additional SH: Habits and lifestyle

Medications/Allergies

ROS: No other constitutional, dermatologic, or

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Problem Statement – Amina Johnson iHuman case study

This 23-year-old female with a history of mononucleosis presents with acute pharyngitis and associated fever, headache, and tender cervical lymphadenopathy. The physical exam is notable for a temperature of 101.5° F orally, posterior pharyngeal erythema, mild to moderate tonsillar enlargement without uvular deviation, prominent tonsillar exudate, and tender bilateral anterior cervical lymphadenopathy without nuchal rigidity or hepatosplenomegaly.

 

Management Plan – Amina Johnson iHuman case study

Pharmacologic Care

Give amoxicillin 500 mg PO tablets BID x 10 days

Give ibuprofen 200 mg PO tablets, 2 tablets every 6 hours, do not exceed 8 tablets in a 24-hour period

Teaching note. If cuiture not already ordered, obtain throat culture

Supportive Care

Rest.

Maintain adequate fluid intake

Gargle with saltwater.

Observe a soft diet and add cold food items such as popsicles or slushies

Avoid irritants such as spicy foods or second-hand smoke.

Patient Education

Educated patient on the high likely diagnosis of strep throat, current test results, empiric treatment regimen, and prognosis

Educated patient on medications, including indications, proper administration, side effects, and red flag symptoms for discontinuation. Advised the patient to finish all of the antibiotics as prescribed, even if they start to feel better.

Advised patient to replace toothbrush after being on antibiotics for 48 hours to avoid re-inoculation.

Discussed the use of a secondary form of birth control while on the antibiotic.

Recommended patient isolate at home and avoid contact with others until on antibiotic for 24 hours

Follow-Up

Follow up in the clinic if symptoms do not start to resolve within 48-72 hours.

Discussed warning signs with which to call the clinic immediately or to go to the ER, including but not limited to, inability to swallow, throat swelling, difficulty breathing, inability to maintain adequate fluid intake, severe increase in pain, inability to open the mouth, or for other concerning symptoms Amina Johnson iHuman case study

EBP Topic Selection: Polypharmacy Management in Older Adults

 
Polypharmacy Management in Older Adults

Reason for picking the topic

Polypharmacy, which is the concurrent prescription and use of five or more medicines is a rising health concern in older adults. Although polypharmacy might be clinically beneficial in many instances, it is associated with numerous adverse clinical consequences. Older adults with polypharmacy are highly likely to have drug-to-drug interactions and adverse events related to drug use.  Also, polypharmacy is connected with frailty, reduced physical function, cognitive impairment, repeated hospitalizations, and mortality. Evidence demonstrates that polypharmacy has the potential to pose a burden on the lives of older adults and lead to negative feelings. For instance, older adults find it challenging to manage multiple medications, resulting in polypharmacy negatively affecting older adults’ medication adherence and quality of life (Cheng et al., 2023) Polypharmacy Management in Older Adults.

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Young et al. (2023) emphasize that an aging population alongside polypharmacy might result in the prescription of potentially inappropriate medications, which can be both ineffective in treating the patient’s condition and result in a greater risk of experiencing adverse drug events, including drug-disease interaction, and drug-drug interaction, as well as failure to take medications because of heightened medication burden. These factors can in the end lead to adverse health outcomes, including a deterioration in cognitive and health status. As around fifty percent of hospitalizations related to adverse drug events are avoidable, when adverse drug events occur, they might subsequently result in increased hospital admissions. The occurrence of adverse drug events might make a patient be prescribed more medications to treat or prevent these adverse events, further aggravating drug use and burden on patients.

Problem statement

Polypharmacy is a serious clinical problem that affects more than half of older adults in the United States, and is linked with poor outcomes, adverse drug events, and increased healthcare costs.

Etiology of the problem

Multimorbidity, multiple prescribers, and availability of drugs are factors associated with polypharmacy in geriatric patients.  According to Young et al. (2021), old age is associated with an increased risk of an individual having multiple chronic diseases, leading to a higher prevalence of concurrent use of multiple medications.  Hoel et al. (2021) emphasize that the problem of polypharmacy is contributed by numerous factors, including accessibility of medications in herbal stores, in stores, and online; multiple pharmacies, and multiple prescribers.  Polypharmacy Management in Older Adults. Due to the segmentation of health care systems, patients visit numerous health care professionals who lack shared records and unknowingly prescribe interacting or duplicative medications. When pharmacies do not have integrated prescription records, it leaves pharmacists unaware of interacting medications or duplicates that their patients have been prescribed.

Lack of adherence to lifestyle changes is another factor contributing to polypharmacy in older adults. According to Hoel et al. (2021), the prescription of treatments is done to meet desired objectives, though there are strong beliefs that medications treat health problems. For instance, the majority of patients with diabetes are treated with multiple medications, few patients adopt recommended lifestyle activities and changes that could enable them to accomplish goals of treatment with fewer medications.

Epidemiology/Prevalence of the problem

Polypharmacy is common phenomenon in both community and clinical settings, with a high prevalence among geriatric patients in the United States and across the globe. According to Keller et al. (2024), in the United States, the approximated rate of polypharmacy among adults 65 percent for adults sixty-five years and above is 65 percent.  In Europe, approximates of the prevalence of polypharmacy in geriatric patients is between 26 percent and 40 percent, with the prevalence rate of polypharmacy is 49, percent, 42 percent, and 36 percent in India, South Korea, and Australia, respectively. Polypharmacy Management in Older Adults

References

Cheng, C., Yu, H., & Wang, Q. (2023). Nurses’ Experiences Concerning Older Adults with Polypharmacy: A Meta-Synthesis of Qualitative Findings.
Healthcare, 11
(3), 334. doi:
10.3390/healthcare11030334

Hoel, R. W., Connolly, R. M., & Takahashi, P. Y. (2021). Polypharmacy Management in Older Patients.
Mayo Clinic Proceedings, 96
(1), 242-256. https://doi.org/10.1016/j.mayocp.2020.06.012,

Keller, M. S., Qureshi, N., Mays, A. M., Sarkisian, C. A., & Pevnick, J. M. (2024). Cumulative Update of a Systematic Overview Evaluating Interventions Addressing Polypharmacy.
JAMA Network Open. 7
(1), e2350963. doi:10.1001/jamanetworkopen.2023.50963

Young, E. H., Pan, S., Yap, A. G., Reveles, K. R., & Bhakta, K. (2021). Polypharmacy prevalence in older adults seen in United States physician offices from 2009 to 2016.
PLoS One, 16(
8), e0255642. doi:
10.1371/journal.pone.0255642
  Polypharmacy Management in Older Adults

Annie Chambers iHuman

Key Findings

Bilateral inner thighs with 10 x 12 cm raised, confluent, erythematous papules and blisters in various stages

Left ventral forearm with 6 cm linear, erythematous papules, and yellow-red blisters

Itching progressing to tenderness

New exposures: Wild brush plants, insects

New exposures: Hot tub

New exposures: Oily suntan lotion

New exposure: Scallops

PMH: No change since last visit

Additional SH: No relevant change in tobacco, alcohol, drug use, lifestyle

Medications/Allergies: No change, hives to cefaclor

ROS: No constitutional, cardiorespiratory, or gastrointestinal symptoms

Communication: Effect on the patient’s life

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Annie Chambers Human Problem Statement

The patient, a 25-year-old otherwise healthy female, presents with 2 days of intensely pruritic erythematous papular rash on the inner thighs and left inny forearm. Recent exposures include hiking through the woods, hot tub use, new lotion use, and ingesting scallops for the first time in her life. Physical examination shows a 6 cm set of linear, circumscribed, erythematous blisters on the left inner forearm and a 10 x 12 cm scattered contiguous erythematous papular rash with surrounding superficial excoriations on the inner thighs. Vitals and the remaining physical examination are unremarkable

 

Annie Chambers Human Management Plan

Pharmacologic Care:

Apply clobetasol propionate 0.05% cream twice a day until clear.

Take OTC cetirizine 10 mg 1 tab PO daily as needed for itching.

Supportive Care:

Take oatmeal baths.

Apply cool, wet compresses to affected areas.

Apply topical calamine lotion or aluminum acetate to affected areas.

Patient Education:

Educated patient on the diagnosis of contact dermatitis, potential etiologies, treatment regimen, and prognosis.

Advised the patient to avoid poison ivy, oak, and sumac. Explained plant appearance.

Educated patient on medications, including indications, proper administration, side effects, and red flag symptoms for discontinuation.

Advised patient to wash all clothing, towels, sheets, etc., in hot water to remove potentially irritant oils.

Follow-Up:

Follow up in the clinic if symptoms do not start to improve within 48-72 hours.

Discussed warning signs to call the clinic immediately or to go to the ER, including but not limited to difficulty breathing, increased swelling, vomiting, fever, purulent skin discharge, or other concerning symptoms. Annie Chambers
iHuman

Reflective journal clinical experience sample essay

Address the following in a reflective journal.

Daily Objective: State the specific learning objectives or goals you aimed to achieve during your clinical experience.

Clinical Objective: Describe the clinical setting, including the type of facility, patient population, and any unique aspects relevant to the day’s activities.

Patient Encounters: Briefly summarize notable patient interactions or cases, highlighting key health concerns, assessments, and interventions.

Challenges Faced: Identify any challenges encountered during the day, whether they were related to patient care, communication, or procedural skills.

Successes and Achievements: Celebrate any successful moments or achievements, whether they are related to clinical decision-making, effective communication, or positive patient outcomes.

Applied Knowledge: Reflect on how you applied theoretical knowledge from your NP program to real-world situations. Discuss any instances where your academic learning directly influenced your clinical decisions.

Collaboration and Communication: Evaluate your collaboration with other healthcare professionals and communication with patients. Consider what strategies were effective and areas that need improvement. reflective journal clinical experience sample essay

Ethical and Cultural Considerations: Reflect on any ethical dilemmas faced or cultural considerations that arose during patient care. Discuss how you navigated these situations and what you learned from them.

Professional Development: Identify any areas for professional growth and development. This could include specific skills you want to enhance, knowledge gaps to address, or aspects of your communication style to refine.

Feedback Received: Note any feedback received from preceptors, colleagues, or patients. Reflect on how you can incorporate this feedback into your future practice.

Goals for Improvement: Set realistic goals for improvement based on your reflections. These could be short-term goals for the next clinical day or longer-term goals for the duration of your NP program.

Overall Reflection: Summarize the overall experience and how it contributes to your development as a Nurse Practitioner. Consider how this experience aligns with your career goals.

Action Plan: Outline specific actions you will take based on your reflections.

Resources Consulted: List any academic or clinical resources you consulted to enhance your understanding of specific topics encountered during the day. Ensure all citations are in APA format (latest edition) and provide a separate reference page.

 

Reflective journal clinical experience sample essay

Daily Objective

My learning aim for today was to deliver culturally competent care to the different patients I would attend to in a military healthcare context and attain increased cultural sensitivity. The objective set at the beginning of my coursework was centered on maintaining cultural competence and client cultural values in practice and adhering to research findings.

Clinical Objective

I was posted to the Naval Medical Readiness & Training Command, a center offering treatment to active-duty retirees and their dependents. Patients here are most diverse, with significant variances in their cultures and ages, including trainers. A specific example was a 32-year-old man from Jordan, an English teacher in a six-month training program in the US who has upper respiratory infections URI.

Patient Encounters

The patient from Jordan had some upper respiratory infection symptoms, such as coughing, sore throat, nasal congestion, and mild fever. Therefore, upon assessment, I conducted a physical evaluation, which involved listening to lung sounds, inspecting the throat, and feeling for sinuses. There were no findings suggestive of pneumonia or other complications. Their travel history, where the patient currently lives in the US, and exposure to new environments or stressors that may contribute to his symptoms were also considered.

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Challenges Faced

A significant limitation was determining and managing patient cultural beliefs regarding disease and treatment. Again, like in most cultures, the family is involved in healthcare decisions, but the patient is alone. It was then a question of how I could offer comfort when he had no family support like the usual father, brother, uncle, or cousin. Furthermore, I handled some language stumbling by observing some facets of language barriers such as simplicity, the language used, and providing an interpreter since the patient did not accept.

Successes and Achievements

I gained trust with the patient by recognizing his cultural beliefs and values and addressing him appropriately. I asked him some questions about his expected medical treatment and if he uses any traditional methods he is practicing now, which led to the discussion about using herbs. This enabled me to explain to the patient the effects of such remedies about over-the-counter medicines that he had been prescribed for his URI.

Applied Knowledge

In this case, I was able to use my knowledge of upper respiratory infection management so that the treatment plan is consistent with the best practices. Moreover, my class work in the area of multicultural populations predisposed me to how to handle the patient. From my NP program, I pulled into practice concepts regarding cultural competence, ensuring I honored the patient’s cultural beliefs and practices as I administered information on his condition.

Collaboration and Communication

Engaging the interdisciplinary team working in the clinic was necessary. Afterward, I consulted with a pharmacist to discuss the compatibility of selected plant medicines with prescribed drugs. My approach to communication with the patient was entirely affirmative or assertive since I listened to him and ensured I understood what he was saying (Schot et al., 2020). I also provided him with educational literature in Arabic that he could read and confirm he understood.

Ethical and Cultural Considerations

Ethical issues emerged when the patient told me in detail that he felt compelled to continue training due to the sickness. I had to find out how much the patient could be trusted to make decisions about his healthy lifestyle while needing to reason with him that rest and recovery are essential (Jarvis, 2023). I thought it was culturally sensitive to use his herbal products while enlightening him on how those substances may lead to drug interactions that are dangerous to him.

Professional Development

I realized the need to learn a foreign language and enhance my skills in handling culturally sensitive problems. I also learned the significance of improving my understanding of Middle Eastern cultures and traditional medicines that involve herbs to enable me to support my patients in the future.

Feedback Received

The attending physician asked me about the patient’s condition and praised me for improving the patient’s understanding of drug interactions while also making the patient feel valued as a person (Schot et al., 2020). One asked me to develop cultural competence by being receptive to learning more about the patients being served by the clinic, which are people of different cultures.

Goals for Improvement

I plan to concentrate on my cultural communication skills, especially regarding practices in different cultures, for my next clinical day. Eventually, I plan to grow in my ability to learn about the various healthcare systems worldwide and the expectations that patients from various parts of the world have towards the medical professionals in … reflective journal clinical experience sample essay

Overall Reflection

This made me learn that cultural competence is vital in healthcare facilities. Thus, examining and incorporating the patient’s culture into care was advantageous and could be useful in the future. This is in line with my career plan of being a culturally competent Nurse Practitioner who can address patients’ needs.

Action Plan

To enhance my cultural competence, I plan to:

Discuss and compare culturally relevant health beliefs of the Middle Easterner.

Take classes on Cultural Sensitivity in healthcare delivery systems.

To attempt to practice the use of language so that they can communicate better with the non-English speaking patient.

 

 
References

Jarvis, C. (2023). 
Physical Examination and Health Assessment-Canadian E-Book: Physical Examination and Health Assessment-Canadian E-Book
. Elsevier Health Sciences.
https://books.google.co.ke/books?hl=en&lr=&id=IWy1EAAAQBAJ&oi=fnd&pg=PP1&dq=taking+a+health+history&ots=7FT28mt968&sig=4doJim6Df1oa3HlG5g25wcdRSCQ&redir_esc=y#v=onepage&q=taking%20a%20health%20history&f=false

Newman, P. A., Guta, A., & Black, T. (2021). Ethical considerations for qualitative research methods during the COVID-19 pandemic and other emergency situations: Navigating the virtual field. 
International Journal of Qualitative Methods
, 
20
, 16094069211047823.
https://doi.org/10.1177/16094069211047823

Schot, E., Tummers, L., & Noordegraaf, M. (2020). Working on working together. A systematic review on how healthcare professionals contribute to interprofessional collaboration. 
Journal of interprofessional care
, 
34
(3), 332-342.
https://doi.org/10.1080/13561820.2019.1636007 
 reflective journal clinical experience sample essay

 

Reflective journal clinical experience sample essay two

Daily Objective

Regarding learning goals for this clinical experience, I focused on three primary areas: further refining and developing my abilities to assess patients presenting with scrotal lumps, strengthening clinical decision-making, and identifying effective communication strategies when interacting with various patient populations. As a student, I planned to conduct myself confidently and warmly to obtain necessary health information from every patient. The accomplishment of these objectives would increase my confidence in clinical practice and enable me to handle other circumstances in which patient relations are central.

Clinical Objective

The Naval Medical Readiness & Training Command offers a clinical perspective to provide care for military retirees, active-duty personnel, and their families. This facility operates under five teams, each responsible for caring for patients of different demographics and diverse healthcare needs. Having insight into these conditions is essential because military members and veterans present exceptional cases due to their lifestyles (Armed et al. Division, 2024). This setting developed specificity in treatments aimed at solving the needs of patients with different backgrounds.

Patient Encounters

One of the interactions would be a patient with a discharge presenting a palpable lump in the scrotal region. Having completed the assessment, I explained possible differential diagnoses and the necessity of a follow-up appointment. It was vital for me to understand that I am the one who needs to ensure that the patient receives all the essential health information in a way that they will appreciate. This patient encounter also underlined the significance of the patient’s emotional situation and focused on the patient’s concerns without hiding the truth. Clavel et al. (2021) indicate that active patient engagement provides optimal opportunities for providing a safe and efficient care environment and ensuring that the underlying healthcare needs are effectively addressed.

Challenges Faced

I identified several challenges that impacted my learning experience and patient care. One of the difficulties was checking on the probable diagnosis with the patient because it is very delicate. There were challenges in maintaining a balance between professional and personal support for the patient when responding to possible consequences of the lump. This is the time I decided that I had to change my approach because what my patients needed was not only information but support as well. According to the research by (Galletta et al., 2022), active and effective patient engagement offers optimal opportunities for providing adequate care approaches and promoting desirable care. However, patients may experience diverse needs, which may be challenging to address using available and accessible resources. This experience suggested greater attention should be paid to patient-centered communication in potentially challenging conversations.

Successes and Achievements

I succeeded in wearing a positive professional image as I built rapport with the patient, making him open during our discussion. Establishing a solid interprofessional collaboration and care coordination with multidisciplinary caregivers and patients enabled me to attain the targeted goals and provide efficiency in service delivery. reflective journal clinical experience sample essay I could clearly explain further procedures and ensure the patient knew what would happen next. This allowed me to interact with the patients further, making them feel more at ease and comfortable asking questions. This inspires me to enhance further my ability to communicate with patients and attend to their needs effectively. In addition, with this approach, I encouraged the client to actively and adequately participate in the car, fostering the attainment of the desired common goals.

Applied Knowledge

This theoretical knowledge I was exposed to in my NP program helped me assess the patient. To build my dialogue about possible conditions and the management of scrotal masses, I referred to clinical criteria for evaluating patients with such symptoms. It was good to understand that theory in practice is quite different, and this applied practice enabled me to relate my learning well (Sagen et al., 2024). The knowledge and skills gained also reassured me of the importance of practicing clinical care based on the current practices and recommended guidelines.

Resources Consulted

I used several resources to enhance a caring environment that could optimize patient care and improve the care and management of a safe and effective care environment. These resources included clinical guidelines; communication with the members of my healthcare team could be helpful as we discussed the possibilities regarding patient care. Nevertheless, it impressed me, and I realized that my interpersonal communication, particularly with patients, should be improved, especially when talking to them about specific issues. For a counselor to create such an environment, they must learn how to do so through experimentation. I will ask my colleagues and preceptors to point out areas of strength and areas where I could improve when it comes to communication.

Action Plan

Based on my reflections, my action plan includes several key steps to enhance my clinical practice. First, I will seek opportunities to role-play sensitive conversations with peers to build confidence in delivering difficult news. Additionally, I plan to actively request feedback from my preceptor on my communication style to identify specific areas for improvement. I will discuss with my healthcare team to share insights and strategies for patient care. Lastly, I aim to research and incorporate patient-centered communication techniques, ensuring I effectively address my patients’ medical and emotional needs reflective journal clinical experience sample essay.

 

References

Armed Forces Health Surveillance Division. (2024). Ambulatory health care visits among active component members of the U.S. Armed Forces, 2023.
MSMR
,
31
(6), 19–25.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11259448/

Clavel, N., Paquette, J., Dumez, V., Del Grande, C., Ghadiri, D. P. (Sacha), Pomey, M., & Normandin, L. (2021). Patient engagement in care: A scoping review of recently validated tools assessing patients’ and healthcare professionals’ preferences and experience.
Health Expectations
,
24
(6).
https://doi.org/10.1111/hex.13344

Galletta, M., Piazza, M. F., Meloni, S. L., Chessa, E., Piras, I., Arnetz, J. E., & D’Aloja, E. (2022). Patient involvement in shared decision-making: Do patients rate physicians and nurses differently?
International Journal of Environmental Research and Public Health
,
19
(21).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9656720/

Sagen, J. S., Kjeken, I., Habberstad, A., Linge, A. D., Simonsen, A. E., Lyken, A. D., Irgens, E. L., Framstad, H., Lyby, P. S., Klokkerud, M., Dagfinrud, H., & Moe, R. H. (2024). Patient involvement in the rehabilitation process is associated with improvement in function and goal attainment: Results from an explorative longitudinal study.
Journal of Clinical Medicine
,
13
(2), 320–320.
https://doi.org/10.3390/jcm13020320
  reflective journal clinical experience sample essay

NRS-425 Community Teaching Project – Part 1

Community and Target Aggregate

·       Describe the demographic of the population being served by this organization.

Legacy Senior Living helps elderly people who, for different reasons, need different types of care, starting with independent living, personal care, and specialized care for those with Alzheimer’s and dementia. It aims to offer senior citizens an upscale and home-like environment where they can experience retirement with an active living plan and no maintenance demand. It also offers those with Alzheimer’s disease and other memory issues the much-needed comprehensive and efficient care (Legacy Senior Living, 2024). This demographic typically includes retired individuals and wartime veterans, with many facilities offering additional support services that cater to both the residents and their families, providing peace of mind through quality, attentive care in a respectful, faith-oriented, and community-focused environment.

Social Determinants of Health (SDOHs)
:

·       Identify actual and potential SDOHs that impact the demographic served by the nonprofit organization.

·       Use the following data sources or similar ones to find relevant data and identify SDOHs: 2023 County Health Rankings National Findings Report, CDC Behavioral Risk Factor Surveillance System, National Center for Chronic Disease Prevention and Health Promotion, and United States Census Bureau QuickFacts.

The senior demographic served by Legacy Senior Living is impacted by several Social Determinants of Health (SDOHs), including access to healthcare, economic stability, and social support networks. Actual SDOHs influencing this population include limited mobility and access to medical resources, as seniors may face challenges in maintaining regular health screenings or managing chronic conditions due to physical limitations and transportation needs (Healthy People 2030, 2020). Economic stability is another concern, as many retirees live on fixed incomes, impacting their ability to afford high-quality, long-term care. Potential SDOHs include the risk of social isolation, which is prevalent among older adults and associated with mental health challenges like depression. Data from the CDC Behavioral Risk Factor Surveillance System highlight the high rates of chronic disease and social isolation among the elderly (Centers for Disease Control and Prevention, 2019). In addition, findings from studies by Mokdad et al. (2020) show that seniors are at increased risk for conditions like heart disease and diabetes, which further emphasize the need for supportive healthcare and social services within these communities.

 

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Topic
:

·       Describe the education topic that will be relevant to provide to your identified nonprofit’s community members.

A health education topic of concern for the community members of Legacy Senior Living is “Managing Diabetes Mellitus.” The education topic is quite suitable for this community as it comprises senior adults at vulnerable ages at risk of developing the disease or those already diagnosed. Essential topics include sections about diabetes signs and symptoms, controlling blood sugar, and avoiding undesirable complications. With proper education, the elderly will learn how to safely manage their diet, be physically active, and adhere to medication regimens necessary to fight diabetes and reduce the risk of developing such complications as heart disease, neuropathy, and vision impairment. Training on signs and symptoms of hypo-or hyperglycemia and how to check their glucose levels will also help residents be more active in managing their health.

The rationale of Topic:

·       Explain the reason for your choice of education topic based on your research.

The education topic “Managing Diabetes Mellitus” is chosen based on high incidences of diabetes among elderly patients who require special attention due to age-related metabolic and physiological changes. Scholarly works show that diabetes is prevalent among seniors and acts as a precursor to multiple adverse health consequences, more especially when accompanied by secondary diseases, including hypertension and cardiovascular diseases (Rajaei & Parvareshi, 2022). Legacy Senior Living targets elderly people with different health complications, so it can improve the quality of their lives, prevent constant hospitalization, and help them manage their health conditions by educating them on diabetes. This emphasis on diabetes as a chronic disease complies with the general health goals in self-management education and developing preventive measures.

Healthy People 2030 (HP2030) Objectives and Measures
:

·       Discuss whether this topic was listed in the HP2030 Objectives and Measures.

·       Explain which information on this website may be relevant to assist you with your presentation.

The topic of “Managing Diabetes Mellitus” aligns with multiple Healthy People 2030 (HP2030) objectives aimed at reducing the incidence and improving diabetes management. HP2030 objectives under the Diabetes topic focus on reducing diabetes complications, increasing awareness and management strategies, and improving access to preventive care. Specific objectives include reducing the number of adults with undiagnosed diabetes, decreasing diabetes-related kidney and vision issues, and increasing the proportion of adults with diabetes who receive annual eye and foot exams (Healthy People 2030, 2021).

The HP2030 website provides relevant data and evidence-based strategies that can strengthen a presentation on diabetes management. Resources like national statistics, the impact of diabetes on quality of life, and recommended interventions are valuable for supporting the educational content. In addition, HP2030’s emphasis on health literacy and access to care highlights the importance of educating older adults on self-management skills, which is critical to reducing the condition’s impact in underserved or at-risk communities like those served by Legacy Senior Living. This guidance can help tailor the presentation to align with national goals and improve diabetes outcomes among community members.

References:

Cite a minimum of two sources in APA format to complete this assignment. Sources must be:

·       Published within the past five years.

·       Appropriate for the assignment criteria.

·       Relevant to nursing practice.

Centers for Disease Control and Prevention. (2019).
CDC – Behavioral risk factor surveillance system
. CDC.
https://www.cdc.gov/brfss/index.html

Healthy People 2030. (2020).
Social determinants of health and older adults | health.gov
. Health.gov.
https://odphp.health.gov/our-work/national-health-initiatives/healthy-aging/social-determinants-health-and-older-adults

Healthy People 2030. (2021).
Diabetes — Healthy People in action – Healthy People 2030 | odphp.health.gov
. Health.gov.
https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/diabetes/healthy-people-in-action

Jyotsna, F., Ahmed, A., Kumar, K., Kaur, P., Chaudhary, M. H., Kumar, S., Khan, E., Khanam, B., Shah, S. U., Varrassi, G., Khatri, M., Kumar, S., & Kakadiya, K. A. (2023). Exploring the complex connection between diabetes and cardiovascular disease: Analyzing approaches to mitigate cardiovascular risk in patients with diabetes.
Cureus
,
15
(8).
https://doi.org/10.7759/cureus.43882

Legacy Senior Living. (2024, May 15).
Legacy Senior Living Home – Legacy Senior Living
. Legacy Senior Living.
https://legacysl.net/

Mokdad, A. H., Ballestros, K., Echko, M., Glenn, S., Olsen, H. E., Mullany, E., Lee, A., Khan, A. R., Ahmadi, A., Ferrari, A. J., Kasaeian, A., Werdecker, A., Carter, A., Zipkin, B., Sartorius, B., Serdar, B., Sykes, B. L., Troeger, C., Fitzmaurice, C., & Rehm, C. D. (2020). The state of US health, 1990-2016.
JAMA
,
319
(14), 1444.
https://doi.org/10.1001/jama.2018.0158