Nikhil Patel is an 12-year-old Indian-American boy brought to you for an evaluation. Nikhil has been involved in outpatient psychotherapy for six months with a child therapist who provides cognitive-behavioral therapy (CBT).

Nikhil has had severe anxiety since age five. The psychotherapy seems to be only helping a little. Nikhil is still not able to go to school most days because he is very anxious. He often stays inside, refusing to go outside and play. He has become what is mother describes as “depressed.”

Answer the following questions from your perspective as his psychiatric nurse practitioner.

1. Based on the DSM-5, what symptoms would you expect to see for a diagnosis of generalized anxiety disorder (GAD)? How would you know if Nikhil has both GAD and a major depressive diagnosis?
2. What questions should you ask Nikhil’s parents relative to family history, school performance, and past treatment for Nikhil? What is your rationale for these questions?
3. What medication(s) would you recommend? Include dosing, titrating if appropriate, side effects, mechanism of action, metabolism, and excretion of the medication.
4. What information would you want from the therapist currently treating Nikhil? Do you think Nikhil should switch therapists, try a new therapy approach, or continue with the same CBT approach? Provide your rationale.

In inpatients admitted to the critical care units (P), how does the implementation of the CAUTI bundled approach to care (I), compared to the use of a single intervention (C), resulting in a decrease in the number of CAUTI cases (O), over a period of 10 weeks (T)?

I used the 3 references below.

Al-Hameed, F. M., Ahmed, G. R., AlSaedi, A. A., Bhutta, M. J., Al-Hameed, F. F., & AlShamrani, M. M. (2018). Applying preventive measures leading to significant reduction of catheterassociated urinary tract infections in adult intensive care unit. Saudi

 

Medical Journal, 39(1), 97.10.15537/smj.2018.1.20999 Shadle, H. N., Sabol, V., Smith, A., Stafford, H., Thompson, J. A., & Bowers, M. (2021). A Bundle-Based Approach to Prevent Catheter-Associated Urinary Tract Infections in the Intensive Care Unit. Critical Care Nurse, 41(2), 62-71. 10.4037/ccn2021934

 

Van Decker, S. G., Bosch, N., & Murphy, J. (2021). Catheter-associated urinary tract infection reduction in critical care units: a bundled care model. BMJ Open Quality, 10(4), e001534. http://dx.doi.org/10.1136/bmjoq-2021-001534.

 

Can you please help me to summarize the 3 sources above that address the target population in the PICOT question.

Then, synthesize the evidence from these sources into one paragraph in support of the target population.

This assessment focuses on crafting an argument in support of the selection of the target population identified in the PICOT question.

Which patient would be an inappropriate candidate for genetic testing. 52 year old Ashkenazi jewish woman diagnosed with breast cancer

34 year old caucasian woman diagnosed with epithelial ovarian cancer

26 year old asian woman with a mother and maternal grandmother diagnosed with breast cancer

64 year old african american woman who ha a grandmother diagnosed with breast cancer at 79 years old