Assessing and Treating Patients With Psychosis and Schizophrenia

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Assignment: Assessing and Treating Patients With Psychosis and Schizophrenia
Psychosis and schizophrenia greatly impact the brain’s normal processes, which interfere with the ability to think clearly. When symptoms of these disorders are uncontrolled, patients may struggle to function in daily life. However, patients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with psychosis and schizophrenia.
To prepare for this Assignment:
Review this week’s Learning Resources, including the Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with schizophrenia-related psychoses.
The Assignment: 5 pages
Examine Case Study: Pakistani Woman With Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
Introduction to the case (1 page)
Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)
Which decision did you select?
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion
Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

Pelvic inflammatory disease

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Pelvic inflammatory disease case study

Ann is a 32-year-old married female who presents to her nurse practitioner reporting lower abdominal pain, cramping, slight fever, and dysuria of 3 days duration.

History includes:

LMP 2 weeks ago (regular)
Reports oral contraceptive use
Reports pain in lower abdomen with cramping and pain on urination for 3 days
Denies any GI problems, reports regular bowel movements.

Denies vaginal discharge
Ann is married and in a monogamous relationship. Has one child age 2
Reports no use of condoms/sexual intercourse 2-3 times per week
Denies any history of STDs

Physical Exam reveals:

Temp 100. 6, P 80 BP 100/62 Wt. 125 Ht. 5’3’’
HEENT WNL
No CVA tenderness
Pain in lower quadrants with light palpation. Positive inguinal lymphadenopathy
External genitalia without lesions or discharge
Pelvic exam reveals minimal cervical mucopus
Bimanual exam reveals uterine and adnexal tenderness and cervical motion pain. Uterus anterior, midline, smooth, not enlarged

1. Based on the above case the diagnosis is PID, What is an appropriate CDC-recommended therapeutic regimen for this patient?

Neurological and Musculoskeletal Disorders

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Knowledge Check Wk6 : Neurological and Musculoskeletal Disorders

• In this exercise, you will complete 5-essay type questions in the Knowledge Check to gauge your understanding of this module’s content.
• Each question will hold one to two parts asked to be addressed and each part will need at least one citation, at least two citations if asked two parts to the question from the textbook and/or current peer-reviewed journals.
• Each question is worth 4 points. I would expect substantive paragraphs per answer (a paragraph would include 6-10 sentences).

KC each essay needs a citation(s) and reference(s), if using textbook apply correct page(s)
Basic book citation format
The APA in-text citation for a book includes the author’s last name, the year, and (if relevant) a page number.
In the reference list, start with the author’s last name and initials, followed by the year. The book title is written in sentence case (only capitalize the first word and any proper nouns). Include any other contributors (e.g. editors and translators) and the edition if specified (e.g. “2nd ed.”).
Format Last name, Initials. (Year). Book title (Editor/translator initials, Last name, Ed. or Trans.) (Edition). Publisher.
Reference entry Anderson, B. (1983). Imagined communities: Reflections on the origins and spread of nationalism. Verso.
In-text citation (Anderson, 1983, p. 23)
QUESTION 1

Scenario 1: Gout
A 68-year-old obese male presents to the clinic with a 3-day history of fever with chills, and Lt. great toe pain that has gotten progressively worse. Patient states this is the first time that this has happened, and nothing has made it better and walking on his right foot makes it worse. He has tried acetaminophen, but it did not help. He took several ibuprofen tablets last night which did give him a bit of relief.
HPI: hypertension treated with Lisinopril/HCTZ .
SH: Denies smoking. Drinking: “a fair amount of red wine” every week. General appearance: Ill appearing male who sits with his right foot elevated.
PE: remarkable for a temp of 100.2, pulse 106, respirations 20 and BP 158/92. Right great toe (first metatarsal phalangeal [MTP]) noticeably swollen and red. Unable to palpate to assess range of motion due to extreme pain. CBC and Complete metabolic profile revealed WBC 15,000 mm3 and uric acid 9.0 mg/dl.
Diagnoses the patient with acute gout.
Question:
Explain the pathophysiology of gout.

QUESTION 2
1. Scenario 1: Gout

A 68-year-old obese male presents to the clinic with a 3-day history of fever with chills, and Lt. great toe pain that has gotten progressively worse. Patient states this is the first time that this has happened, and nothing has made it better and walking on his right foot makes it worse. He has tried acetaminophen, but it did not help. He took several ibuprofen tablets last night which did give him a bit of relief.

HPI: hypertension treated with Lisinopril/HCTZ .

SH: Denies smoking. Drinking: “a fair amount of red wine” every week. General appearance: Ill appearing male who sits with his right foot elevated.

PE: remarkable for a temp of 100.2, pulse 106, respirations 20 and BP 158/92. Right great toe (first metatarsal phalangeal [MTP]) noticeably swollen and red. Unable to palpate to assess range of motion due to extreme pain. CBC and Complete metabolic profile revealed WBC 15,000 mm3 and uric acid 9.0 mg/dl.

Diagnoses the patient with acute gout.

Question:
Explain why a patient with gout is more likely to develop renal calculi.

QUESTION 3
1. Scenario 2: Osteoporosis
A 78-year-old female was out walking her small dog when her dog suddenly tried to chase a rabbit and made her fall. She attempted to try and break her fall by putting her hand out and she landed on her outstretched hand. She immediately felt severe pain in her right wrist and noticed her wrist looked deformed. Her neighbor saw the fall and brought the woman to the local ER for evaluation. Radiographs revealed a Colles’ fracture (distal radius with dorsal displacement of fragments) as well as radiographic evidence of osteoporosis. A closed reduction of the fracture was successful, and she was placed in a posterior splint with ace bandage wrap and instructed to see an orthopedist for follow up.
Question:
Discuss what is osteoporosis and how does it develop pathologically?

QUESTION 4
1. Scenario 3: Rheumatoid Arthritis
A 48-year-old woman presents with a five-month history of generalized joint pain, stiffness, and swelling, especially in her hands. She states that these symptoms have made it difficult to grasp objects and has made caring for her grandchildren problematic. She admits to increased fatigue, but she thought it was due to her stressful job.
FH: Grandmothers had “crippling” arthritis.
PE: remarkable for bilateral ulnar deviation of her hands as well as soft, boggy proximal interphalangeal joints. The metatarsals of both of her feet also exhibited swelling and warmth.
Diagnosis: rheumatoid arthritis.
Question:
The pt. had various symptoms, explain how these factors are associated with RA and what is the difference between RA and OA?

QUESTION 5
1. Scenario5: Multiple Sclerosis (MS)
A 28-year-old obese, female presents today with complaints for several weeks of vision problems (blurry) and difficulty with concentration and focusing. She is an administrative para-legal for a law firm and notes her symptoms have become worse over the course of the addition of more attorneys and demands for work. Today, she noticed that her symptoms were worse and were accompanied by some fine tremors in her hands. She has been having difficulty concentrating and has difficulty voiding. She went to the optometrist who recommended reading glasses with small prism to correct double vision. She admits to some weakness as well. No other complaints of fevers, chills, URI or UTI
PMH: non-contributory
PE: CN-IV palsy. The fundoscopic exam reveals edema of right optic nerve causing optic neuritis. Positive nystagmus on positional maneuvers. There are left visual field deficits. There was short term memory loss with listing of familiar objects.
DIAGNOSIS: multiple sclerosis (MS).
Question:
Describe what is MS and how did it cause the above patient’s symptoms?

Stages of syphilis

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Stages of syphilis

A 37-year-old male comes to the clinic with a complaint of a “sore on my penis” that has been there for 5 days. He says it burns and leaked a little fluid. He denies any other symptoms. Past medical history noncontributory.
SH: Bartender and he states he often “hooks up” with some of the patrons, both male and female after work. He does not always use condoms.
PE: WNL except for a lesion on the lateral side of the penis adjacent to the glans. The area is indurated with a small round raised lesion. The APRN orders laboratory tests but feels the patient has syphilis.

Question:
What are the 4 stages of syphilis

Pelvic Inflammatory Disease (PID)

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Pelvic Inflammatory Disease (PID)

A 30-year-old female comes to the clinic with a complaint of abdominal pain, foul-smelling vaginal discharge, and fever and chills for the past 5 days. She denies nausea, vomiting, or difficulties with bowels. Last bowel movement this morning and was normal for her.

Nothing has helped with the pain despite taking ibuprofen 200 mg orally several times a day. She describes the pain as sharp and localizes the pain to her lower abdomen. Past medical history noncontributory. GYN/Social history for having had unprotected sex while at a fraternity party. Physical exam: thin, Ill appearing anxious-looking white female who is moving around on the exam table and unable to find a comfortable position. Temperature 101.6F orally, pulse 120, respirations 22 and regular.

Review of systems negative except for chief complaint. Focused assessment of abdomen demonstrated moderate pain to palpation left and right lower quadrants. Upper quadrants are soft and non-tender. Bowel sounds diminished in bilateral lower quadrants. Pelvic exam demonstrated adnexal tenderness, cervical motion tenderness, and copious amounts of greenish thick secretions. The APRN diagnoses the patient as having the pelvic inflammatory disease (PID).

Question:
What is the pathophysiology of PID?

Polycystic Ovarian Syndrome (PCOS)

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Polycystic Ovarian Syndrome (PCOS)
A 29-year-old female presents to the clinic with a complaint of hirsutism and irregular menses. She describes irregular and infrequent menses (five or six per year) since menarche at 11 years of age. She began to develop dark, coarse facial hair when she was 13 years of age, but her parents did not seek treatment or medical opinion at that time. The symptoms worsened after she gained weight in college. She got married 3 years ago and has been trying to get pregnant for the last 2 years without success. Height 66 inches and weight 198. BMI 32 kg.m2. Moderate hirsutism without virilization noted. Laboratory data reveal CMP within normal limits (WNL), CBC with manual differential (WNL), TSH 0.9 IU/L SI units (normal 0.4-4.0 IU/L SI units), total testosterone of 65 ng/dl (normal 2.4-47 ng/dl), and glycated hemoglobin level of 6.1% (normal value ≤5.6%). Based on this information, the APRN diagnoses the patient with the polycystic ovarian syndrome (PCOS) and refers her to the Women’s Health APRN for further workup and management.

Question:
What is the pathogenesis of PCOS?
How does PCOS affect a woman’s fertility or infertility?

Cluster Headache

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Cluster Headache

Bob, a 38-year-old male, has been experiencing severe intermittent headaches for about 10 years. When they occur, he experiences intense burning pain on one side of his head, tearing in his eye, congestion and a runny nose. These headaches generally occur several times a day and last approximately one hour. The headaches are episodic; Bob can be headache-free for several months but then experience an attack.

Based on the case scenario, provide a diagnosis for Bob. Provide the pathophysiology for this type of headache and discuss current treatment options

Medication Administration and patient safety

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Medication Administration and patient safety

  1. Introduction of Topic- What is the topic about? Why is it important?  What are some statistics related to the topic?  Why is it relevant today?
  2. Key points of topic that nurses need to be aware of
    1. Information about subtopic broken down into paragraphs, as many as needed, with in-text citations
  • Current initiatives related to the topic (federal, state level, and/or facility level).
    1. Information about subtopic broken down into paragraphs, as many as needed, with in-text citations
  1. RN role in topic as it relates to nursing practice and a safety, not just for clients but also for nurses.
    1. Information about subtopic broken down into paragraphs, as many as needed, with in-text citations
  2. Conclusion- Summarize the main themes of the paper; What do you what your reader to take away from reading this paper? Have you demonstrated that you thoroughly understand the topic?

Cognitive Impairment and B Vitamins

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Cognitive Impairment and B Vitamins

The original research paper you will compose on your approved topic will consist of 5 sections;

Section 1: Introduction
Section 2: Review of Literature
Section 3: Summary for Healthcare Professionals and Conclusions
Section 4: Tabled Synopsis of Recommendations
Section 5: References

Section 1: Introduction

Provide an overview of the topic. Give information such as: What is the disease/disorder you are reviewing? What is its prevalence? Who does it affect? What type of dietary or nutrition component are you reviewing? How is it possibly related to the disease/disorder you are reviewing? Is there a possible mechanism that is known for this relationship?
End your introduction with a purpose statement. In this purpose statement, you should identify the dietary/nutrition component of interest, the disease/disorder of interest, and the population you are focusing on. Ex: The purpose of this review is to examine the effect of vitamin D supplementation on cardiovascular disease incidence in adults.

Section 2: Review of Literature
Review/discuss a minimum of 5 original research articles. I do not recommend using meta-analyses for these, as they can be very difficult to summarize succinctly. Also, at least 4 of the 5 should be human research. The remaining 1 of the required 5 can be bench research or animal research if you wish but, again, these can be challenging to review correctly so I do not recommend it.
For each study briefly describe the purpose and design of the study. How many participants were included? Was there anything interesting about their inclusion/exclusion criteria? (Note – you don’t need to list all inclusion/exclusion criteria, but definitely identify the main ones.) Present the major results and conclusions. Identify any limitations of the research.

Section 3: Summary for Healthcare Professionals and Conclusions
This section should be written in paragraph form, summarizing the important points of your Review of Literature.

Section 4: Tabled synopsis of recommendations written in layperson language for use in the community (or clinical) setting and justifications for the recommendations.
This section should contain 3 recommendations and justifications for community education or clinical practice, written in table format.

Personal Nursing Philosophy

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Personal Nursing Philosophy

You have explored theories of nursing. These represent the “how” of what we do as nurses. Enter a higher level of thought and explore the “why” of what we do. Present a personal nursing philosophy. Apply what you have read throughout the course and explore the literature on nursing philosophy.

While Fawcett was not a nursing theorist, she is a nursing philosopher and her Metaparadigm of Nursing approaches philosophy over theory. Once you have discussed your philosophy, identify a theoretical framework (not the middle-range theories but the underlying assumptions in that framework) that fits your philosophy.

Compare and contrast your philosophy and the chosen framework. Describe a possible situation in which the framework may conflict or not fit your philosophy. While it is an important skill to be able to match a theory with a situation, it is also critical to understand when a theory or framework does not fit a situation.