Nursing

Mrs G, a 55 year old Hispanic female, presents to the office for her annual exam. She reports that lately she has been very fatigued and just does not seem to have any energy. This has been occurring for 3 months. She is also gaining weight since menopause last year. She joined a gym and forces herself to go twice a week, where she walks on the treadmill at least 30 minutes but she has not lost any weight, in fact she has gained 3 pounds. She doesn’t understand what she is doing wrong. She states that exercise seems to make her even more hungry and thirsty, which is not helping her weight loss. She wants get a complete physical and to discuss why she is so tired and get some weight loss advice. She also states she thinks her bladder has fallen because she has to go to the bathroom more often, recently she is waking up twice a night to urinate and seems to be urinating more frequently during the day. This has been occurring for about 3 months too. This is irritating to her, but she is able to fall immediately back to sleep.
Current medications: Tylenol 500 mg 2 tabs daily for knee pain. Daily multivitamin
PMH: Has left knee arthritis. Had chick pox and mumps as a child. Vaccinations up to date.
GYN hx: G2 P1. 1 SAB, 1 living child, full term, wt 9lbs 2 oz. LMP 15months ago. No history of abnormal Pap smear.
FH: parents alive, well, child alive, well. No siblings. Mother has HTN and father has high cholesterol.
SH: works from home part time as a planning coordinator. Married. No tobacco history, 1-2 glasses wine on weekends. No illicit drug use
Allergies: NKDA, allergic to cats and pollen. No latex allergy
Vital signs: BP 129/80; pulse 76, regular; respiration 16, regular
Height 5’2.5”, weight 185 pounds
General: obese female in no acute distress. Alert, oriented and cooperative.
Skin: warm dry and intact. No lesions noted
HEENT: head normocephalic. Hair thick and distribution throughout scalp. Eyes without exudate, sclera white. Wears contacts. Tympanic membranes gray and intact with light reflex noted. Pinna and tragus nontender. Nares patent without exudate. Oropharynx moist without erythema. Teeth in good repair, no cavities noted. Neck supple. Anterior cervical lymph nontender to palpation. No lymphadenopathy. Thyroid midline, small and firm without palpable masses.
CV: S1 and S2 RRR without murmurs or rubs
Lungs: Clear to auscultation bilaterally, respirations unlabored.
Abdomen- soft, round, nontender with positive bowel sounds present; no organomegaly; no abdominal bruits. No CVAT.
Labwork:
CBC: WBC 6,000/mm3 Hgb 12.5 gm/dl Hct 41% RBC 4.6 million MCV 88 fl MCHC 34 g/dl RDW 13.8%
UA: pH 5, SpGr 1.013, Leukocyte esterase negative, nitrites negative, 1+ glucose; small protein; negative for ketones
CMP:
Sodium 139
Potassium 4.3
Chloride 100
CO2 29
Glucose 126
BUN 12
Creatinine 0.7
GFR est non-AA 94 mL/min/1.73
GFR est AA 101 mL/min/1.73
Calcium 9.5
Total protein 7.6
Bilirubin, total 0.6
Alkaline phosphatase 72
AST 25
ALT 29
Anion gap 8.10
Bun/Creat 17.7
Hemoglobin A1C: 6.9 %
TSH: 2.35, Free T 4 0.8 ng/dL
Cholesterol: TC 230 mg/dl, LDL 144 mg/dl; VLDL 36 mg/dl; HDL 38mg/dl, Triglycerides 232
EKG: normal sinus rhythm
Use the categories below to create section headings for your paper. Review the APA Manual for paper format instructions.
Introduction: briefly discuss the purpose of this paper.
Assessment: review the provided case study information.
Identify the primary, secondary and differential diagnoses for the patient. Use the 601 SOAP note format as a guide to develop your diagnoses.
Each diagnosis will include the following information:
1. ICD 10 code.
2. A brief pathophysiology statement which his no longer that 2 sentences, paraphrased and includes common signs and symptoms of the diagnosis.
3. The patient’s pertinent positive and negative findings, including a brief 1-2 sentence statement which links the subjective and objective findings (including lab data and interpretation).
4. A rationale statement which summarizes why the diagnosis was chosen.
5. Do not include quotes, paraphrase all scholarly information and provide an intext citation to your scholarly reference. Use the Reference Guidelines document for information on scholarly references.
Plan (there are five (5) sections to the management plan)
1. Diagnostics. List all labs and diagnostic test you would like to order. Each test includes a rationale statement following the listed lab which includes the diagnosis for the test, the purpose of the test and how the test results will contribute to your management plan. Each rationale statement is cited.
2. Medications: Each medication is listed in prescription format. Each prescribed and OTC medication is linked to a specific diagnosis and includes a paraphrased EBP rationale for prescribing.
3. Education: section includes personalized detailed education on all five (5) subcategories: diagnosis, each medication purpose and side effects, diet, personalized appropriate exercise recommendations and warning sign for diagnosis and medications if applicable. All education steps are linked to a diagnosis, paraphrased, and include a paraphrased EBP rationale. Review the NR601 SOAP note guideline for more detailed information.
4. Referrals: any recommended referrals are appropriate to the patient diagnosis and current condition, is linked to a specific diagnosis and includes a paraphrased EBP rationale with in text citation.
5. Follow up: Follow up includes a specific time, not a time range, to return to PCP office for next scheduled appointment. Includes EBP rationale with in text citation.
Medication costs: in this section students will research the costs of all prescribed and OTC monthly medications. Students may use Good Rx, Epocrates or another resource (can use local pharmacy websites) which provides medication costs. Students will list each medication, the monthly cost of the medication and the reference source. Students will calculate the monthly cost of the case study patient’s prescribed and OTC medications and provide the total costs of the month’s medications. Reflect on the monthly cost of the medications prescribed. Discuss if prescriptions were adjusted due to cost. Discuss if will you use medication pricing resources in future practice.
SOAP note: A focused SOAP note, written on a separate page, follows the assignment. The SOAP note is written following the provided SOAP note format.
• The subjective section is organized to follow the SOAP note format. The ROS is focused, only pertinent body systems are included. Only provided information is included in the ROS. No additional data is added.
• The objective section is maintained as written, no additional information is added.
• The assessment section includes only the diagnoses and ICD 10 codes. Diagnosed are labeled as primary, secondary or differential diagnoses. Rationale is not included in the SOAP note.
• The plan includes 5 sections. Rationale is not included in the SOAP note.

Classmate (Adriana)Response (1) PUB 655 Public health-655-Topic 3 DQ 1 Health and Burden Of Disease
This order is for a response to a classmate’s essay. I have uploaded the question and the classmate’s essay that requires a response.
Respond to the classmate essay by:
1. sharing an insight and asking a probing question
2. offering and supporting an opinion please elaborate on one or two points from the classmate’s post.
3. validating an idea
4. making a suggestion
-Please use your own words and do not copy what she wrote
– Sources must be published within the last 5 years. It must be from 2017 and after and appropriate for the paper criteria and public health content.
– Please do not use blogs as references
-References should be in APA 7th ed.
-Add references to reference page
-Add the hyperlink/DOI for each reference in APA 7th edition format.
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Solution
Controlling Infectious Diseases
Your post is quite informative. Adriana, I agree that globalization brings about complex resources, infrastructure, and monetary considerations that pose risks and benefits to humans and the environment. Globalization is the spread of products, technology, information, and jobs across the national borders and cultures (Castañeda & Shemesh.,2020). Many individuals have wondered whether globalization is bad or good. Generally, advocates for globalization will point at the affected decline in the poverty that has occurred throughout the world over some decades back, that many economic experts attribute in part to improved investment and trade between the countries. Equally, these economists will say that globalization has allowed services and products like airplanes, information technology, and cellphones to be spread far more extensively across the globe. On the other hand, the globalization critics point to the negative influence it has had on particular nation productions that may face improved competition from the global firms. Globalization may also have adverse environmental effects following industrialization, economic development, and international travel.
Globalization in healthcare has contributed positively very much. I support your point that several citizens who flock to other nations for healthcare purposes obtain better care and treatments with meaningfully shorter wait times and better-maintained facilities for which they are most likely to pay more money. As well, there’s also a cross-border use of the health services that benefit patients providing much-required resources to the national health systems and enhanced regulatory practices (Navarro Espigares.,2019).
The national agencies like Ministries of Health have set objectives implemented via policy. These objectives include bridging equity gaps in access to healthcare and nutrition services, ensuring maintainable financing measures that protect the poor, strengthening governance and enhancing the effectiveness of the health system, and improving quality of the health services delivery including mental health services (Bukhman et al., 2020). As you have pinpointed, these agencies ensure they advocate, execute, assess, and create strategic plans that simplify and mobilize the resources for public health. In addition to your advice to the Minister of Health in integrating healthcare and public health, I would advise them on coordinating healthcare services for individuals. This is because coordination of healthcare services for individuals is a key approach for promoting cross-sectoral collaboration between healthcare and public health for excellent outcomes.
References
Bukhman, G., Mocumbi, A. O., Atun, R., Becker, A. E., Bhutta, Z., Binagwaho, A., … & Wroe, E. B. (2020). The Lancet NCDI Poverty Commission: bridging a gap in universal health coverage for the poorest billion. The Lancet, 396(10256), 991-1044. DOI: https://doi.org/10.1016/S0140-6736(20)31907-3
Castañeda, E., & Shemesh, A. (2020). Overselling globalization: the misleading Conflation of economic globalization and immigration, and the subsequent backlash. Social Sciences, 9(5), 61. https://doi.org/10.3390/socsci9050061
Navarro Espigares, J. L. (2019). Healthcare services and globalization. HAL. DOI: 10.15122/isbn.978-2-406-09230-8.p.0045

BSN program NRS 490 Scholarly Activity
This is a scholarly activity assignment for NRS 490 and must address the Grand Canyon University objectives for BSN-RN competency and mission critical elements listed below
I also wanted to know if you have a list of portfolio documents that are required in this same course and cost of each
How does this Individual Success Plan support the GCU Mission?
MC1: Effective Communication:
Therapeutic communication is central to baccalaureate nursing practice. Students gain an understanding of their ethical responsibility and how verbal and written communication affects others intellectually and emotionally. Students begin to use nursing terminology and taxonomies within the practice of professional and therapeutic communication. Courses require students to write scholarly papers, prepare presentations, develop persuasive arguments, and engage in discussion that is clear, assertive, and respectful.
MC2: Critical Thinking:
Courses require students to use critical thinking skills by analyzing, synthesizing, and evaluating scientific evidence needed to improve patient outcomes and professional practice.
MC3: Christian Worldview:
Students will apply a Christian worldview within a global society and examine ethical issues from the framework of a clearly articulated system of professional values. Students will engage in discussion of values-based decisions made from a Christian perspective.
MC4: Global Awareness, Perspectives, and Ethics:
The concept of global citizenship is introduced to baccalaureate students in the foundational curriculum. Some courses will focus on the human experience across the world health continuum. The World Health Organization (WHO) definitions of health, health disparities, and determinants of health are foundational to nursing practice.
MC5: Leadership:
Students will apply a Christian worldview within a global society and examine ethical issues from the framework of a clearly articulated system of professional values. Students will engage in discussion of values-based decisions made from a Christian perspective.
B. Domains and Competencies
How does this Individual Success Plan support the Program Domains and Competencies?
Domain 1: Professional Role
Graduates of Grand Canyon University’s RN-BSN program will be able to incorporate professional values to advance the nursing profession through leadership skills, political involvement, and life-long learning.
Competencies:
1.1: Exemplify professionalism in diverse health care settings.
1.2: Manage patient care within the changing environment of the health care system.
1.3: Exercise professional nursing leadership and management roles in the promotion of patient safety and quality care.
1.4: Participate in health care policy development to influence nursing practice and health care.
1.5: Advocate for autonomy and social justice for individuals and diverse populations.
Domain 2: Theoretical Foundations of Nursing Practice
Graduates of Grand Canyon University’s RN-BSN program will have acquired a body of nursing knowledge built on a theoretical foundation of liberal arts, science, and nursing concepts that will guide professional practice.
Competencies:
2.1: Incorporate liberal arts and science studies into nursing knowledge.
2.2: Comprehend nursing concepts and health theories.
2.3: Understand and value the processes of critical thinking, ethical reasoning, and decision making.
Domain 3: Nursing Practice
Graduates of Grand Canyon University’s RN-BSN program will be able to utilize the nursing process to provide safe quality care based on nursing best practices.
Competencies:
3.1: Utilize the nursing process to provide safe and effective care for patients across the health-illness continuum: promoting, maintaining, and restoring health; preventing disease; and facilitating a peaceful death.
3.2: Implement patient care decisions based on evidence-based practice.
3.3: Provide individualized education to diverse patient populations in a variety of health care settings.
3.4: Demonstrate professional standards of practice.
Domain 4: Communication/Informatics
Graduates of Grand Canyon University’s RN-BSN program will be able to manage information and technology to provide safe quality care in a variety of settings. In addition, graduates will be able to communicate therapeutically and professionally to produce positive working relationships with patients and health care team members.
Competencies:
4.1: Utilize patient care technology and information management systems.
4.2: Communicate therapeutically with patients.
4.3: Professionally communicate and collaborate with the interdisciplinary health care teams to provide safe and effective care.
Domain 5: Holistic Patient Care
Graduates of Grand Canyon University’s RN-BSN program will be able to provide holistic individualized care that is sensitive to cultural and spiritual aspects of the human experience.
Competencies:
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Example Solution:
Scholarly activity summary
My research focus was on advocacy and activism, particularly to highlight and address the health needs of vulnerable groups who are typically overlooked during health policy development and implementation owing to underrepresentation. My basic research was on the position that documentation play in facilitating nursing care. Besides that, I presented a summary of the merits and demerits of electronic health records (EHR) system for the patients, nursing personnel and other medical personnel. My research was intended to improve the acceptance and implementation of EHR among medical facilities and adoption among medical personnel. In particular, how can EHR be leverage to improve the provision of nursing care services?
My work on the area of EHR first identified the need for such systems. I determined that although EHR systems are costly during the implementation phase, it is an imperative for medical facilities to implement the system so as to be compliant with HITECH Act. The Act offers incentives for medical facilities to implement EHR having noted that it improves security protection and privacy with regards to how patient information is handled. This includes introducing mandatory penalties for facilities that have contravened the HIPAA with the intention of enhancing the enforcement of HIPAA and public confidence. Secondly, it improves patients’ involvement in the care process. Thirdly, it facilitates patients’ access to their medical records. Finally, it defines the information that is protected and what can be freely shared with third parties (Feldman, 2012). While determining that EHR systems are intended to improve protection and authorized access of medical records, I also identified that the system has some demerits. Of particular concern is the fact that medical facilities are largely motivated by the need to be compliant with HIPAA and HITECH Act, and not the need to improve care provision (Mennemeyer et al., 2016). My current work looks at how to bring about an attitude change so that medical personnel and facilities are motivated to implement EHR systems as a strategy for improving care outcomes and not a need to be compliant with the legal requirements for information protection.
References
Feldman, A. (2012). Understanding health care reform: bridging the gap between myth and reality. Boca Raton, FL: CRC Press.
Mennemeyer, S., Menachemi, N., Rahurkar, S. & Ford, E. (2016). Impact of the HITECH Act on physicians’ adoption of electronic health records. J Am Med Inform Assoc., 23(2), 375-379. doi: 10.1093/jamia/ocv103

NURS 6521 week 8 Assignment: Assignment: Decision Tree for Neurological and Musculoskeletal
To Prepare
Review the interactive media piece assigned. http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_07/index.html
Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.
Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.
You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.
By Day 7 of Week 8
Write a 1- to 2-page summary paper that addresses the following:
Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.
You will submit this Assignment by the end of Week 8.
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Solution

Assignment 2: Study Plan NRNP 6665
Based on your practice test question results, and considering the national certification exam, summarize your strengths and opportunities for improvement. Note: Your grade for this Assignment will not be derived from your test results but from your self-reflection and study plan.
Create a study plan for this quarter to prepare for the certification exam, including three or four SMART goals and the tasks you need to complete to accomplish each goal. Include a timetable for accomplishing them and a description of how you will measure your progress.
Describe resources you would use to accomplish your goals and tasks, such as ways to participate in a study group or review course, mnemonics and other mental strategies, and print or online resources you could use to study.
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Solution
Assignment 2: Study Plan NRNP 6665
Based on the practice test question results, I have realized that my strength is in clinical competence. I have shown ability to perform and act in various real-life situations and so, I am looking forward to skill-based practical exams to help me hone my skills. Essentially, the current health care is highly complex and requires quick decisions and care to ensure patient well-being. As such, tapping on my strength in clinical competence will be crucial in navigating the complex and evolving health care system (Adib Hajbaghery & Eshraghi Arani, 2018). In regard to the national certification exam, I acknowledge that this exam will ensure that I have requisite education, skills, and experience for patient care and improving health outcomes. Therefore, the opportunity to improve on this exam includes creating study plan, effective study strategies, building confidence, reducing anxiety, developing test-taking skills, and ensuring time management. These skills are crucial and resourceful for success. Once I have mastered these skills, I will most likely learn the subject materials effectively and enhance my opportunity of passing the certification exams.
Study Plan with SMART Goals
Smart Goals How to Achieve SMART Goals
Specific I want to enhance my overall performance to pass my certification exam and become certified registered nurse. Develop a study plan using my set target, study materials, and knowledge about myself.
Measurable I will earn credit pass or better in my certification exams. Start studying for the exam and improving on my weak areas.
Attainable I will meet with my instructor once a week to help me focus on my weak areas. Ensuring one-on-one interaction to ensure proper guidance on how to play to my strengths.
Relevant I would like to focus on myself and behaviors and not the things above my control. This will help me to remain focused and pass my certification exam, which will open new doors for me. Look at my past successes, test-taking skills, and failures. This will help me clearly recognize what has worked for me and what has not worked.
Time-Based I still have three months to certification exam. This provides sufficient time to prepare and also meet with my instructor and decide if more steps are appropriate. Update and revise on the areas that need more effort.
Resources to Accomplish Goals and Tasks
Different resources will be used to achieve my goals and tasks. One of the resources includes study group which is essential in encouraging creative thinking and building effective communication skills, which are crucial in nursing practice (Yusuf et al., 2019). The other strategy is to use mnemonic strategy to help in enhancing memory on critical information. This technique is essential in connecting the new learning to the past knowledge by use acoustic cues and visuals (Dresler et al., 2017). Finally, online resources such as documents on Internet and web pages can be used to provide valuable information.
References
Adib Hajbaghery, M., & Eshraghi Arani, N. (2018). Assessing nurses’ clinical competence from their own viewpoint and the viewpoint of head nurses: A descriptive study. Iran Journal of Nursing, 31(111), 52-64. http://ijn.iums.ac.ir/article-1-2628-en.html
Dresler, M., Shirer, W. R., Konrad, B. N., Müller, N. C., Wagner, I. C., Fernández, G., … & Greicius, M. D. (2017). Mnemonic training reshapes brain networks to support superior memory. Neuron, 93(5), 1227-1235. https://doi.org/10.1016/j.neuron.2017.02.003
Yusuf, Q., Jusoh, Z., & Yusuf, Y. Q. (2019). Cooperative Learning Strategies to Enhance Writing Skills among Second Language Learners. International Journal of Instruction, 12(1), 1399-1412. https://eric.ed.gov/?id=EJ1201198

Disease Analysis Paper
For this assignment, you will select a disease of your choice ( YOU CAN CHOOSE) and conduct a detailed analysis of that disease, exploring it from a balanced traditional and alternative health perspective.
Begin by searching the Center for Disease Control (CDC) website Diseases and Conditions Index (https://www.cdc.gov/DiseasesConditions/az/a.html ) to choose a disease or condition of interest to you.
Next, review the website for Healthy People 2020 (https://health.gov/healthypeople) for information related to the disease or the disease category (e.g., mental health for ADHD).
In your paper, discuss the following:
Prominent aspects of this disease
Current data and statistics related to the disease
Health disparities related to the disease
Prevention strategies including complementary and alternative health therapies
Contemporary research and clinical studies related to the disease
An analysis of the pathophysiologic effects of stress related to the disease
Evidence-based stress management interventions that might help with prevention or cure
The paper should be between 3–4 pages.
Incorporate at least three scholarly sources within the paper. Sources should be no more than three years old.
Use proper APA format to cite and reference sources.
Review the rubric for further information on how your assignment will be graded.
Due: Sunday, 11:59 p.m. (Pacific time)
Points: 100
Rubric
NURS_561_DE – Paper/Essay Rubric
NURS_561_DE – Paper/Essay Rubric
Criteria Ratings Pts
This criterion is linked to a Learning Outcome Content
40 to >31.6 pts
Meets Expectations
The writer clearly and effectively responds to the assignment.
31.6 to >23.6 pts
Approaches Expectations
The response to the assignment is generally adequate but may not be thorough.
23.6 to >0 pts
Not Meeting Expectations
The writer does not respond to the assignment.
40 pts
This criterion is linked to a Learning Outcome Focus and Detail
30 to >23.7 pts
Meets Expectations
There is one clear, well-focused topic. Main ideas are clear and are well supported by detailed and accurate information.
23.7 to >17.7 pts
Approaches Expectations
There is one clear, well-focused topic. Main ideas are clear but are not well supported by detailed information.
17.7 to >0 pts
Not Meeting Expectations
The topic and main ideas are not clear.
30 pts
This criterion is linked to a Learning Outcome Organization
20 to >15.8 pts
Meets Expectations
The introduction is inviting, states the main topic, and provides an overview of the paper. Information is relevant and presented in a logical order. The conclusion is strong.
15.8 to >11.8 pts
Approaches Expectations
The introduction states the main topic and provides an overview of the paper. A conclusion is included.
11.8 to >0 pts
Not Meeting Expectations
There is no clear introduction, structure, or conclusion.
20 pts
This criterion is linked to a Learning Outcome Mechanics and APA
10 to >7.9 pts
Meets Expectations
The assignment consistently follows current APA format and is free from errors in formatting, citation, and references. No grammatical, spelling, or punctuation errors. All sources are cited and referenced correctly.
7.9 to >5.9 pts
Approaches Expectations
The assignment consistently follows current APA format with only isolated and inconsistent mistakes and/or has a few grammatical, spelling, or punctuation errors. Most sources are cited and referenced correctly.
5.9 to >0 pts
Not Meeting Expectations
The assignment does not follow current APA format and/or has many grammatical, spelling, or punctuation errors. Many sources are cited and referenced incorrectly, or citations and references are missing.
10 pts
Total Points: 100
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Solution
Prominent Aspects
Depression which is also referred to as major depressive disorder is a common but quite severe mood disorder that results from a persistent feeling of loss of interest or sadness (Wang et al., 2017). Depression affects how an individual feels and can have a significant effect on behavior and, in turn, lead to a variety of physical and emotional problems. Depression can lead to a variety of physical and emotional problems. Depressed individuals might experience a lot of trouble in going through their day-to-day activities and can have the feeling that life is not worth living many times. Contrary to some prevailing beliefs, depression is not a form of weakness but is a clinical illness that may require long-term treatment. The general symptoms of depression normally include irritability, frustration, and significant angry outbursts, even over small matters (Alkadhi, 2019). Depression can also result in a constant feeling of sadness, hopelessness, and emptiness. Depression can also cause a loss of pleasure and interest in normal activities such as hobbies, sports, and sex. Depression can also cause consistent occurring in sleep disturbances such as sleeping too much and insomnia, while it can also contribute to a general lack of energy and tiredness which will make patients require an extra effort for even small tasks. Depression can also lead to reduced appetite and weight loss in some patients and can also contribute to an increased appetite and significant weight gain among other patients (Alkadhi, 2019). Depression can also contribute to restless agitation and anxiety. Depression is also a significant contributor to both feeling worthless, self-blame, and fixating on past failures. Depression is also a significant contributor to lack of concentration, trouble thinking, and making decisions and can also affect how one remembers things. Depression can also contribute to significant physical problems such as headaches or back pain and can also contribute to recurrent or frequent thoughts of suicide and suicide attempts (de Menezes Galvão et al., 2021).
The main causes of depression include biological differences, hormones, brain chemistry, and inherited traits. Relating to biological differences, people with depression appear to have significant physical changes in their brain, which increases their susceptibility to depression (de Menezes Galvão et al., 2021). On the other hand, hormones can also contribute to the onset of depression, with the changes in the body’s balance of hormones being involved in the triggering of depression. For example, the onset of postpartum depression can be attributed to hormones. On the other hand, depression can also result from a malfunction of brain chemistry. Scholarly research has clearly highlighted that a change in the function of neurotransmitters and how different neurotransmitters interact with each other can have a significant impact on the onset of depression. Finally, inherited traits can have a significant impact on depression in that depression can be more common among individuals who are blood relatives (Wang et al., 2017).
Current Data and Statistics Related To the Disease
According to the National Institute of Mental Health (NIMH), by the end of 2020, it was estimated that at least 21 million adults over the age of 18 had experienced at least one major depressive disorder episode. This represents 8.4% of the total adult population of the US having experienced a major depressive disorder episode by 2020. According to the NIMH, the prevalence of major depressive disorder was also higher among females compared to males, which represented a 10.5% compared to a 6.2% prevalence rate (NIMH, 2021). Statistics also indicate that the prevalence of major depressive disorder was higher among individuals between 18 to 25 years old, which represented at least 17% of all Young adults in the US experiencing depression. The prevalence of major depressive disorder was also high among individuals from multiple races, which included a 15.9% prevalence rate (NIMH, 2021).
Health Disparities Related To Depression
Considering the prevalence statistics of depression across the US, clear disparities can be observed in the prevalence of depression across different groups of people and ethnic groups. Across the US, there is a significantly higher prevalence of depression among women compared to men. However, this disparity is attributed to the fact that men are less likely to seek treatment for depression due to the stigma associated with the disease (NIMH, 2021). Across the United States, young adults between the ages of 18 and 25 are also disproportionately affected by depression, while individuals who identify themselves as being from mixed races are also likely to experience higher rates of depression compared to the regular population. Minority populations, such as individuals from the LGBTQ community, also experience disproportionately higher rates of depression compared to other groups (NIMH, 2021).
Prevention Strategies Including Complementary and Alternative Health Therapies
Over the years, scholars have identified different lifestyle modifying behavior as being effective preventative measures against depression. The consumption of a healthy diet, getting enough sleep, and exercising regularly can go a long way in helping to prevent depression. There are different forms of complementary and alternative health therapies that have been shown to help mitigate the effects of depression, including herbal supplements, massage therapy, meditation, and yoga (Haller et al., 2019). Meditation and yoga can help depressed individuals to relax, which can help mitigate the effects of depression. On the other hand, massage therapy can play a significant role in helping are depressed individuals relax and improve their mental, physical and emotional well-being. Finally, herbal supplements can help to moderate the effects of depression (Haller et al., 2019).
Contemporary Research and Clinical Studies Related To the Disease
Contemporary research studies have focused on specific alternative methods of the treatment of depression which include music therapy and guided imagery. According to Haller et al. (2019), guided imagery helps individuals picture peaceful mental images, which can help ease stress for the individual. On the other hand, music therapy is an effective non-drug approach to help mitigate the symptoms of depression which include anxiety, fear, grief, and stress (Haller et al., 2019).
Pathophysiologic Effects of Stress-Related To the Disease
The pathophysiologic effects of stress might include anxiety which can contribute to headaches and substantially contribute to overeating and undereating. On the other hand, stress can also contribute to muscle tension and pain, which can significantly contribute to restlessness and angry outbursts. Strength can also result in chest pain and fatigue, which can make an individual feel overwhelmed and lack motivation or focus (Haller et al., 2019).
Evidence-Based Stress Management Interventions
Evidence-based stress management interventions among patients suffering from depression include taking a healthy diet, having sufficient sleep, and exercising regularly. Being involved in psychotherapy such as cognitive behavioral therapy can also help an individual with depression handle stress effectively. Alternative treatments such as music therapy, guided imagery, massage therapy, meditation and yoga, and herbal supplements can also help to mitigate the effects of depression (Haller et al., 2019).
References
Alkadhi, K. (2019). Brain Physiology and Pathophysiology in Mental Stress. ISRN Physiology, 203, 1–23. https://doi.org/10.1155/2013/806104
De Menezes Galvão, A. C., Almeida, R. N., de Sousa, G. M., Leocadio-Miguel, M. A., Palhano-Fontes, F., de Araujo, D. B., Lobão-Soares, B., Maia-de-Oliveira, J. P., Nunes, E. A., Hallak, J. E. C., Schuch, F. B., Sarris, J., & Galvão-Coelho, N. L. (2021). Pathophysiology of Major Depression by Clinical Stages. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.641779
Haller, H., Anheyer, D., Cramer, H., & Dobos, G. (2019). Complementary therapies for clinical depression: an overview of systematic reviews. BMJ Open, 9(8), e028527. https://doi.org/10.1136/bmjopen-2018-028527
National Institute of Mental Health (NIMH). (2021). Major Depression. Retrieved April 8, 2022, from https://www.nimh.nih.gov/health/statistics/major-depression
Wang, J., Wu, X., Lai, W., Long, E., Zhang, X., Li, W., Zhu, Y., Chen, C., Zhong, X., Liu, Z., Wang, D., & Lin, H. (2017). Prevalence of depression and depressive symptoms among outpatients: a systematic review and meta-analysis. BMJ Open, 7(8), e017173. https://doi.org/10.1136/bmjopen-2017-017173

This is a reflection paper. This is meant to be informal and open-ended. Identify the topic(s) such as Inspiration vs. Knowledge in the “Ion” and explain why it is most compelling.
up to 3 sources if needed

Assignment- PUB 655- TOPIC 3- Integrating Health Care and Public Health Systems
-This assignment invovles selecting a low- or middle-income country of interest. I want to leave that to the writer’s choice.
-Please read the question page in details.
-Details of the question and the rubric are also uploaded
-Please read the Rubric before you start
-Please include the Introduction, Thesis statement, and conclusion in the paper.
– Include section headings for each section component where needed
– Sources must be published within the last 5 years. It must be from 2016 and after
– Sources must be appropriate for the assignment criteria and public health content.
– Please do not use blogs as references
-References should be in APA 7th ed.
-Add references to reference page
-Add the hyperlink for each reference in APA 7th edition format.
Thank you
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Solution
Integrating Health System
Integration of the health system entails combining health services into a more advanced level that is manageable and cost-effective to enhance quality care services to everyone. Mainly, it involves financial plans, health approaches, and operational activities that can be implemented for sustainability purposes and favors all (Topp et al., 2018).
Many scholars have described the integration of the health system in different ways. Still, all their concepts aim in the framework of coordinating, organizing, and managing several healthcare activities and resources to enhance efficient and effective service delivery (Topp et al., 2018). However, this process can be challenging in low and middle-income countries due to pre-conditions such as fewer health centers with few staff members, insufficient medical health equipment, and accessibility. Thus requires more advanced approaches in facilitating the integration process. This study discusses the assessment of the health system in the low-income country through a causal diagram of system thinking.
Causal Loop Diagram
In low-income countries such as Afghanistan, the health system has become a major issue due to inefficiencies of health information and funds to advance healthcare (Paul et al., 2018). A study review conducted in Afghanistan shows various reforms made with improving the health system. The health system used is Pay for Performance (P4P) to strengthen health system performance and identify the agency problems blocking the systems from coordinating (Alonge et al., 2017).
A causal loop diagram is a presentation of system thinking that improves the cognitive thinking of individuals through creativity and logical reasoning. It follows four basic frameworks in its development; the variables, links between them, the signs on the links, and the loop sign. Based on the health system issue of Afghanistan, the causal loop diagram helps determine causal relationships between variables identified (Alonge et al., 2017). The arrows connect through the links and variables to help understand the connection, forming a structural statement that can be applied in developing an effective health system to solve the health problem in this country.
For instance, the diagram above represents a causal diagram of public health services provided in bridging the identified gaps to enhance strong health system in the country. The arrows are moving in the same direction thus proving positive relationship in the three variables, hence an indication, that the pay for performance system has helped in bridging the gap and restoring quality healthcare in the country, ever since it was introduced (Alonge et al., 2017).
Major Components of the Pay for Performance System
Pay for performance system is an approach used especially in low and middle-income countries to strengthen their health systems. Mainly it involves donor organizations that decide to invest in program activities and projects that can benefit these low-income countries and improve the health system (Alonge et al., 2017). The major components are; quality maternal and child health, accessibility of essential drugs and availability of trained health staffs. For instance, pay for performance enables the donor to provide monetary incentives to the beneficiary of the implemented programs based on the agreement.
The monetary incentives are then used to fund other similar programs that can help improve the health system in Afghanistan. Therefore, the health system discussed above also helps recognize agency problems that might arise. For instance, problems such as an agent using the projects’ funds for personal gains are discouraged and can easily be identified using the pay for performance approach.
Core Services Provided
The pay for performance system enhances quality service delivery, health workforce, and leadership (Manyazewal, 2017). Through the sponsorship of programs by the donors, the beneficiaries, such as women in the community, can access free maternal and child immunization services. The health system also equips the programs’ participants with enough knowledge and skills through training, thus managing their wellbeing. These systems are managed mainly by non-governmental organizations.
Payments and Funding of the Services
This health system is mostly provided to low-income countries to improve their healthcare services through available resources. The payments and funding of services are done mainly by the donor, stakeholders, and volunteers and not necessarily the beneficiaries. Therefore, it is challenging for donors to ensure that they are financially, physically, and psychologically ready to engage in health system programs. Implementation of poor pay for performance system can lead to low quality and service delivery though not beyond the optimum level. In such situations, it can cause financial constraints too.
Application of a System Thinking Tool
A causal loop diagram implies the causal relationships between variables and the links in integrating the health system. In this case, the pay for performance system converges the application of the causal loop diagram tool in understanding its formation, benefits, and weaknesses in strengthening the healthcare services in Afghanistan.
The three positive causal relationships identified in the causal loop diagram above show the interconnection. The public health services provided in Afghanistan after the introduction of pay for performance system, has increased the number of skilled births and child immunization in the country. The system has also reduced maternal mortality in the region with most women and girls accessing health basic trainings.
The causal diagram can be used to implement the appropriate health system in Afghanistan in reducing infectious diseases such as waterborne diseases. Most of the regions in this country are partly rural and thus contribute to the low development. The country is mostly faced with challenges of frequent military wars and immigration that threaten the wellbeing of the population (Wagner et al., 2017). Due to poor sanitation and lack of safe water in the country, the most vulnerable groups are the children, women, and young girls.
Most children suffer from infectious and communicable diseases mainly caused by poor sanitation and the environment they live in. Women and young girls face gender inequality and are highly prone to contracting infectious diseases (Wagner et al., 2017). Therefore, a causal loop diagram can be used in implementing effective health systems to reduce the transmission of infectious diseases. For instance, the donor-funded programs can be implemented, and identified gaps such as gender inequality, poor sanitation, and lack of food can be denoted on the causal loop diagram to determine the public health services that can be provided in ensuring strong health system in the country.
Conclusion
Implementing the health system in low and middle-income countries remains a battle in improving healthcare in such countries. Therefore, applying system thinking tools is essential in ensuring that an effective health system is implemented in providing quality health care to the people, thus improving public health. The major links, variables, and loops should be identified in cases where causal loop diagrams are implied in solving health problems.
References
Alonge, O., Lin, S., Igusa, T., & Peters, D. H. (2017). Improving health systems performance in low-and middle-income countries: a system dynamics model of the pay-for-performance initiative in Afghanistan. Health Policy and Planning, 32(10), 1417-1426.https://academic.oup.com/heapol/article/32/10/1417/4210153?login=true
Manyazewal, T. (2017). Using the World Health Organization health system building blocks through survey of healthcare professionals to determine the performance of public healthcare facilities. Archives of Public Health, 75(1), 1-8.https://archpublichealth.biomedcentral.com/articles/10.1186/s13690-017-0221-9
Paul, E., Dramé, M. L., Kashala, J. P., Ndema, A. E., Kounnou, M., Aïssan, J. C., & Gyselinck, K. (2018). Performance-based financing to strengthen the health system in Benin: challenging the mainstream approach. International Journal of Health Policy and Management, 7(1), 35.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5745866/
Topp, S. M., Abimbola, S., Joshi, R., & Negin, J. (2018). How to assess and prepare health systems in low-and middle-income countries for integration of services—a systematic review. Health Policy and Planning, 33(2), 298-312.https://academic.oup.com/heapol/article/33/2/298/4759471?login=true
Wagner, A. L., Mubarak, M. Y., Johnson, L. E., Porth, J. M., Yousif, J. E., & Boulton, M. L. (2017). Trends of vaccine-preventable diseases in Afghanistan from the Disease Early Warning System, 2009–2015. PloS one, 12(6), e0178677.https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0178677

Assignment 2: Clinical Skills Self-Assessment
Before embarking on any professional or academic activity, it is important to understand the background, knowledge, and experience you bring to it. You might ask yourself, “What do I already know? What do I need to know? And what do I want to know?” This critical self-reflection is especially important for developing clinical skills such as those for advanced practice nursing.
The PMHNP Clinical Skills List and PMHNP Clinical Skills Self-Assessment Form provided in the Learning Resources can be used to celebrate your progress throughout your practicum and identify skills gaps. The skills list covers all the necessary skills you should demonstrate during your practicum experiences.
For this Assignment (just as you did in PRAC 6645), you assess where you are now in your clinical skill development and make plans for this practicum. Specifically, you will identify strengths and opportunities for improvement regarding the required practicum skills. In this practicum experience, when developing your goals and objectives, be sure to keep assessment and diagnostic reasoning in mind. As you complete your self-assessment this week, you may wish to look back over your self-assessments from prior practicums to reflect on your growth.
To Prepare
Review the clinical skills in the PMHNP Clinical Skills List document. It is recommended that you print out this document to serve as a guide throughout your practicum.
Review the “Developing SMART Goals” resource on how to develop goals and objectives that follow the SMART framework.
Review the resources on nursing competencies and nursing theory, and consider how these inform your practice.
Download the?PMHNP Clinical Skills Self-Assessment Form?to complete this Assignment.
The Assignment
Use the PMHNP Clinical Skills Self-Assessment Form to complete the following:
Rate yourself?according to?your confidence level?performing the skills identified in the Clinical Skills Self-Assessment Form.
Based on your ratings, summarize?your strengths and opportunities for improvement.
Based on your self-assessment and theory of nursing practice, develop?three to four (3–4)?measurable goals and objectives for this?practicum?experience.?Include them on the designated area of the form.
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Solution
PRAC 6665/6675 Clinical Skills
Self-Assessment Form
Desired Clinical Skills for Students to Achieve Confident (Can complete independently) Mostly confident (Can complete with supervision) Beginning (Have performed with supervision or needs supervision to feel confident) New (Have never performed or does not apply)
Comprehensive psychiatric evaluation skills in:
Recognizing clinical signs and symptoms of psychiatric illness across the lifespan ?
Differentiating between pathophysiological and psychopathological conditions ?
Performing and interpreting a comprehensive and/or interval history and physical examination (including laboratory and diagnostic studies) ?
Performing and interpreting a mental status examination ?
Performing and interpreting a psychosocial assessment and family psychiatric history ?
Performing and interpreting a functional assessment (activities of daily living, occupational, social, leisure, educational). ?
Diagnostic reasoning skill in:
Developing and prioritizing a differential diagnoses list ?
Formulating diagnoses according to DSM 5 based on assessment data ?
Differentiating between normal/abnormal age-related physiological and psychological symptoms/changes ?
Pharmacotherapeutic skills in:
Selecting appropriate evidence based clinical practice guidelines for medication plan (e.g., risk/benefit, patient preference, developmental considerations, financial, the process of informed consent, symptom management) ?
Evaluating patient response and modify plan as necessary ?
Documenting (e.g., adverse reaction, the patient response, changes to the plan of care) ?
Psychotherapeutic Treatment Planning:
Recognizes concepts of therapeutic modalitiesacross the lifespan ?
Selecting appropriate evidence based clinical practice guidelines for psychotherapeutic plan (e.g., risk/benefit, patient preference, developmental considerations, financial, the process of informed consent, symptom management, modality appropriate for situation) ?
Applies age appropriate psychotherapeutic counseling techniques with individuals and/or any caregivers ?
Develop an age appropriate individualized plan of care ?
Provide psychoeducation to individuals and/or any caregivers ?
Promote health and disease prevention techniques ?
Self-assessment skill:
Develop SMART goals for practicum experiences ?
Evaluating outcomes of practicum goals and modify plan as necessary ?
Documenting and reflecting on learning experiences ?
Professional skills:
Maintains professional boundaries and therapeutic relationship with clients and staff ?
Collaborate with multi-disciplinary teams to improve clinical practice in mental health settings ?
Identifies ethical and legal dilemmas with possible resolutions ?
Demonstrates non-judgmental practice approach and empathy ?
Practices within scope of practice ?
Selecting and implementing appropriate screening instrument(s), interpreting results, and making recommendations and referrals:
Demonstrates selecting the correct screening instrument appropriate for the clinical situation ?
Implements the screening instrument efficiently and effectively with the clients ?
Interprets results for screening instruments accurately ?
Develops an appropriate plan of care based upon screening instruments response ?
Identifies the need to refer to another specialty provider when applicable ?
Accurately documents recommendations for psychiatric consultations when applicable ?
Summary of strengths:
I possess a number of strengths that would enable me to perform my roles competency as a psychiatric mental health nurse practitioner. One of the strengths is my knowledge and skills in recognizing the signs and symptoms of psychiatric conditions. Having worked in the psychiatric clinic for some time now, I can confidently differentiate between the symptoms of psychiatric and medical conditions. I can also order appropriate laboratory and diagnostic investigations to guide in the development of accurate diagnoses and treatment plans for the clients. I also have the strength of working effective with other healthcare providers in the provision of patient care. Inter-professional collaboration is a critical tool for optimizing the outcomes of care for psychiatric patients. The collaboration ensures the adoption of highly efficient and effective interventions that would enhance the recovery and coping of patients with psychiatric illnesses. I also have the strength of undertaking and interpreting mental status examination.
Mental status examination provides an accurate picture of the health needs and problems of clients. The examination guides the evaluation of the effectiveness of the adopted treatment interventions. I believe that my competency in undertaking mental status examination and interpreting its findings will contribute to my success in the practicum experience. I also have the strength of selecting effective screening tests for psychiatric patients. I can also interpret the screening results to guide the development of the desired treatment plans for the patients. The strength will enable me ensure effective care delivery for the patients suffering from mental health problems. The last strength that I possess as a psychiatric mental health nurse practitioner is being able to maintain professional boundaries and therapeutic relationship with my patients. Nurses have the obligation of ensuring professionalism in their practice. They ensure the protection of the patient rights as well as therapeutic relationship for the realization of optimum outcomes of patient care (Morgan & Townsend, 2019). Therefore, I will leverage on the above strengths to achieve my desired competencies in the practicum experience.
Opportunities for growth:
An area of opportunities for growth that I need to explore during the practicum experience is developing my competencies in the implementation of screening test results in psychiatric practice. Despite being knowledgeable on the different screenings for psychiatric patients, I have the weakness of ensuring the effective implementation of the screening results. I have to work closely with my preceptor as well as other healthcare providers in the practicum experience to ensure that I develop the desired competencies in this area of practice. The other area of growth that I need to explore during the practicum experience is the use of age appropriate psychotherapeutic techniques in patient care.
Different psychotherapies exist for use in patients presenting with psychiatric conditions. The therapies also vary based on the age of the patients under consideration. I have inadequate knowledge and skills on the use of the different types of psychotherapies for the wide range of patient age groups in psychiatric practice. As a result, I have to ensure that I develop the desired competencies in the use of psychotherapy to ensure that I provide high quality, safe and efficient care to psychiatric patients in my practice. The other area of growth that I will need to explore during the practicum experience is the assessment of effectiveness of care given to psychiatric patients. Evaluation of treatment in psychiatry is important in informing if the adopted interventions have been effective or not ((Hercelinskyj & Alexander, 2019). It informs the revisions that are made to ensure optimum outcomes in patient care. I feel that I have not mastered the knowledge and skills needed in the evaluation of psychiatric treatments. Consequently, I would wish to enhance my competencies in this area during my practicum experience.
Now, writethree to four (3–4)possible goals and objectives for this practicum experience. Ensure that they follow the SMARTStrategy, as described in the Learning Resources.
1. Goal: Develop competencies in the implementation of screening results of psychiatric conditions by the end of the practicum experience.
a. Objective: interpret at least ten psychiatric screening results on a weekly basis during the practicum experience.
b. Objective: Develop at least ten treatment plans based on screening results for psychiatric patients during the practicum experience.
c. Objective: Collaborate with my preceptor and other healthcare providers in the practicum site in interpreting and implementing treatment plans for psychiatric patients during the practicum experience.
2. Goal: Develop competencies on the use of different psychotherapeutic treatments in psychiatric patients of various age groups by the end of the practicum experience
a. Objective: Learn about the different psychotherapeutic modalities used for psychiatric patients in the practicum site by the end of the first month of the experience.
b. Objective: To implement the use of different psychotherapeutic modalities in treating patients of various age groups during the practicum experience.
c. Objective: Collaborate with my preceptor and other healthcare providers in the use of different psychotherapeutic modalities in managing psychiatric conditions during the practicum experience.
3. Goal: Develop competencies in the assessment of psychiatric treatments by the end of the practicum experience
a. Objective: Evaluate the treatment plans for at least 10 patients on a weekly basis during the practicum experience.
b. Objective: Implement evidence-based interventions of evaluating psychiatric treatments during my practicum experience.
c. Objective: Collaborate with my preceptor and other healthcare providers in evaluating psychiatric treatments during the practicum experience.
References
Hercelinskyj, G. (Julie), & Alexander, L. (2019).Mental Health Nursing: Applying Theory to Practice.Cengage AU.
Morgan, K. I., & Townsend, M. C. (2019).Essentials of Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice. F. A. Davis Company.
Morgan, K. I., & Townsend, M. C. (2020).Pocket Guide to Psychiatric Nursing. F.A. Davis.

Legal and ethical nursing
Assignment Description:
For this assignment, create a PowerPoint presentation based on any three of the following four case studies.
Read the case study You be the Judge presented at the end of Chapter 18 which begins, “The older adult male patient was admitted…” (Guido, p. 363) and answer the following questions:
You be the Judge
The older adult male patient was admitted to the hospital emergency center with major blunt abdominal trauma following a car crash. In the emergency center, the nurse carried out the physician’s order for a dose of morphine for the patient’s pain, which he said was an 8 on a scale from 1 to 10. After being given the morphine, the patient’s blood pressure dropped significantly, and the patient went into cardiac and respiratory arrest after lapsing into unconsciousness.
The nurse alerted the physician, who immediately intubated the patient and sent him to the operating room to be resuscitated and then for exploratory surgery to determine the extent and cause of the abdominal bleeding. The patient was never revived, and he died the next day in the facility’s intensive care unit.
The family has brought a wrongful death lawsuit, alleging that the morphine was the cause of the patient’s demise. In the lawsuit, there were no allegations of excessive dose, improper administration of the medication, or inattentive monitoring by the nurses in the emergency center.
• Was the nurse negligent for not questioning the use of morphine for a patient with blunt abdominal pain before administering the dose of morphine?
• Would knowing that the patient’s blood pressure was 148/94 when the morphine was administered impact the finding of the trial court?
• What evidence would you argue in the nurse’s defense regarding the care of this patient?
• How would you decide this case?
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Read the case study You be the Judge presented at the end of Chapter 19 that begins, “An 82-year-old patient…” (Guido, p. 394) and answer the following questions:
An 82-year-old patient who was herself a retired physician was admitted to a rehabilitation facility after surgery to repair a broken hip. During her stay at the rehabilitation facility, she woke one morning feeling nauseous and began vomiting blood. The rehabilitation physician believed that the patient had an upper gastrointestinal bleed for which she needed to be hospitalized.
She was immediately taken to the emergency department at the acute care hospital located on the same campus as the rehabilitation facility. She was evaluated and monitored in the hospital emergency department for two hours and then moved to the hospital’s intensive care area for continuous monitoring and treatment.
Legal and ethical nursing
Complications caused her death in the early hours of the subsequent morning. Her estate subsequently filed a lawsuit for an EMTALA violation, alleging that the patient was not stabilized as mandated by the Act.
• What initial care should the patient have received in the emergency center?
• Did the emergency department staff meet the standards of care for a patient with these presenting signs and symptoms?
• Was the admission to the intensive care area a violation of the EMTALA law?
• How would you decide this case and what provisions of the EMTALA law would you anticipate the court enumerated in its holding?
Read the case study You be the Judge presented at the end of Chapter 20 (Guido, p. 415) beginning with, “The patient was a detainee,…” and answer the following questions:
The patient was a detainee, not yet proven guilty, who was being held in the county jail pending trial on felony charges of dealing controlled substances and creating a public nuisance. The patient suffers from a blood clotting disorder that causes him chronic pain. He was prescribed OxyContin for this pain by his current physician. The patient was seen and evaluated as part of his booking into the county jail. Instead of prescribing the OxyContin
for him, the jail physician-prescribed Vistaril, clonidine, and Donnatal to manage his narcotic withdrawal, started ibuprofen and Tylenol for his pain management, and continued the metroprolol, Coumadin, and Nexium that he had been taking. The jail nurses administered these medications per the physician’s orders.
The patient continued to suffer chronic and debilitating pain while in the county jail and, on his transfer to the state prison system, he brought a lawsuit against the county jail physician and nurses for violation of his Constitutional rights.
• Should the nurses have followed the physician’s orders and continued the ordered medications, which varied significantly from his pre-jail medications, specifically his medications for pain?
• Was it deliberate indifference to the patient’s medical needs to change his pain medications in the belief that he needed to withdraw from narcotics?
• What more could the nurse have done to prevent a lawsuit from being filed for an Eighth Amendment violation?
• How would you expect the court decided this case?
Read the case study You be the Judge presented at the end of Chapter 21 (Guido, p. 440-441) beginning with, “An elderly woman was admitted to the hospital…” and answer the following questions:
An elderly woman was admitted to the hospital from home, then admitted to a skilled nursing facility for rehabilitation, and then to an assisted living facility. She had chronic
kidney failure that required dialysis. Sometimes her mental status deteriorated into confusion, usually just before her dialysis appointments. At some point, she also suffered a
stroke, which seemed to affect her cognitive status.
Over the course of a few weeks, she spoke with an attorney several times on the phone, discussing with him how to write her last will and testament. She had had a lifelong rift with one of her siblings and chose not to give anything in her will to the now deceased sibling’s children. She also wanted to give substantial amounts to charity rather than to her other two siblings and their children.
The attorney mailed her will to her at the assisted living facility. The social worker and a second individual from the facility’s staff witnessed her signature on the document in her
room at the assisted living facility. When she died, the children of her estranged sibling contested the will and sued in court to have the will vacated.
• What types of questions should be asked of the social worker and the other individual who witnessed her signature on the will?
• What other evidence should be requested of the nursing staff to best ascertain her cognitive ability at the time she dictated how she wanted the will drafted and at the time she signed the document?
• Does the fact that she had been estranged for many years from the sibling whose children are now suing factor into the final decision of the court?
• How would you decide this case?