Nursing

PHN 690-Topic 3 DQ 1-Classmate Response (1): Best Practices For Type Of Setting-(Please see upload for question and classmate’s essay)
This order is for a response to a classmate’s post. I have uploaded the question and the classmate’s essay that requires a response
Respond to the classmate essay by-
Sharing an insight to the question
Also add other points related to the topic.
Offering and supporting an opinion from the classmate essay.
Please elaborate on one or two points from the classmate’s essay. Please do not just re-write what the classmate wrote.
Validating an idea
Topic 3 DQ 1
Identify internal and external factors that can help or hinder organizational or program success in your practicum setting. How can weaknesses be converted into strengths? Can strengths be used to overcome threats? If so, provide an example. How can opportunities be maximized?
Please read classmate’s (Diane) essay below essay and offer and support an opinion from the classmate’s essay-
share an insight into the question
Also add other points related to the topic.
Order a PHN 690 Discussion Paper Today !
Classmate essay
By identifying weaknesses, work can begin to improve that area, or convert it into a stronger component. Overtime It can be overcome by assessing the weakness and planning for a modification in order to strengthen that area.
Strengths can and should be used to overcome threats. When threats are acknowledged, strengths that counter the threat can be built up or reinforced. This lessens the risk of the threat (Community Toolbox, 2022).
An example is a new program targeting multi-resistant tuberculosis (MRTB) in immigrants. A threat to the program is that government officials are moving the immigrants to other areas before a diagnosis can be made, or treatment can be completed. Additionally, the ability to monitor this groups whereabouts is impossible.
However, leveraging the connection of the TB center with the CDC, policies and procedures can be developed to reinforce compliance. Further, the vast knowledge the TB center has regarding this disease and their mindfulness of cultural competence, promotes a strong disease education program. Thus, adding to the comfort of those entering the program. Another strength is the financial backing of the program, and the observed importance to the United States population. By emphasizing these strengths, the threat can be lessened, and overcome.
Opportunities can be maximized by taking advantage of all that it provides. The above example can be used to illustrate this concept. The opportunity to begin the diagnosis of TB, for those newly entering the U.S., is upon arrival. Instead of directing the immigrants to a health department, an immediate screening would give more time to transfer those with the disease to a facility for continued support and treatment. By maximizing the increase in trends, available cashflow, political support and regulations, the targeted population can benefit (Furgison, 2022).
References
Community Toolbox. (2022). Section 14. SWOT Analysis: Strengths, Weaknesses, Opportunities, and Threats. University of Kansas. https://ctb.ku.edu/en/table-of-contents/assessment/assessing-community-needs-and-resources/swot-analysis/main
Furgison, L. (2022). SWOT Analysis Step 3: How to Identify Opportunities. Bplans. https://articles.bplans.com/swot-analysis-challenge-day-3-identify-opportunities/

Advance nursing health assestment FO
76-year-old black male with disabilities living in an urban setting
?
By Day 1 of this week, you will be assigned a new patient profile by your Instructor for this Discussion. Note: Please see the “Course Announcements” section of the classroom for your new patient profile assignment.
? How would your communication and interview techniques for building a health history differ with each patient?
? How might you target your questions for building a health history based on the patient’s social determinants of health?
? What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?
? Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.
? Select one of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the Seidel’s Guide to Physical Examination text, or another tool with which you are familiar, related to your selected patient.
? Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.
3 current resources from 2016 to current.
ORDER A PLAGIARISM-FREE PAPER HERE !!
Solution
76-year-old black/American male with disabilities living in an urban setting
Communication and interview techniques for building a health history
Interviewing and communication techniques that are effective foster a positive relationship between the patient and the care provider. In this case, I would introduce myself and then ask the patient his preferred name and title; addressing a patient by his preferred title or name makes him feel respected and at ease. Since the patient has advanced in age, it would be crucial to make him feel respected by addressing him using the proper preferred title or his name (Murfield et al., 2021).
To establish a rapport with the patient, I would ask friendly questions about him; for example, I would inquire about where he is from and his family. Creating rapport is necessary to minimize tension between the care provider and the patient and facilitate better communication. I would speak slowly because the elderly require time to process what is asked or said about them (Murfield et al., 2021). Most people over the age of 65 suffer from debilitating hearing loss, therefore the need to speak slowly. Furthermore, slowly and discussing concerns with a patient will undoubtedly aid in the gathering of relevant information that will improve cooperation and treatment obedience. I would not interrupt the patient and would practice active listening, avoid jargon, and show empathy (Cohen et al., 2017).
Risk Assessment Tool
Home Safety Self-Assessment Tool; the tool developed to evaluate the living conditions of older adults. It examines the environment where the patient resides is secure from mishaps such as falls (Neubert et al., 2017). As individuals age, they may be unable to maintain their homes, generating structural concerns, accessibility problems, and fall risks, which may impair an older adult’s mental and physical challenges. Considering his age, this tool will be used to assess the patient’s life quality and safety. Based on the patient’s age, ethnicity, and gender, some of the potential health risks include heart diseases, hypertension, stroke, falls, renal disease, and cancer (Maness et al., 2021).
Questions
Do you live with your family?
How often do you participate in social gatherings?
When was the last time you visited a hospital/clinic?
Are you currently taking any medication?
When was the last time you were sick/felt sick?
Have you experienced a fall lately?
References
Cohen, J. M., Blustein, J., Weinstein, B. E., Dischinger, H., Sherman, S., Grudzen, C., & Chodosh, J. (2017). Studies of physician?patient communication with older patients: How often is hearing loss considered? A systematic literature review. Journal of the American Geriatrics Society, 65(8), 1642-1649. https://agsjournals.onlinelibrary.wiley.com/doi/full/10.1111/jgs.14860
Maness, S. B., Merrell, L., Thompson, E. L., Griner, S. B., Kline, N., & Wheldon, C. (2021). Social determinants of health and health disparities: COVID-19 exposures and mortality among African American people in the United States. Public Health Reports, 136(1), 18-22. https://journals.sagepub.com/doi/full/10.1177/0033354920969169
Murfield, J., Moyle, W., & O’Donovan, A. (2021). Mindfulness-and compassion-based interventions for family carers of older adults: A scoping review. International journal of nursing studies, 116, 103495. https://www.sciencedirect.com/science/article/abs/pii/S0020748919303025
Neubert, L., Kocher, A., Noble, A., Hynes, A., Nguyen, C., Nguyen, J., … & Bass, J. D. (2017). Interdisciplinary Fall Risk Screening and Assessment: An Evidence-Based Practice Project. https://sophia.stkate.edu/ma_osot/27/

Topic 5 DQ 1 -Developing Evidence-Based Interventions-Please see upload for full question
Topic 5: Developing Evidence-Based Interventions
QUESTION- What is the importance of evaluating population-based interventions? Why is it important to consider evaluation during the planning and development of evidence-based interventions?
ORDER A PLAGIARISM-FREE PAPER HERE !!
Solution
Interventions
Interventions can only be proven evidence-based if they meet the necessary criteria of evaluation. The evaluation outcome should be driven to implement effective programs in that the interventions are clearly stated to solve the problem in question. Therefore, developing an evidence-based intervention follows all the required steps; planning, implementation, monitoring, and evaluation processes to enhance positive outcomes. This study focuses on the development of the evidence-based intervention, the importance of evaluating a population-based intervention, and its importance during the planning, development of evidence-based interventions.
Importance of Evaluating Population-based Intervention
Population-based interventions are essential in enhancing and improving health services (Stojanovic et al., 2020). They work widely than the clinical approaches, thus bridging the gap left out by the clinics. The population-based interventions focus primarily on the public, aiming to achieve the population’s interest in improving their wellbeing and health. Evaluating population-based intervention is essential in ensuring that the interventions meet the specific objectives that the program tends to solve among the public. Evaluation tends to answer the questions as to why the chosen interventions are appropriate for a particular population and how suitable they can solve the problem and improve the population’s wellbeing. This can be applied in clinical settings.
Importance of Evaluation during Planning and Development
Evaluation is crucial during the implementation and development of the evidence-based intervention. It acts as a drive-through or tool especially for stakeholders to entice their programs successfully (Wandersman et al., 2016). Evaluation helps assess specific needs since it tends to analyze data collected and tools to enhance their effectiveness in the implementation stage. Therefore, evaluation contributes a lot to the planning and implementation process by examining data, tools, and resources effectively to ensure they impact solving the health problems, thus leading to the implementation of suitable population-based interventions.
References
Stojanovic, J., Wübbeler, M., Geis, S., Reviriego, E., Gutiérrez-Ibarluzea, I., & Lenoir-Wijnkoop, I. (2020). Evaluating Public Health Interventions: A Neglected Area in Health Technology Assessment. Frontiers in public health, 8, 106 https://www.frontiersin.org/articles/10.3389/fpubh.2020.00106/full
Wandersman, A., Alia, K., Cook, B. S., Hsu, L. L., & Ramaswamy, R. (2016). Evidence-based interventions are necessary but not sufficient for achieving outcomes in each setting in a complex world: Empowerment evaluation, getting to outcomes, and demonstrating accountability. American Journal of Evaluation, 37(4), 544-561. https://journals.sagepub.com/doi/pdf/10.1177/1098214016660613?casa_token=xGL1DWShULAAAAAA:2JczGN8N-NdSPD7hrgzIOBFHaUBchu0Ehj_1_LvbZYTjUk4nFnhvFFj1tLXydjy_G35j0l2EKstoPjg

Discussion: Differentiating Strategic, Operational, and Tactical Planning
Continuous planning is an important activity for any organization that aims to evolve to stay current in its industry and serve its intended purpose. There are several types of planning used by nurse executives: strategic planning, operational planning, and tactical planning. Each type of planning usually occurs at different management levels and over different periods of time. A clear understanding of the differences between each type of plan will aid you next week in selecting a meaningful strategic issue for your Strategic Plan.
By Day 3
In your own words, differentiate between an operational plan, a tactical plan, and a strategic plan in nursing. Provide an example of each.
Place your order today!
Solution
Discussion: Differentiating Strategic, Operational, and Tactical Planning
In your own words, differentiate between an operational plan, a tactical plan, and a strategic plan in nursing.
Strategic plan
A strategic plan focuses on why a planned activity or action needs to take place. It revolves around long-term thinking and a big picture that starts from the highest level of the organization with casting a vision, presenting values and defining a mission. In addition, it includes a high-level overview of the entire organization. Besides that, it dictates the organization’s long-term decisions. Its scope can be as long as twenty years and as short as two years. Its long-term scope opens it up to significant uncertainties, such as a war occurring or geopolitical changes. For instance, an organization’s strategic plan can be to become the world’s premier medical facility by developing and adopting innovative and advanced medical technologies that ensure the best care outcomes (Huber & Joseph, 2021).
Tactical plan
A tactical plan focuses on what is going to happen. It presents short-term plans that are specific and focused. It is at this point that the strategic plan is broken down into manageable sections that can be addressed by units/department within the organization. It supports strategic planning by presenting the tactics that would be applied to achieve the outlined strategic plan. Its scope is short, typically less than one year. The short scope exposes it to moderate uncertainties, such as the price of commodities changing within a week or a flooding occurring to make roads impassable. For instance, an organization’s tactical plan can be to create a high level research facility where cutting edge medical technologies are developed and tested (Weiss, Tappen & Grimley, 2019).
Operational plan
An operational plan focuses on how things need to happen. It presents the guidelines on how the mission and vision presented in the strategic plan would be accomplished. It describes the daily activities in the organization (day-to-day running of the organization). It can be created for a single occurrence activity/event such as a promotional campaign, or it can be created for an ongoing activity/event such as procedures, regulations and policies for addressing workplace misconduct with step-by-step processes for achieving particular goals (Vana & Tazbir, 2021).
References
Huber, D., & Joseph, L. (2021). Leadership and Nursing Care Management (7th ed.). Elsevier, Inc.
Vana, P. K., & Tazbir, J. (2021). Kelly Vana’s Nursing Leadership and Management (4th ed.). John Wiley & Sons Ltd.
Weiss, S. A., Tappen, R. M., & Grimley, K. (2019). Essentials of Nursing Leadership & Management (7th ed.). F. A. Davis Company.

NRP/543: Management Of Pediatric And Adolescent Populations
Wk 6 Discussion – Orthopedic and Hematologic Disorders
Respond to the following in a minimum of 175 words:
1. Research community resources available for children with orthopedic and hematologic disorders.
2. Describe a resource that can be used in clinics to help a child patient or to educate the patient’s family about the orthopedic and hematologic disorder.
Substantive Posts:
A substantive post should follow these criteria:
• At least 175 words
• Integrate theory, research, and/or professional experience
• Include specific examples and/or substantiating evidence
• Include in-text citations and references in 7th edition APA format
• Stay on topic and address the course objectives
• Demonstrate proper spelling, grammar, and scholarly tone You MUST include a question with every post to receive full credit.
Textbook for NRP/543:
Burns, C. E., Dunn, A. M., Brady, M. A., Barber Starr, N., Blosser, C. G., & Garzon, D. L. (2017). Pediatric primary care (6th ed.). Elsevier.
Place your order today!
Solution
Wk 6 Discussion – Orthopedic and hematological Disorders
Community resources available for children with orthopedic and hematologic disorders
When a child has a hematological or orthopedic disorder, it can impact her or his life in numerous ways, from chronic health problems like anemia and joint pain to quality of life issues such as missing school. But with proper management, children with hematological and orthopedic disorders can lead healthy lives. Physical therapy centers, nursing care, community health workers and pediatric orthopaedists, and hematologists are community resources available for children with hematological and orthopedic disorders.
A resource that can be used in clinical to help a child patient
Community health workers are a resource that can be used in clinical to help a child patient. According to Hsu et al. (2016), community health workers (CHWs) are non-clinicians who work with socially and medically complex individuals by acting as a bridge between patients and medical services to improve patient self-management, healthcare engagement, health outcomes, and adherence to treatment plan.
Community health workers can help the child patient and the family by offering emotional support, providing family and individual counseling, and supporting collaboration and coordination with health care service providers. HCWS can also provide advocacy and navigation of the social service and insurance systems. As indicated by Hsu et al. (2016), HCWS can provide navigation of health resources and systems, social counseling, and lay counseling. CHWS usually share responsibility for patient education, social services, and clinicians.
CHWs can improve health for patients by providing social support and informal counseling, advocating for community and individual needs, providing culturally appropriate health education, and assurance that individuals receive essential social and medical services they are entitled to (Hsu et al., 2016).
References
Hsu, L. L., Green, N. S., Ivy, E. D…. Martin, M. (2016). Community Health Workers as Support for Sickle Cell Care: American Journal of Preventive Medicine, 51(1Suppl 1), S87-S98. doi: 10.1016/j.amepre.2016.01.016

Public Health Nursing roles in Environmental health – Climate changes and health effects on children
Scholarly Researched Position Paper—Environmental Health (submit via SafeAssign)
The Code of Ethics for Nurses (American Nurses Association, 2015) Principle 9.4 calls for nurses to “advocate for policies, programs, and practices within the healthcare environment that maintain, sustain, and repair the natural world” (p. 37). During a recent testimony for the Minnesota Climate Caucus, it was reported that nurses are ethically bound to recognize that “Social justice extends beyond human health and well-being to the health and well-being of the natural world” (p.37). Further, The Executive Summary of the 2019 Lancet Countdown report warns: The life of every child born today will be profoundly affected by climate change, with populations around the world increasingly facing extremes of weather, food and water insecurity, changing patterns of infectious disease, and a less certain future. Without accelerated intervention, this new era will come to define the health of people at every stage of their lives.
Nursing roles in Environmental health
Review lectures, read Stanhope & Lancaster Chapters 6 and 14, and review the following resources:
• http://www.lancetcountdown.org/2019-report/
• Center for Global Health and Social Responsibility
• Global Consortium on Climate and Health Education
• Planetary Health Alliance
• Medical Consortium on Climate and Health
Like a debate, a position paper presents one side of an arguable opinion about a topic or issue. The goal of a position paper is to convince the audience that your opinion is valid and defensible. Ideas that you are considering need to be carefully examined in choosing a topic, developing your argument, and organizing your paper. Select a topic related to how the environment affects the health of a population. Review and present the relevant literature. Your job is to take one side of the argument and persuade your audience that you have well-founded knowledge of the topic being presented. It is important to support your argument with evidence to ensure the validity of your claims, as well as to refute the counterclaims to show that you are well informed about both sides. Be certain to consider all sides and present the issue clearly.
I strongly recommended that you structure your paper with sections listed below:
• Introduction to the topic 5 pts
• Summary of the relevant literature 5 pts
• Development and presentation of the argument 5 pts
• Refutation of counterclaims 5 pts
• Nursing role in the promotion of the health of the affected population 5 pts
• Summary of issue’s relevance to nursing and health 5 pts
• Writing style, APA 7 citation 5 pts
Order a Scholarly Researched Position Paper Paper Today

FOR THIS ASSIGNMENT I ATTACHED A COPY OF (E/M patient case scenario)
To Prepare
Review this week’s Learning Resources on coding, billing, reimbursement.
Review the E/M patient case scenario provided.
The Assignment
Assign DSM-5 and ICD-10 codes to services based upon the patient case scenario.
Then, in 1–2 pages address the following. You may add your narrative answers to these questions to the bottom of the case scenario document and submit them all together as one document.
Explain what pertinent information, generally, is required in documentation to support DSM-5 and ICD-10 coding.
Explain what pertinent documentation is missing from the case scenario, and what other information would be helpful to narrow your coding and billing options.
Finally, explain how to improve documentation to support coding and billing for maximum reimbursement.
Learning Resources
Required/ Optional Readings (click to expand/reduce)
American Psychiatric Association. (2020). Updates to DSM–5 criteria, text, and ICD-10 codes. https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm-5
American Psychiatric Association. (2013). Insurance implications of DSM-5. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM_Insurance-Implications-of-DSM-5.pdf
Clicking on this link will initiate the download of the PDF.
American Psychiatric Association. (2020). Coding and reimbursement.
https://www.psychiatry.org/psychiatrists/practice/practice-management/coding-reimbursement-medicare-and-medicaid/coding-and-reimbursement
American Psychiatric Association. (2013). Numerical listing of DSM-5 diagnoses and codes (ICD-10-CM). In Diagnostic and statistical manual of mental disorders (5th ed.). http://dsm.psychiatryonline.org.ezp.waldenulibrary.org/doi/10.1176/appi.books.9780890425596.ICD10Num_list
Buppert, C. (2021). Nurse practitioner’s business practice and legal guide (7th ed.). Jones & Bartlett Learning.
Chapter 9, “Reimbursement for Nurse Practitioner Services”
Centers for Medicare & Medicaid Services. (2020). Your billing responsibilities. https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/ProviderServices/Your-Billing-Responsibilities
Stewart, J. G., & DeNisco, S. M. (2019). Role development for the nurse practitioner (2nd ed.). Jones & Bartlett Learning.
Chapter 15, “Reimbursement for Nurse Practitioner Services”
Walden University Academic Skills Center. (2017). Developing SMART goals. https://academicguides.waldenu.edu/ld.php?content_id=51901492
Zakhari, R. (2021). The psychiatric-mental health nurse practitioner certification review manual. Springer Publishing Company.
Chapter 4 “Neuroanatomy, Physiology, and Mental Illness”
Document: E/M Patient Case Study
Patient Scenario
Instructions
Use the following case template to complete Week 2 Assignment 1. On page 5, assign DSM-5 and ICD-10 codes to the services documented. You will add your narrative answers to the assignment questions to the bottom of this template and submit them altogether as one document.
Identifying Information
Identification was verified by stating of their name and date of birth.
Time spent for evaluation: 0900am-0957am
Chief Complaint
“My other provider retired. I don’t think I’m doing so well.”
HPI
25 yo Russian female evaluated for psychiatric evaluation referred from her retiring practitioner for PTSD, ADHD, Stimulant Use Disorder, in remission. She is currently prescribed fluoxetine 20mg po daily for PTSD, atomoxetine 80mg po daily for ADHD.
Today, client denied symptoms of depression, denied anergia, anhedonia, amotivation, no anxiety, denied frequent worry, reports feeling restlessness, no reported panic symptoms, no reported obsessive/compulsive behaviors. Client denies active SI/HI ideations, plans or intent. There is no evidence of psychosis or delusional thinking. Client denied past episodes of hypomania, hyperactivity, erratic/excessive spending, involvement in dangerous activities, self-inflated ego, grandiosity, or promiscuity. Client reports increased irritability and easily frustrated, loses things easily, makes mistakes, hard time focusing and concentrating, affecting her job. Has low frustration tolerance, sleeping 5–6 hrs/24hrs reports nightmares of previous rape, isolates, fearful to go outside, has missed several days of work, appetite decreased. She has somatic concerns with GI upset and headaches. Client denied any current binging/purging behaviors, denied withholding food from self or engaging in anorexic behaviors. No self-mutilation behaviors.
Diagnostic Screening Results
Screen of symptoms in the past 2 weeks:
PHQ 9 = 0 with symptoms rated as no difficulty in functioning
Interpretation of Total Score
Total Score Depression Severity 1-4 Minimal depression 5-9 Mild depression 10-14 Moderate depression 15-19 Moderately severe depression 20-27 Severe depression
GAD 7 = 2 with symptoms rated as no difficulty in functioning
Interpreting the Total Score:
Total Score Interpretation ?10 Possible diagnosis of GAD; confirm by further evaluation 5 Mild Anxiety 10 Moderate anxiety 15 Severe anxiety
MDQ screen negative
PCL-5 Screen 32
Past Psychiatric and Substance Use Treatment
· Entered mental health system when she was age 19 after raped by a stranger during a house burglary.
· Previous Psychiatric Hospitalizations: denied
· Previous Detox/Residential treatments: one for abuse of stimulants and cocaine in 2015
· Previous psychotropic medication trials: sertraline (became suicidal), trazodone (worsened nightmares), bupropion (became suicidal), Adderall (began abusing)
· Previous mental health diagnosis per client/medical record: GAD, Unspecified Trauma, PTSD, Stimulant use disorder, ADHD confirmed by school records
Substance Use History
Have you used/abused any of the following (include frequency/amt/last use):
Substance Y/N Frequency/Last Use
Tobacco products Y ½
ETOH Y last drink 2 weeks ago, reports drinks 1-2 times monthly one drink socially
Cannabis N
Cocaine Y last use 2015
Prescription stimulants Y last use 2015
Methamphetamine N
Inhalants N
Sedative/sleeping pills N
Hallucinogens N
Street Opioids N
Prescription opioids N
Other: specify (spice, K2, bath salts, etc.) Y reports one-time ecstasy use in 2015
Any history of substance related:
· Blackouts: +
· Tremors: –
· DUI: –
· D/T’s: –
· Seizures: –
Longest sobriety reported since 2015—stayed sober maintaining sponsor, sober friends, and meetings
Psychosocial History
Client was raised by adoptive parents since age 6; from Russian orphanage. She has unknown siblings. She is single; has no children.
Employed at local tanning bed salon
Education: High School Diploma
Denied current legal issues.
Suicide / HOmicide Risk Assessment
RISK FACTORS FOR SUICIDE:
· Suicidal Ideas or plans – no
· Suicide gestures in past – no
· Psychiatric diagnosis – yes
· Physical Illness (chronic, medical) – no
· Childhood trauma – yes
· Cognition not intact – no
· Support system – yes
· Unemployment – no
· Stressful life events – yes
· Physical abuse – yes
· Sexual abuse – yes
· Family history of suicide – unknown
· Family history of mental illness – unknown
· Hopelessness – no
· Gender – female
· Marital status – single
· White race
· Access to means
· Substance abuse – in remission
PROTECTIVE FACTORS FOR SUICIDE:
· Absence of psychosis – yes
· Access to adequate health care – yes
· Advice & help seeking – yes
· Resourcefulness/Survival skills – yes
· Children – no
· Sense of responsibility – yes
· Pregnancy – no; last menses one week ago, has Norplant
· Spirituality – yes
· Life satisfaction – “fair amount”
· Positive coping skills – yes
· Positive social support – yes
· Positive therapeutic relationship – yes
· Future oriented – yes
Suicide Inquiry: Denies active suicidal ideations, intentions, or plans. Denies recent self-harm behavior. Talks futuristically. Denied history of suicidal/homicidal ideation/gestures; denied history of self-mutilation behaviors
Global Suicide Risk Assessment: The client is found to be at low risk of suicide or violence, however, risk of lethality increased under context of drugs/alcohol.
No required SAFETY PLAN related to low risk
Mental Status Examination
She is a 25 yo Russian female who looks her stated age. She is cooperative with examiner. She is neatly groomed and clean, dressed appropriately. There is mild psychomotor restlessness. Her speech is clear, coherent, normal in volume and tone, has strong cultural accent. Her thought process is ruminative. There is no evidence of looseness of association or flight of ideas. Her mood is anxious, mildly irritable, and her affect appropriate to her mood. She was smiling at times in an appropriate manner. She denies any auditory or visual hallucinations. There is no evidence of any delusional thinking. She denies any current suicidal or homicidal ideation. Cognitively, She is alert and oriented to all spheres. Her recent and remote memory is intact. Her concentration is fair. Her insight is good.
Clinical Impression
Client is a 25 yo Russian female who presents with history of treatment for PTSD, ADHD, Stimulant use Disorder, in remission.
Moods are anxious and irritable. She has ongoing reported symptoms of re-experiencing, avoidance, and hyperarousal of her past trauma experiences; ongoing subsyndromal symptoms related to her past ADHD diagnosis and exacerbated by her PTSD diagnosis. She denied vegetative symptoms of depression, no evident mania/hypomania, no psychosis, denied anxiety symptoms. Denied current cravings for drugs/alcohol, exhibits no withdrawal symptoms, has somatic concerns of GI upset and headaches.
At the time of disposition, the client adamantly denies SI/HI ideations, plans or intent and has the ability to determine right from wrong, and can anticipate the potential consequences of behaviors and actions. She is a low risk for self-harm based on her current clinical presentation and her risk and protective factors.
Diagnostic Impression
[Student to provide DSM-5 and ICD-10 coding]
Double click inside this text box to add/edit text. Delete placeholder text when you add your answers.
Treatment Plan
1) Medication:
· Increase fluoxetine 40mg po daily for PTSD #30 1 RF
· Continue with atomoxetine 80mg po daily for ADHD. #30 1 RF
Instructed to call and report any adverse reactions.
Future Plan: monitor for decrease re-experiencing, hyperarousal, and avoidance symptoms; monitor for improved concentration, less mistakes, less forgetful
2) Education: Risks and benefits of medications are discussed including non-treatment. Potential side effects of medications discussed. Verbal informed consent obtained.
Not to drive or operate dangerous machinery if feeling sedated.
Not to stop medication abruptly without discussing with providers.
Discussed risks of mixing medications with OTC drugs, herbal, alcohol/illegal drugs. Instructed to avoid this practice. Praised and Encouraged ongoing abstinence. Maintain support system, sponsors, and meetings.
Discussed how drugs/ETOH affects mental health, physical health, sleep architecture.
3) Patient was educated about therapy and services of the MHC including emergent care. Referral was sent via email to therapy team for PET treatment.
4) Patient has emergency numbers: Emergency Services 911, the national Crisis Line 800-273-TALK, the MHC Crisis Clinic. Patient was instructed to go to nearest ER or call 911 if they become actively suicidal and/or homicidal.
5) Time allowed for questions and answers provided. Provided supportive listening. Patient appeared to understand discussion and appears to have capacity for decision making via verbal conversation.
6) RTC in 30 days
7) Follow up with PCP for GI upset and headaches, reviewed PCP history and physical dated one week ago and include lab results
Patient is amenable with this plan and agrees to follow treatment regimen as discussed.
Narrative Answers
[In 1-2 pages, address the following:
· Explain what pertinent information, generally, is required in documentation to support DSM-5 and ICD-10 coding.
· Explain what pertinent documentation is missing from the case scenario, and what other information would be helpful to narrow your coding and billing options.
· Finally, explain how to improve documentation to support coding and billing for maximum reimbursement.]
Add your answers here. Delete instructions and placeholder text when you add your answers.
Place your order today!
Solution
Psychiatric Patient Evaluation
Instructions
Use the following case template to complete Week 2 Assignment 1. On page 5, assign DSM-5 and ICD-10 codes to the services documented. You will add your narrative answers to the assignment questions to the bottom of this template and submit them altogether as one document.
Identifying Information
Identification was verified by stating of their name and date of birth.
Time spent for evaluation: 0900am-0957am
Chief Complaint
“My other provider retired. I don’t think I’m doing so well.”
HPI
25 yo Russian female evaluated for psychiatric evaluation referred from her retiring practitioner for PTSD, ADHD, Stimulant Use Disorder, in remission. She is currently prescribed fluoxetine 20mg po daily for PTSD, atomoxetine 80mg po daily for ADHD.
Today, client denied symptoms of depression, denied anergia, anhedonia, amotivation, no anxiety, denied frequent worry, reports feeling restlessness, no reported panic symptoms, no reported obsessive/compulsive behaviors. Client denies active SI/HI ideations, plans or intent. There is no evidence of psychosis or delusional thinking. Client denied past episodes of hypomania, hyperactivity, erratic/excessive spending, involvement in dangerous activities, self-inflated ego, grandiosity, or promiscuity. Client reports increased irritability and easily frustrated, loses things easily, makes mistakes, hard time focusing and concentrating, affecting her job. Has low frustration tolerance, sleeping 5–6 hrs/24hrs reports nightmares of previous rape, isolates, fearful to go outside, has missed several days of work, appetite decreased. She has somatic concerns with GI upset and headaches. Client denied any current binging/purging behaviors, denied withholding food from self or engaging in anorexic behaviors. No self-mutilation behaviors.
Diagnostic Screening Results
Screen of symptoms in the past 2 weeks:
PHQ 9 = 0 with symptoms rated as no difficulty in functioning
Interpretation of Total Score
Total Score Depression Severity 1-4 Minimal depression 5-9 Mild depression 10-14 Moderate depression 15-19 Moderately severe depression 20-27 Severe depression
GAD 7 = 2 with symptoms rated as no difficulty in functioning
Interpreting the Total Score:
Total Score Interpretation ?10 Possible diagnosis of GAD; confirm by further evaluation 5 Mild Anxiety 10 Moderate anxiety 15 Severe anxiety
MDQ screen negative
PCL-5 Screen 32
Past Psychiatric and Substance Use Treatment
· Entered mental health system when she was age 19 after raped by a stranger during a house burglary.
· Previous Psychiatric Hospitalizations: denied
· Previous Detox/Residential treatments: one for abuse of stimulants and cocaine in 2015
· Previous psychotropic medication trials: sertraline (became suicidal), trazodone (worsened nightmares), bupropion (became suicidal), Adderall (began abusing)
· Previous mental health diagnosis per client/medical record: GAD, Unspecified Trauma, PTSD, Stimulant use disorder, ADHD confirmed by school records
Substance Use History
Have you used/abused any of the following (include frequency/amt/last use):
Substance Y/N Frequency/Last Use
Tobacco products Y ½
ETOH Y last drink 2 weeks ago, reports drinks 1-2 times monthly one drink socially
Cannabis N
Cocaine Y last use 2015
Prescription stimulants Y last use 2015
Methamphetamine N
Inhalants N
Sedative/sleeping pills N
Hallucinogens N
Street Opioids N
Prescription opioids N
Other: specify (spice, K2, bath salts, etc.) Y reports one-time ecstasy use in 2015
Any history of substance related:
· Blackouts: +
· Tremors: –
· DUI: –
· D/T’s: –
· Seizures: –
Longest sobriety reported since 2015—stayed sober maintaining sponsor, sober friends, and meetings
Psychosocial History
Client was raised by adoptive parents since age 6; from Russian orphanage. She has unknown siblings. She is single; has no children.
Employed at local tanning bed salon
Education: High School Diploma
Denied current legal issues.
Suicide / HOmicide Risk Assessment
RISK FACTORS FOR SUICIDE:
· Suicidal Ideas or plans – no
· Suicide gestures in past – no
· Psychiatric diagnosis – yes
· Physical Illness (chronic, medical) – no
· Childhood trauma – yes
· Cognition not intact – no
· Support system – yes
· Unemployment – no
· Stressful life events – yes
· Physical abuse – yes
· Sexual abuse – yes
· Family history of suicide – unknown
· Family history of mental illness – unknown
· Hopelessness – no
· Gender – female
· Marital status – single
· White race
· Access to means
· Substance abuse – in remission
PROTECTIVE FACTORS FOR SUICIDE:
· Absence of psychosis – yes
· Access to adequate health care – yes
· Advice & help seeking – yes
· Resourcefulness/Survival skills – yes
· Children – no
· Sense of responsibility – yes
· Pregnancy – no; last menses one week ago, has Norplant
· Spirituality – yes
· Life satisfaction – “fair amount”
· Positive coping skills – yes
· Positive social support – yes
· Positive therapeutic relationship – yes
· Future oriented – yes
Suicide Inquiry: Denies active suicidal ideations, intentions, or plans. Denies recent self-harm behavior. Talks futuristically. Denied history of suicidal/homicidal ideation/gestures; denied history of self-mutilation behaviors
Global Suicide Risk Assessment: The client is found to be at low risk of suicide or violence, however, risk of lethality increased under context of drugs/alcohol.
No required SAFETY PLAN related to low risk
Mental Status Examination
She is a 25 yo Russian female who looks her stated age. She is cooperative with examiner. She is neatly groomed and clean, dressed appropriately. There is mild psychomotor restlessness. Her speech is clear, coherent, normal in volume and tone, has strong cultural accent. Her thought process is ruminative. There is no evidence of looseness of association or flight of ideas. Her mood is anxious, mildly irritable, and her affect appropriate to her mood. She was smiling at times in an appropriate manner. She denies any auditory or visual hallucinations. There is no evidence of any delusional thinking. She denies any current suicidal or homicidal ideation. Cognitively, She is alert and oriented to all spheres. Her recent and remote memory is intact. Her concentration is fair. Her insight is good.
Clinical Impression
Client is a 25 yo Russian female who presents with history of treatment for PTSD, ADHD, Stimulant use Disorder, in remission.
Moods are anxious and irritable. She has ongoing reported symptoms of re-experiencing, avoidance, and hyperarousal of her past trauma experiences; ongoing subsyndromal symptoms related to her past ADHD diagnosis and exacerbated by her PTSD diagnosis. She denied vegetative symptoms of depression, no evident mania/hypomania, no psychosis, denied anxiety symptoms. Denied current cravings for drugs/alcohol, exhibits no withdrawal symptoms, has somatic concerns of GI upset and headaches.
At the time of disposition, the client adamantly denies SI/HI ideations, plans or intent and has the ability to determine right from wrong, and can anticipate the potential consequences of behaviors and actions. She is a low risk for self-harm based on her current clinical presentation and her risk and protective factors.
Diagnostic Impression
PTSD & ADHD
PTSD:
· DSM-5 diagnostic code: 309.81 (F43.10) (APA, 2013)
· ICD-10 code: F43.10 (ICM10Data.com, n.d.-a)
ADHD (combined presentation):
· DSM-5 code: 314.01 (F90.2) (APA, 2013)
· ICD-10 code: F90.2 (ICM10Data.com, n.d.-b)
Treatment Plan
1) Medication:
· Increase fluoxetine 40mg po daily for PTSD #30 1 RF
· Continue with atomoxetine 80mg po daily for ADHD. #30 1 RF
Instructed to call and report any adverse reactions.
Future Plan: monitor for decreased re-experiencing, hyperarousal, and avoidance symptoms; monitor for improved concentration, fewer mistakes, less forgetful
2) Education: Risks and benefits of medications are discussed including non-treatment. Potential side effects of medications discussed. Verbal informed consent was obtained.
Not to drive or operate dangerous machinery if feeling sedated.
Not to stop the medication abruptly without discussing it with providers.
Discussed risks of mixing medications with OTC drugs, herbal, alcohol/illegal drugs. Instructed to avoid this practice. Praised and Encouraged ongoing abstinence. Maintain support system, sponsors, and meetings.
Discussed how drugs/ETOH affects mental health, physical health, sleep architecture.
3) Patient was educated about therapy and services of the MHC including emergent care. Referral was sent via email to therapy team for PET treatment.
4) Patient has emergency numbers: Emergency Services 911, the national Crisis Line 800-273-TALK, the MHC Crisis Clinic. Patient was instructed to go to nearest ER or call 911 if they become actively suicidal and/or homicidal.
5) Time allowed for questions and answers provided. Provided supportive listening. Patient appeared to understand discussion and appears to have capacity for decision making via verbal conversation.
6) RTC in 30 days
7) Follow up with PCP for GI upset and headaches, reviewed PCP history and physical dated one week ago and include lab results
Patient is amenable with this plan and agrees to follow treatment regimen as discussed.
Narrative Answers
The ICD-10 coding system is used to classify diseases and aid in billing and payment. According to Leon-Chisen (2018), it stands for the tenth revision of the International Classification of Diseases, Clinical Modification. The information needed in records to complement DSM-5 and ICD-10 classification usually defines what was done to the client and whether the interventions were provided as an outpatient or inpatient. It’s worth noting, though, that the DSM-5 helps clinicians diagnose more exactly, whereas the ICD-10 helps them classify and bill for payment much more correctly.
This relevant information is that there must be a match in the DSM-5 and ICD-10 codes, it must be indicated whether the client is an inpatient or an outpatient, the procedure or intervention done must be stated exactly and unambiguously including the amount of time it took to do it, there has to be a maximum of 7 alphanumeric characters in the ICD-10 code, and there must be a provision for clinician query process to find out answers to unclear parts of the billing and coding.
The Missing Information According to the resented Case
The following information is missing from the documentation of the case scenario presented:
a. The age at which the ADHD symptoms first appeared. This is because treatment plans for childhood-onset and adult-onset ADHD may differ (Sadock et al., 2015).
b. The duration of the patient’s treatment with fluoxetine and atomoxetine. This, too, may have an impact on the treatment approach, as additional medications may be considered if the therapeutic effect is delayed or non-existent.
Given the preceding observation, further information about the length of time the patient will be on therapy in weeks as well as the duration of each session might be valuable in restricting the coding and billing possibilities. It would also be beneficial to know if the practitioner performed any more testing to get at the diagnosis.
Improving Documentation for Better Coding and Billing
The quest for higher income for both the practitioner and the organization is centered on proper coding and billing. The following are some of the tactics the business can take to improve billing and coding so that reimbursement claims generate more revenue:
a) Having a designated person whose duty it is to countercheck claims and follow up on any claims that have been denied and need to be resubmitted. This is due to the fact that, as humans, we will occasionally fail to properly document something. When filling out the details in the electronic health record (EHR) system, certain information may have been overlooked.
b) Keeping up with changes in billing and coding protocols that occur from time to time. This guarantees that the organization’s billing and coding methods are up to date.
c) Ensuring that any deadlines established by stakeholders, such as payers, are reached on time.
d) Appointment of a coder to assist physicians with coding so that crucial information required for seamless and better reimbursement is not overlooked. Clinicians, such as physicians, frequently overlook vital information because they believe it is unimportant.
e) Ascertaining that each patient’s primary and secondary payers are identified.
f) Verifying benefits before administering any treatment to avoid administering treatment that is not covered, causing the claim to be refused.
References
American Psychiatric Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed. Author.
ICM10Data.com (n.d.-a). Post-traumatic stress disorder, unspecified. https://www.icd10data.com/ICD10CM/Codes/F01-F99/F40-F48/F43-/F43.10
ICM10Data.com (n.d.-b). Attention-deficit hyperactivity disorder, combined type. https://www.icd10data.com/ICD10CM/Codes/F01-F99/F90-F98/F90-/F90.2
Leon-Chisen, N. (2018). ICD-10-CM and ICD-10-PCS coding handbook 2019, revised ed. Health Forum, Inc.
Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Synopsis of psychiatry: Behavioral sciences clinical psychiatry, 11th ed. Wolters Kluwer.

NRS 427V All Week Assignments Package
Order NRS 427V All Week Assignments Today !
NRS 427V Week 2 Assignment Benchmark Assignment: Epidemiology Paper
Details:
In a written paper of 1,200-1,500 words, apply the concepts of epidemiology and nursing research to a communicable disease.
Communicable Disease Selection
Choose one communicable disease from the following list:
Chickenpox
Tuberculosis
Influenza
Mononucleosis
Hepatitis B
HIV
Epidemiology Paper Requirements
Include the following in your assignment:
Description of the communicable disease (causes, symptoms, mode of transmission, complications, treatment) and the demographic of interest (mortality, morbidity, incidence, and prevalence).
Describe the determinants of health and explain how those factors contribute to the development of this disease.
Discuss the epidemiologic triangle as it relates to the communicable disease you have selected. Include the host factors, agent factors (presence or absence), and environmental factors. (The textbook describes each element of the epidemiologic triangle).
Explain the role of the community health nurse (case finding, reporting, data collecting, data analysis, and follow-up).
Identify at least one national agency or organization that addresses the communicable disease chosen and describe how the organization(s) contributes to resolving or reducing the impact of disease.
A minimum of three references is required.
Refer to “Communicable Disease Chain.”
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.
NRS 427V Week 4 CLC Assignment
Assignment and Presentation
Details:
This is a CLC assignment. The instructor will assign you to a CLC group.
NRS 427V
The RN to BSN program at Grand Canyon University meets the requirements for clinical competencies as defined by the Commission on Collegiate Nursing Education (CCNE) and the American Association of Colleges of Nursing (AACN), using nontraditional experiences for practicing nurses. These experiences come in the form of direct and indirect care experiences in which licensed nursing students engage in learning within the context of their hospital organization, specific care discipline, and local communities.
This assignment consists of both an interview and a PowerPoint (PPT) presentation.
Assessment/Interview
Select a community of interest. It is important that the community selected be one in which a CLC group member currently resides. Students residing in the chosen community should be assigned to perform the physical assessment of the community.
Perform a direct assessment of a community of interest using the “Functional Health Patterns Community Assessment Guide.”
Interview a community health and public health provider regarding that person’s role and experiences within the community.
Interview Guidelines
Interviews can take place in-person, by phone, or by Skype. Complete the “Provider Interview Acknowledgement Form” and submit with the group presentation.
Develop one set of interview questions to gather information about the role of the provider in the community and the health issues faced by the chosen community.
Compile key findings from the interview, including the interview questions used, and submit with the group presentation.
PowerPoint Presentation
Within your group, create a PowerPoint presentation of 15-20 slides (slide count does not include title and reference slide) describing the chosen community interest.
Include the following in your presentation:
Description of community and community boundaries: the people and the geographic, geopolitical, financial, ethnic, and phenomenological features of the community as well as types of social interactions, common goals and interests, barriers, and challenges.
Summary of community assessment.
Summary of interview with community health/public health provider.
A conclusion summarizing your key findings and a discussion of your impressions of the general health of the community.
While APA format is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.
You are not required to submit this assignment to Turnitin, unless otherwise directed by your instructor. If so directed, refer to the Student Success Center for directions. Only Word documents can be submitted to Turnitin.
When submitting this assignment, include the interview questions, the interview findings, completed “Provider Interview Acknowledgement Form,” and the community assessment PPT presentation.
NRS 427V Week 5 Assignment Community Teaching Plan: Community Presentation
Details:
Note: This is an individual assignment. Based on the feedback offered by the provider, identify the best approach for teaching. Prepare a presentation to accompany the teaching plan and present the information to your community. Select one of the following options for delivery of the presentation:
PowerPoint presentation – no more than 30 minutes
Pamphlet presentation – 1 to 2 pages
Poster presentation
Appropriate community settings include:
Public health clinic
Community health center
Long-term care facility
Transitional care facility
Home health center
University/School health center
Church community
Adult/Child care center
Before presenting information to the community, seek approval from an agency administrator or representative.
Upon receiving approval from the agency, include the “Community Teaching Experience Form” as part of your assignment submission.
APA format is required for essays only. Solid academic writing is always expected. For all assignment delivery options, documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
You are not required to submit this assignment to Turnitin.
Order NRS 427V Week Assignments Today !
NRS 427V Week 5 Assignment 2 Community Teaching Plan: Community Teaching Work Plan Proposal
Details:
Note: This is an individual assignment. Applying what you have learned thus far, develop a community teaching proposal designed to address the needs of your community.
Select one of the following as the focus for the teaching plan:
Primary Prevention/Health Promotion
Secondary Prevention/Screenings for a Vulnerable Population
Bioterrorism/Disaster
Environmental Issues
Complete the “Community Teaching Work Plan Proposal.” This will help you organize your plan and create an outline for the written assignment.
After completing the teaching proposal, review the teaching plan with a community health and public health provider in your local community.
Request feedback (strengths and opportunities for improvement) from the provider.
Complete the “Community Teaching Experience” form.
APA format is required for essays only. Solid academic writing is always expected. For all assignment delivery options, documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are not required to submit this assignment to Turnitin.
NRS 427V Week 5 Assignment 3 – Community Teaching Plan: Teaching Experience Paper
Details:
Note: This is an individual assignment. In 1,500-2,000 words, describe the teaching experience and discuss your observations. The written portion of this assignment should include:
Summary of teaching plan
Epidemiological rationale for topic
Evaluation of teaching experience
Community response to teaching
Areas of strengths and areas of improvement
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

Case Study
Patient AO has a history of obesity and has recently gained 9 pounds. The patient has been diagnosed with hypertension and hyperlipidemia. Drugs currently prescribed include the following:
Atenolol 12.5 mg daily
Doxazosin 8 mg daily
Hydralazine 10 mg daily
Sertraline 25 mg daily
Simvastatin 80 mg daily
Please keep in mind that there are multiple drugs for these disorders, and it is important to always think about the following when evaluating a case:
Co-morbid conditions of the patient
Differential—how do you rule out certain conditions
Current medications and if the dose is appropriate
Adverse effects
Contraindications for the patient
Despite the high mortality rates associated with cardiovascular disorders, improved treatment options do exist that can help address those risk factors that afflict the majority of the population today. As an advanced practice nurse, it is your responsibility to recommend appropriate treatment options for patients with cardiovascular disorders. To ensure the safety and effectiveness of drug therapy, advanced practice nurses must consider aspects that might influence pharmacokinetic and pharmacodynamic processes such as medical history, other drugs currently prescribed, and individual patient factors.
To Prepare
Review the Resources for this module and consider the impact of potential pharmacotherapeutics for cardiovascular disorders introduced in the media piece.
Review the case study assigned by your Instructor for this Assignment.
Select one of the following factors: genetics, gender, ethnicity, age, or behavior factors.
Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.
Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.
Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient.
By Day 7 of Week 2
Write a 2- to 3-page paper that addresses the following:
Explain how the factor you selected (genetics, gender, ethnicity, age, or behavior factors) might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.
Place your order!
Solution
Cardiovascular problems have a significant effect on the health and wellbeing of the affected patient populations. They act as a source of considerable disease burden. Nurses and other healthcare providers have a crucial role to play in facilitating the realization of the health needs of patients with cardiovascular problems. Therefore, this paper examines AO’s case study to determine the influence of age on pharmacokinetics and pharmacodynamics of the prescribed medications and the influence of changes on the recommended drug therapy. It also examines the ways of improving drug therapy.
Effect of the Selected Factor
Age is a significant factor that influences the pharmacokinetics and pharmacodynamics of medications prescribed for AO. The changes in the age of the patient affect drug metabolism. For example, the level of first metabolism being undertaken by cytochrome P450 declines with advancing age due to the liver being less effective. The effect is the reduction in drugs metabolized in the liver and an increase in the level of drug metabolites in the system (Kuprash et al., 2020). Renal function also declines with the advancing age. The elderly patients have reduced renal functions, which lower the elimination of drugs via the renal system. The effect of this change is that elderly patients are likely to suffer from drug toxicity due to reduced elimination of medications, hence, affecting the pharmacokinetics and pharmacodynamics of drugs (van den Anker et al., 2018). It can be seen from AO’s case study that the metabolism of hydralazine is likely to be reduced with the advancing age of the patient. Besides, drugs such as atenolol are likely to be minimally eliminated via the renal system, increasing the risk for its toxicity in elderly patients. The last effect of age on pharmacokinetics and pharmacodynamics is also seen in the reduction in the absorption of drugs via the gastrointestinal system with the advancing age (Groenland et al., 2021). As a result, the use of the oral route of medication should be avoided to ensure the optimum absorption of medications for the desired therapeutic effect.
Effect of Changes on Recommended Drug Therapy
The effect of changes attributed to age has implications on the recommended drug therapy for AO. Firstly, the effect of age on drug metabolism increases the need for the alteration in the dosage of the medications that undergo first-pass metabolism. The reduction in the dosage is to eliminate the risk of potential liver toxicity due to an increase in the level of drug metabolites in the blood (Peeters et al., 2019). The changes also increase the need for prescribing AO medications that are eliminated via other routes such as through feces for the drug metabolites. The consideration of other routes such as through feces will preserve optimal renal functioning in elderly patients. The dosage of medications such as atenolol and hydralazine also needs to be reduced to minimize renal damage and enhance excretion. The last implication of the effect is considering medications administered through other routes such as intravenous medications. Intravenous medications will enhance the absorption of medications by bypassing the gastrointestinal route that has a reduced rate of absorption in elderly patients (Farkouh et al., 2020).
Improving Patient’s Drug Therapy
An effective intervention that should be adopted for AO is reducing the dosage of the prescribed medications. Reducing the dosage of medications that undergo first-pass metabolism in the liver and elimination via the renal system will enhance their pharmacokinetics and pharmacodynamics. It will also minimize harm to the patient; ensuring safety in the care process is achieved (van den Anker et al., 2018). The reduction in the risk of harm will also ensure the protection of the patient’s right to high-quality care.
Conclusion
Age has a significant effect on the pharmacokinetics and pharmacodynamics of medications prescribed for AO. Advancing age alters the pharmacokinetics and pharmacodynamics of medications. Healthcare providers should ensure the prescription of patients with medications has minimal harm and optimum benefits to the patients. Through it, safety, quality, and efficiency in healthcare will be achieved.
References
Farkouh, A., Riedl, T., Gottardi, R., Czejka, M., & Kautzky-Willer, A. (2020). Sex-Related Differences in Pharmacokinetics and Pharmacodynamics of Frequently Prescribed Drugs: A Review of the Literature. Advances in Therapy, 37(2), 644–655. https://doi.org/10.1007/s12325-019-01201-3
Groenland, E. H., van Kleef, M. E. A. M., Bots, M. L., Visseren, F. L. J., van der Elst, K. C. M., & Spiering, W. (2021). Plasma Trough Concentrations of Antihypertensive Drugs for the Assessment of Treatment Adherence. Hypertension, 77(1), 85–93. https://doi.org/10.1161/HYPERTENSIONAHA.120.16061
Kuprash, L., Gudarenko, S., Kuprash, O., Gorchakova, N., & Khodakivska, O. (2020). Age peculiarities of pharmacokinetics and pharmacodynamics of medicines. Ageing and longevity, 1(1), Article 1. http://aging-longevity.org.ua/index.php/journal-description/article/view/9
Peeters, L. E. J., Kester, M. P., Feyz, L., Van Den Bemt, P. M. L. A., Koch, B. C. P., Van Gelder, T., & Versmissen, J. (2019). Pharmacokinetic and pharmacodynamic considerations in the treatment of the elderly patient with hypertension. Expert Opinion on Drug Metabolism & Toxicology, 15(4), 287–297. https://doi.org/10.1080/17425255.2019.1588249
van den Anker, J., Reed, M. D., Allegaert, K., & Kearns, G. L. (2018). Developmental Changes in Pharmacokinetics and Pharmacodynamics. The Journal of Clinical Pharmacology, 58(S10), S10–S25. https://doi.org/10.1002/jcph.1284

Post an explanation of your plan for creating a balanced scorecard for your Strategic Plan, including the processes you would use to gather data to measure performance. Explain how the use of this balanced scorecard will enable you to evaluate progress, assess the impact of your proposed change, and determine if the costs are justified in terms of the outcomes.
To prepare:
Review the information in the Learning Resources, including this week’s media presentation, focusing on the development of performance metrics for a strategic plan.
With your Strategic Plan in mind, think about how you would develop a balanced scorecard to measure performance, including the processes you would use to gather appropriate data.
Consider how the use of a balanced scorecard reflects the importance of being able to evaluate progress, assess the impact of planned change on performance, and determine if the costs are justified in terms of the outcome.
Place your order today!
Solution
The Balanced Scorecard in the Strategic Plan Process
The discussion will focus on using a balanced scorecard in the strategic plan and its effectiveness in evaluating the proposed change progress.
Using a Balanced Scorecard in the Strategic Plan
Over the years, the balanced scorecard has undergone great changes from its traditional performance measurement framework to adopting a full strategic and management system. Hasan and Chyi (2017) accentuate that a balanced scorecard in strategic planning makes it easier to attain feedback from healthcare organizations’ internal and external processes. Hence, by incorporating the balanced scorecard into our healthcare facility, the manager will effectively align its strategic plan with its strategy and vision. Also, it will be easier for the manager to improve external and internal means of communication while evaluating the healthcare facility’s performance compared to its strategic goals. The process to gather data necessary for performance measurement will involve evaluating the 360-degree feedback. Kamal Sobky et al. (2021) accentuate that through the 360-degree feedback, it is easier to gain insight on the management talent since the commentary comes from people who work closely with the managers. Considering that the organization’s main strategic issues are funding and management, the healthcare stakeholders will create an even ground in spotting development opportunities that can inform the success of the proposed change.
Balanced Scorecard Effectiveness in Evaluating the Proposed Change Progress
The balanced scorecard will help ensure that the strategic plan is a success. Consequently, Kamal Sobky et al. (2021) posit that for effective application of a balanced scorecard, there will be a need to consider the four perspectives: the customer perspective, internal operation perspective, learning and growth, and financial perspective. That approach will be effective in the healthcare facility’s strategic planning process since it will impact its long-term goals and criteria for making future decisions (Smith, 2020).
Conclusion
Through the balanced scorecard, the strategic plan will make it a point to focus on the necessary strategies since only key performance indicators are involved, thus preventing the organization from focusing on irrelevant aspects.
References
Hasan, R. U., & Chyi, T. M. (2017). Practical application of Balanced Scorecard-A literature review. Journal of Strategy and Performance Management, 5(3), 87.
Kamal Sobky, H., Ahmed Elsayed, K., & Farouk Kamel, F. (2021). Nursing Staff Perception about Quality Improvement and Organizational Development. Journal of Nursing Science Benha University, 2(2), 88-98.
Smith, C. (2020). The Role of Organizational Change Management in Successful Strategic Enrollment Management Implementation. Strategic Enrollment Management Quarterly, 8(2), 31.