Nursing

PHN 652 Topic 7 DQ 1-Principles And Sources For Financial Management
-Please DO NOT include anything about mental health.
-The question will be uploaded
– Sources must be published within the last 5 years. It must be from 2016 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.
Thank you
ORDER A PLAGIARISM-FREE PAPER HERE !!
Solution
QUESTION-Topic 7 DQ 1
Describe financial planning and management best practices in the implementation of population-based interventions.
Financial planning and management best practices in the implementation of population-based interventions include laying out detailed financial plans that can allow healthcare facilities to introduce any proven services provided in population-based interventions. Financial planning can therefore help health care facilities or government departments to come up with an accurate and high-performing budget that can promote the sustained use of a population-based intervention (Shrank et al., 2021). Sustaining population-based interventions can therefore only be possible through a well-designed balanced budget and effective community engagement. Financial planning before the implementation of a population-based intervention will therefore include determining community assets. By understanding the community assets that will be available is therefore important so as to mobilize such assets in the implementation of a population health plan. The success of a population health intervention is therefore based on the assets and resources that will be at hand for certain stakeholders. Another important financial planning practice is to maintain population-based intervention initiatives after the end of funding. Collaborators and sponsors in the implementation of a population health initiative can experience a form of lack of funding constraints. A series of strategic plans and financial plans must therefore be readily available to sustain public health interventions (Sohn et al., 2020).
How does financial management play a role in the effectiveness and efficiency of population-based interventions?
Financial management plays a significant role in the efficiency and effectiveness of population-based interventions because financial management will determine whether different population interventions can be implemented and sustained for a certain time. Financial management, therefore, helps the different stakeholders in the implementation of public health interventions to determine the costs of implementation of different interventions and also determine the costs associated with running such programs until certain results are realized (Sohn et al., 2020).
References
Shrank, W. H., DeParle, N. A., Gottlieb, S., Jain, S. H., Orszag, P., Powers, B. W., & Wilensky, G. R. (2021). Health Costs And Financing: Challenges And Strategies For A New Administration. Health Affairs, 40(2), 235–242. https://doi.org/10.1377/hlthaff.2020.01560
Sohn, H., Tucker, A., Ferguson, O., Gomes, I., & Dowdy, D. (2020). Costing the implementation of public health interventions in resource-limited settings: a conceptual framework. Implementation Science, 15(1). https://doi.org/10.1186/s13012-020-01047-2

you formulate questions to address a particular nursing issue or problem. You use the PICOT model—patient/population, intervention/issue, comparison, and outcome—outlined in the Learning Resources to design your questions.
To prepare:

Reflect on an issue or problem that you have noticed in your nursing practice. Consider the significance of this issue or problem.
Generate at least five questions that relate to the issue which you have identified. Use the criteria in your course text to select one question that would be most appropriate in terms of significance, feasibility, and interest. Be prepared to explain your rationale.
Formulate a preliminary PICO question—one that is answerable—based on your analysis. What are the PICO variables (patient/population, intervention/issue, comparison, and outcome) for this question?
Note: Not all of these variables may be appropriate to every question. Be sure to analyze which are and are not relevant to your specific question.
Using the PICOT variables that you determined for your question, develop a list of at least 10 keywords that could be used when conducting a literature search to investigate current research pertaining to the question.

To complete:
Write a 3page paper that includes the following:
A summary of your area of interest, an identification of the problem that you have selected, and an explanation of the significance of this problem for nursing practice
The 5 questions you have generated and a description of how you analyzed them for feasibility
Your preliminary PICOT question and a description of each PICOT variable relevant to your question
At least 10 possible keywords that could be used when conducting a literature search for your PICOT question and a rationale for your selections

A mother brings her 6-month-old daughter to the HCP for evaluation of possible colic. The mother says the baby has had many episodes of crying after eating and, despite having a good appetite, is not gaining weight. The mother says the baby’s belly “gets all swollen sometimes.” The mother says the baby tastes “salty” when the mother kisses the baby. Further workup reveals a diagnosis of cystic fibrosis. The mother relates that her 23-month-old son has had multiple episodes of “chest congestion” and was hospitalized once for pneumonia. The mother wants to know what cystic fibrosis is and she also wants to know if she should have any more children.
The role genetics plays in the disease.
Why the patient is presenting with the specific symptoms described.
The physiologic response to the stimulus presented in the scenario and why you think this response occurred.
The cells that are involved in this process.
How another characteristic (e.g., gender, genetics) would change your response
Place your order today!
Solution
Cystic Fibrosis in Children
Genetic Role
Cystic fibrosis is a genetic disorder that results in severely damaged lungs, digestive systems, and other body organs. The disease mainly affects mucus, sweat, and digestive juices secreting cells (Brown et al., 2017). For a patient to reveal the disease, they must be homozygous for the recessive allele. An individual typically has a pair of genes expressing a specific trait. If the two parents carry genes with the CF, they are both carriers, and they, therefore, give a pass-on gene to their child since the child will carry two genes containing CF. Hence the child will suffer from CF.
Reason for the symptoms described
Enzymes break down food into nutrients in the pancreas for body absorption in the body. CF results in reduced enzymes in the pancreas resulting in indigestion and nutrient mal-absorption (VanDevanter et al., 2016). This explains why there is stomach discomfort after eating, making the child cry. It also results in no weight gain and growth. It also caused the dysfunction of the chloride and sodium channels that caused excessive sodium and chloride deposits on the skin surfaces; hence the child tasted salty when the mother kissed her (Dos Santos et al., 2018). It also thickens the mucus in the lungs resulting in congested chest episodes.
Physiologic response to the stimulus
Due to the CF transmembrane regulator dysfunction that results in mucus obstruction of the pancreatic duct blocks the catalysts and the bronchioles mucus (Lausen et al., 2021). All these causes indigestion, constipation, and chest clogging that inhibits nasal airflow and reduced growth and weight gain as presented by the child.
Cells that are involved in this process.
As a result of the CF gene in the body, the epithelial cell produces a defective enzyme commonly referred to as the transmembrane regulator, which is located in the cell lining of the lungs, digestive system, sweat glands, reproductive system, and pancreas (Mesinele et al., 2020).
How another characteristic (e.g., gender, genetics) would change your response
The transfer and display of the CF gene are gender-independent. If both parents are not CF gene carriers, the child cannot have CF, which would have resulted from more tests to determine the disease behind the symptoms.
References
Brown, S., White, R., & Tobin, P. (2017). Keep them breathing. Journal Of The American Academy Of Physician Assistants, 30(5), 23-27. https://doi.org/10.1097/01.jaa.0000515540.36581.92
dos Santos, A., de Melo Santos, H., Nogueira, M., Távora, H., de Lourdes Jaborandy Paim da Cunha, M., & de Melo Seixas, R. et al. (2018). Cystic Fibrosis: Clinical Phenotypes in Children and Adolescents. Pediatric Gastroenterology, Hepatology & Nutrition, 21(4), 306. https://doi.org/10.5223/pghn.2018.21.4.306
Lausen, M., Uhre Nielsen, B., Møller, R., Rossi, E., Rye Ostrowski, S., & Pressler, T. et al. (2021). P132 Reduced systemic immune responses in cystic fibrosis patients. Journal Of Cystic Fibrosis, 20, S79. https://doi.org/10.1016/s1569-1993(21)01158-9
Mesinele, J., Ruffin, M., Guillot, L., Boëlle, P., & Corvol, H. (2020). P048 Pseudomonas aeruginosa lung infection in paediatric cystic fibrosis patients: risk factors and impact on lung function. Journal Of Cystic Fibrosis, 19, S68. https://doi.org/10.1016/s1569-1993(20)30384-2
VanDevanter, D., Kahle, J., O’Sullivan, A., Sikirica, S., & Hodgkins, P. (2016). Cystic fibrosis in young children: A review of disease manifestation, progression, and response to early treatment. Journal Of Cystic Fibrosis, 15(2), 147-157. https://doi.org/10.1016/j.jcf.2015.09.008
Place your order today!

PUB 655 Public health-655- Topic 7 DQ 2-Prof question-Reproductive Health And Nutrition (Please see upload for question)
-The question will be uploaded
– The word count can be between 100-150 words
– 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.
-Please make sure you add the in text citations
NO PLAGARISM
-Add references to reference page
-Add the hyperlink/DOI for each reference in APA 7th edition format.
Thank you
ORDER A PLAGIARISM-FREE PAPER HERE !!
Solution
Public Health roles
Public health is one of the most important things to invest in as a government. The main aim of public health is to improve the healthcare outcome through achieving the objectives of preventing disease and health consequences of hazards and disasters which can be natural or man-made. Understanding the roles of public health helps in giving advice as a minister of health (World Health Organization, 2018). One of the roles to know is that of creating awareness. This is a major role of the public health professional as lack of awareness can be a major reason why various deadly diseases are spread. Public health professionals should ensure that people are aware of how severe a disease is and what to practice to reduce the spread of such diseases. Upon knowing the importance of this role, the health minister can be able to advise on how to strengthen the workforce of healthcare.
Another role is monitoring and collecting data to allow the healthcare providers to keep track of the spread of diseases. Knowing this role may help in stopping the spread of diseases without causing any delay. The Minister of Health also has a role of identifying any health hazards, diseases that are chronic, health issues that are evolving and the outbreak of diseases and advice the healthcare practitioners on necessary steps to take to reduce the diseases (Jin et al, 2019). Public health officers also have a role to conduct a sanitary investigation that may endanger public health. These investigations may include unclean working environment, garbage, rodents, insects and safe drinking water inspections.
Initiating educational programs is another role that minister of health should know. A public health practitioner should educate people on personal hygiene, how to maintain cleanliness, practice a healthy diet, schedules of immunization, how to conduct first aid when there is an emergency and so on. This will help protect people from health problems and help them lead a life free of diseases. Another important role is to develop policies, regulations and plans that can improve healthcare services. The Minister of health should also know the role of conducting wellness programs to provide medical supplies, vaccination and to conduct health surveys among the public. It is important to know these roles in order to give advice and prevent the spread of diseases.
References
Jin, Y., Austin, L., Vijaykumar, S., Jun, H., & Nowak, G. (2019). Communicating about infectious disease threats: Insights from public health information officers. Public Relations Review, 45(1), 167-177.

World Health Organization. (2018). Essential public health functions, health systems and health security: developing conceptual clarity and a WHO roadmap for action.

THE ASSESSMENT TOOL IS :
Patient Stress Questionnaire
Post an explanation of the psychometric properties of the assessment tool provided above .
Explain when it is appropriate to use this assessment tool with clients, including whether the tool can be used to evaluate the efficacy of psychopharmacologic medications.
Support your approach with evidence-based literature.

RS – 6501N
Week 2: Altered Physiology
Module 1 Assignment: Case Study Analysis
An understanding of cells and cell behavior is a critically important component of disease diagnosis and treatment. But some diseases can be complex in nature, with a variety of factors and circumstances impacting their emergence and severity.
Effective disease analysis often requires an understanding that goes beyond isolated cell behavior. Genes, the environments in which cell processes operate, the impact of patient characteristics, and racial and ethnic variables all can have an important impact.
An understanding of the signals and symptoms of alterations in cellular processes is a critical step in the diagnosis and treatment of many diseases. For APRNs, this understanding can also help educate patients and guide them through their treatment plans.
In this Assignment, you examine a case study and analyze the symptoms presented. You identify cell, gene, and/or process elements that may be factors in the diagnosis, and you explain the implications to patient health.
To prepare:
By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
The Assignment (1- to 2-page case study analysis)
Develop a 1- to 2-page case study analysis in which you:
• Explain why you think the patient presented the symptoms described.
• Identify the genes that may be associated with the development of the disease.
• Explain the process of immunosuppression and the effect it has on body systems.
By Day 7 of Week 2
Submit your Case Study Analysis Assignment by Day 7 of Week 2.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates). All papers submitted must use this formatting.
Place your order!
Solution
Case Study
The case involves a 65 years old patient with obesity and experiences pain in the lower quadrant region. Also, the patient has symptoms such as fever and constipation. He experienced multiple episodes of the signs and symptoms in the past 15 years; though, he has not received adequate treatment. Besides, the patient has always been using bowel rest and oral antibiotics to manage the condition. He refused to have the colonoscopy despite having a history of chronic inflammatory bowel disease, a sedentary lifestyle, and even consuming a diet lacking fiber. The patient has a family history of cancer; the grandfather died of cancer in the 1950s. Understanding such is essential in exploring the possibility of the patient having inherited the condition. The patient finally had a colonoscopy, and the findings indicated multiple polyps and adenocarcinoma of the colon. The purpose of this assignment is to analyze the genes, cells, and process elements involved in the patient’s case and outline their roles in the diagnosis and implications to the patient’s health.
Reasons for the Patient’s Presentation
Diverticulitis is a condition characterized by inflammation of the pouches in the intestine. According to Kamal et al. (2019), diverticulitis disease is common among older patients and affects the colon’s left side. Environmental factors and genetic predisposition influence the disease’s progression. Furthermore, the other causative factors for the disease include lack of fiber in the dietary intake and obesity. The complications associated with the condition include bleeding and perforation in the stomach linings. There are high chances that the patient had diverticulitis that contributed to the signs and symptoms. The inflammation in the diverticula results in painful experiences and fever. The condition can respond to antibiotics and hydration, which is why the patient had used the remedies for a long time to manage the disease. The other common signs and symptoms of diverticulitis include pain in the lower left part of the abdomen that tends to be episodic. The pain worsens after eating. Also, the patient is likely to have constipation or diarrhea with occasional blood in the stool.
Diverticulitis may either be symptomatic or asymptomatic. Most people with the condition may occur asymptomatic and unaware unless the condition is detected using colonoscopy imaging. However, the symptomatic cases are characterized by attacks in the iliac fossa. The condition can also co-exist with other diseases such as irritable bowel disease. The disease progression begins with obstruction in the diverticulum that results in intraluminal pressure, perforation, and abscesses. The patient experienced instances of constipation, which could be due to poor dietary intake.
Genetic Predisposition
Diverticulitis is a hereditary condition that commonly occurs among first-degree relatives. The specific genes involved in the condition include the TNFSF15 rs7848647, which is also associated with colon carcinoma. Besides, MLH1, MSH6, MSH2, and PMS2 are also linked with pathogenesis (Nasef & Mehta, 2020).
According to Nasef & Mehta (2020), the tumor necrosis factor superfamily member 15 is associated with an increased risk for inflammatory bowel diseases and diverticulitis. The study reports that the gene factor encodes the tumor necrosis factor ligand-related molecule 1, essential in mucosal immunity. The TNFSF15 is expressed in the endothelial cells. The TLIA is a splicing variant of the gene TNFS15 encoded by four exons (Nasef & Mehta, 2020). With the fourth exon and the adjacent intron that encodes the TL1. The TL1A is closely associated with the levels of inflammation in the course of IBD and diverticulitis. Also, their function triggers the T cell subtypes’ production, resulting in the elevated concentration of the interleukin 2 signalings. The study also explored the role of the TNFSF15 in inflammatory bowel diseases, and the findings indicated that the gene has a significant role in the inflammatory response in diverticulitis.
The MSH6 and MLH1 also have significant roles in the disease development and progression of the patient. The study by Jun et al. (2019) indicates that MLH1 and MSH2 are tumor suppressor cells involved in repairing errors occurring during genetic replication. The mutations in the MLH1 and MSH2 are associated with the development of diverticulitis. On the other hand, the loss in the function in the mismatched repair genes, including the MLH1, MSH2, PMS1, MSH6, and the PMS2, results in the microsatellite instability that eventually causes diverticulitis (Jun et al., 2019).
The Process of Immunosuppression and Effect on Body System
Immunosuppression is the process through which the body’s immune response is weakened. The process results in the inability of the body to recognize antigens and influence the production of antibodies. The immune responses occur in many phases and depend on the pathogens involved. The natural barriers, complement system, and natural killer cells are the primary line of defense for many infections. The body recognizes the antigens presented to the macrophages through the antigen-presenting cells and then triggers the T-helper cells to produce other immune responses. Therefore, one of the ways through which immunosuppression occurs is through the reduction of the amount of T-helper cells produced; therefore, reducing the ability of the body to recognize the pathogens. The process can occur naturally due to chronic infections such as HIV/AIDs, obesity, and diabetes or through therapeutic intervention. One of the drugs used in reducing the immune system is cyclosporine, which reverses the inhibition of the immunocompetent lymphocytes in the G0 and G1 phases of cell division.
Immunosuppression has significant impacts on the body system. The cyclosporine also inhibits the production of lymphokines such as interleukin-2 and the T-cell growth factor that makes one more prone to infections. The body loses its ability to fight infections, and this could trigger the rising of opportunistic infections. Besides, reduced immunity means that an individual cannot respond accordingly to the pathogens, and this could lead to cell death. Continuous exposure to pathogens also affects the body’s organ system. For example, people with prolonged COPD conditions could have compromised lungs and respiratory system functioning.
Conclusion
The patient in the case presents with diverticulitis and carcinoma in the colon. The signs and symptoms are consistent with the disease progression. The condition is genetically inheritable and is influenced by a series of genes, as indicated in this study. Finally, the human body has a natural immune response that protects the body from pathogens. Immunosuppression reduces the ability of the body to fight infection. The case helps in understanding how genetic factors play a role in disease development and progress. People with a family history of cancer are most likely to develop the disease in their lifetime, and this could explain the origin of the patient’s present condition, among other factors.
References
Jun, S., Park, E. S., Lee, J. J., Chang, H., Jung, E. S., Oh, Y., & Hong, S. (2019). Prognostic significance of Stromal and Intraepithelial tumor-infiltrating lymphocytes in small intestinal adenocarcinoma. American Journal of Clinical Pathology, 153(1), 105-118. https://doi.org/10.1093/ajcp/aqz136
Kamal, M. U., Baiomi, A., & Balar, B. (2019). Acute diverticulitis: A rare cause of abdominal pain. Gastroenterology Research, 12(4), 203-207. https://doi.org/10.14740/gr1166
Nasef, N. A., & Mehta, S. (2020). Role of inflammation in the pathophysiology of colonic disease: An update. International Journal of Molecular Sciences, 21(13), 4748. https://doi.org/10.3390/ijms21134748

Assignment 1: Evaluation and Management (E/M)
Insurance coding and billing is complex, but it boils down to how to accurately apply a code, or CPT (current procedural terminology), to the service that you provided. The payer then reimburses the service at a certain rate. As a provider, you will have to understand what codes to use and what documentation is necessary to support coding.
For this Assignment, you will review evaluation and management (E/M) documentation for a patient and perform a crosswalk of codes from DSM-5 to ICD-10.
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 altogether 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.
By Day 7 of Week 2
Submit your Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the naming convention “WK2Assgn1+last name+first initial.(extension)” as the name.
Click the Week 2 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
Click the Week 2 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK2Assgn1+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Pathways Mental Health
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 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, the client denied symptoms of depression, denied anergia, anhedonia, motivation, no anxiety, denied frequent worry, reports feeling restlessness, no reported panic symptoms, no reported obsessive/compulsive behaviors. The client denies active SI/HI ideations, plans or intent. There is no evidence of psychosis or delusional thinking. The client denied past episodes of hypomania, hyperactivity, erratic/excessive spending, involvement in dangerous activities, self-inflated ego, grandiosity, or promiscuity. The client reports increased irritability and easily frustration, 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 a previous rape, isolates, fearful to go outside, has missed several days of work, appetite decreased. She has somatic concerns with GI upset and headaches. The 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 being 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
The client was raised by adoptive parents since age 6; from a 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 a history of self-mutilation behaviors
Global Suicide Risk Assessment: The client is found to be at low risk of suicide or violence, however, the risk of lethality increased under the 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 the 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 a 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 is 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 a 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 at 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 the 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.
REFERENCES
[ADD APA-FORMATTED CITATIONS FOR ANY SOURCES YOU REFERENCED]
Delete instructions and placeholder text when you add your citations.
Place your order today!
Solution
Diagnostic Impression: Post-traumatic stress disorder with ADHD, F43, F90-F99
Complete, accurate information is essential for developing accurate diagnoses and assigning them to DSM-5 and ICD-10 codes. Subjective and objective data should be obtained to support DSM-5 and ICD-10 codes. The other information needed to support DSM-5 and ICD-10 coding is mental status examination. Psychiatric mental health nurses should undertake a comprehensive mental status examination to reach an accurate diagnosis aligned with DSM-5 and ICD-10 coding. The mental status examination will guide the treatment interventions and the billing process. Diagnostic investigations should also be documented to support DSM-5 and ICD-10 coding. Diagnostic and laboratory investigations are essential in facilitating the development of accurate diagnoses. They also rule out potential medical conditions that might be contributing to the problem (Dodd, 2021). Information about the adopted treatment should be provided to guide reimbursement decisions for the healthcare providers and institutions.
The provided scenario is missing some pertinent information needed to narrow the client’s coding and billing. One of the data relates to the client’s behaviors. The psychiatric mental health nurse should provide detailed information about the character of symptoms and behaviors. Information such as symptom duration, factors that alleviate and aggravate them should be obtained. Information about the effect of the symptoms on the social and occupational functioning of the client is also lacking. Mental health disorders have adverse effects on patients’ levels of functioning and productivity. The nature of impaired functioning and productivity is crucial in determining the most appropriate diagnoses and DSM-5 and ICD-10 billing. The psychiatric mental health nurse should have explored the effects of the symptoms on functioning to determine the precise cause of the problem. The case study also lacks information about the laboratory and diagnostic investigations that were considered in determining the cause of the problem (Wright, 2020). For example, information including blood tests and radiological examination should have been provided to rule out any pathologies contributing to the problem.
Several strategies can be adopted to improve documentation that supports DSM-5 and ICD-10 coding and billing. One of the strategies is creating an organizational culture characterized by learning from mistakes. The organization should encourage the staff to identify documentation errors and analyze the factors that led to them and how to prevent their occurrence in the future. Learning from errors will promote continuous improvement in documentation practices, hence, the efficiency in the care processes. The second strategy that can be adopted to improve documentation is encouraging compliance with the billing requirements and policies. Healthcare providers should be encouraged to ensure their adherence to the developed guidelines for documentation. Compliance will minimize the risk for errors, which leads to accurate coding and billing for the services offered in the institution. Healthcare technologies can also be incorporated into the care process to minimize errors in documentation. Technologies such as integrated electronic health records will enable healthcare providers to perform regular checks on the accuracy of information (Lorenzetti et al., 2018). As a result, technologies will enhance the efficiency of documentation in the organization.
References
Dodd, S. (2021). A Critical Evaluation of the DSM-5 as a Taxonomical Information Organisation Tool for Psychiatry. https://hcommons.org/deposits/item/hc:38485/
Lorenzetti, D. L., Quan, H., Lucyk, K., Cunningham, C., Hennessy, D., Jiang, J., & Beck, C. A. (2018). Strategies for improving physician documentation in the emergency department: A systematic review. BMC Emergency Medicine, 18(1), 1–12. https://doi.org/10.1186/s12873-018-0188-z
Wright, A. J. (2020). Conducting Psychological Assessment: A Guide for Practitioners. John Wiley & Sons.

NURS 6521N WEEK 11 WALDEN, ASSIGNMENT, OFF-Label drug use in Pediatrics
Week 11: Pediatrics
Children, like adults, deal with variety of health issues, but they also have issues that are more prevalent within their population. One issue that significantly impacts children is the prescription of drugs for off-label use. As an advanced practice nurse, how do you determine the appropriate use of off-label drugs in pediatrics? Are there certain drugs that should be avoided with pediatric patients?
This week, you examine the practice of prescribing off-label drugs to children. You also explore strategies for making off-label drug use safer for children from infancy to adolescence, as it is essential that you are prepared to make drug-related decisions for pediatric patients in clinical settings.
Learning Objectives
Students will:
Evaluate the practice of prescribing off-label drugs to children
Analyze strategies to make the off-label use of drugs safer for children
Identify key terms, concepts, and principles related to prescribing drugs to treat patient disorders
________________________________________
Learning Resources
Required Readings (click to expand/reduce)
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.
Chapter 8, “Drug Therapy in Pediatric Patients” (pp. 65—67)
Corny, J., Lebel, D., Bailey, B., & Bussieres, J. (2015). Unlicensed and off-label drug use in children before and after pediatric governmental initiatives. The Journal of Pediatric Pharmacology and Therapeutics, 20(4), 316–328. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557722/
This article highlights pediatric governmental initiatives to prevent unlicensed and off-label drug use in children. Review these initiatives and guidelines and how they might impact your practice as an advanced practice nurse.
Panther, S. G., Knotts, A. M., Odom-Maryon, T., Daratha, K., Woo, T., & Klein, T. A. (2017). Off-label prescribing trends for ADHD medications in very young children. The Journal of Pediatric Pharmacology and Therapeutics, 22(6), 423–429. doi:10.5863/1551-6776-22.6.423
Note: You will access this article from the Walden Library databases.
This study examines the frequency of off-label prescribing to children and explores factors that impact off-label prescribing. This study also examines off-label prescribing to children with ADHD.
Required Media (click to expand/reduce)
Laureate Education (Producer). (2019i). Therapy for pediatric clients with mood disorders [Interactive media file]. Baltimore, MD: Author.
Assignment: Off-Label Drug Use in Pediatrics
The unapproved use of approved drugs, also called off-label use, with children is quite common. This is because pediatric dosage guidelines are typically unavailable, since very few drugs have been specifically researched and tested with children.
When treating children, prescribers often adjust dosages approved for adults to accommodate a child’s weight. However, children are not just “smaller” adults. Adults and children process and respond to drugs differently in their absorption, distribution, metabolism, and excretion.
Photo Credit: Getty Images
Children even respond differently during stages from infancy to adolescence. This poses potential safety concerns when prescribing drugs to pediatric patients. As an advanced practice nurse, you have to be aware of safety implications of the off-label use of drugs with this patient group.
To Prepare
Review the interactive media piece in this week’s Resources and reflect on the types of drugs used to treat pediatric patients with mood disorders.
Reflect on situations in which children should be prescribed drugs for off-label use.
Think about strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Consider specific off-label drugs that you think require extra care and attention when used in pediatrics.
By Day 5 of Week 11
Write a 1-page narrative in APA format that addresses the following:
Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples.
Describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.
Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center offers an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.
Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression
Decision Point One
Begin Zoloft 25 mg orally daily
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
No change in depressive symptoms at all
Decision Point Two
Increase dose to 37.5 mg orally daily
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Depressive symptoms decrease by 20%. Client reports feeling a little bit better
Decision Point Three
Maintain current dose
Guidance to Student
At this point, sufficient symptom reduction has not been realized. Should either increase dose or consider different SSRI. At 8 weeks post-initiation of therapy, there should have been a significant (as defined as 50%) decrease in symptoms. This would be considered an adequate trial of antidepressant and change in dose or to a different agent would be appropriate.
Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression
Decision Point One
Begin Paxil 10 mg orally daily
RESULTS OF DECISION POINT ONE
• Client returns to clinic in four weeks
• Reduction in The Children’s Depression Rating Scale by 5 points overall, but with complaints of nausea, vomiting, and diarrhea
Decision Point Two
Decrease dose for 7 days then return to previous 10 mg day dose
RESULTS OF DECISION POINT TWO
• Client returns to clinic in four weeks
• Nausea, vomiting, diarrhea subsides with dose reduction, but returns with reinitiation of 10 mg dose
Decision Point Three
Attempt to decrease dose for another 7 days then return to 10 mg dose
Guidance to Student
Temporarily decreasing the drug for 7 days and then increasing is an acceptable option- however, if the side effects return with the reinitiation of the dose, you will need to select a different agent as these side effects are unfavorable to the client and may result in refusal to take treatment. Also, continuing to drop medication dose to subtherapeutic level will do minimal to treat depressive symptoms. Changing to a different SSRI would be the ideal choice as not all SSRIs have the same side effect profile in all clients. It would not be appropriate to increase the dose at this time as it would most likely result in increased intensity of side effects.
Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression
BACKGROUND INFORMATION
The client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression.
• Client complained of feeling “sad”
• Mother reports that teacher said child is withdrawn from peers in class
• Mother notes decreased appetite and occasional periods of irritation
• Client reached all developmental landmarks at appropriate ages
• Physical exam unremarkable
• Laboratory studies WNL
• Child referred to psychiatry for evaluation
MENTAL STATUS EXAM
Alert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation, but does admit that he often thinks about himself being dead and what it would be like to be dead.
You administer the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression)
RESOURCES
§ Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.
Decision Point One
Select what you should do:
Begin Zoloft 25 mg orally daily
Begin Paxil 10 mg orally daily
Begin Wellbutrin 75 mg orally BID
Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression
Decision Point One
Begin Paxil 10 mg orally daily
RESULTS OF DECISION POINT ONE
• Client returns to clinic in four weeks
• Reduction in The Children’s Depression Rating Scale by 5 points overall, but with complaints of nausea, vomiting, and diarrhea
Decision Point Two
Increase dose to 20 mg orally daily
RESULTS OF DECISION POINT TWO
• Client returns to clinic in four weeks
• Nausea, vomiting, and diarrhea has increased and client is refusing to take medication
Decision Point Three
Discontinue Paxil and begin Prozac 10 mg orally daily
Guidance to Student
Temporarily decreasing the drug for 7 days and then increasing is an acceptable option- however, if the side effects return with the reinitiation of the dose, you will need to select a different agent as these side effects are unfavorable to the client and may result in continued refusal to take treatment. Changing to a different SSRI may be appropriate if the trial decrease of dose is unsuccessful and if the nausea, vomiting, and diarrhea return with reinitiation of 20 mg orally daily. Changing the medication may be appropriate as not all SSRIs have the same side effect profile in all clients.
Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression
Decision Point One
Begin Wellbutrin 75 mg orally BID
RESULTS OF DECISION POINT ONE
• Client returns to clinic in four weeks
• Child is unable to fall asleep at night
Decision Point Two
Change from immediate release to extended release 150 mg orally daily in the morning
RESULTS OF DECISION POINT TWO
• Client returns to clinic in four weeks
• Child’s sleep patterns return to baseline. No change in depressive symptoms
Decision Point Three
Change to SSRI
Guidance to Student
You can continue drug therapy for another 4 weeks, however, it is discouraging that there have been no changes in depressive symptomatology. Increasing the dose to 300 mg orally daily may be appropriate if the child is tolerating the medication well. Changing to an SSRI may also be appropriate, but it may be more prudent to give the Wellbutrin at an appropriate dose for an adequate duration of therapy before switching therapeutic classes.
REFERENCE GIVEN IN THE SYUDENT PORTAL
Panther, S. G., Knotts, A. M., Odom-Maryon, T., Daratha, K., Woo, T., & Klein, T. A. (2017). Off-label prescribing trends for ADHD medications in very young children. The Journal of Pediatric Pharmacology and Therapeutics, 22(6), 423–429. doi:10.5863/1551-6776-22.6.423
REFERENCE GIVEN IN THE STUDENT PORTAL
• ———NCBI
• Skip to main content
• Skip to navigation
• Resources
• How To
• About NCBI Accesskeys PMC
US National Library of Medicine
National Institutes of Health
Search database
Search term
• Advanced
• Journal list
• Help
• Journal List
• J Pediatr Pharmacol Ther
• v.20(4); Jul-Aug 2015
• PMC4557722
J Pediatr Pharmacol Ther. 2015 Jul-Aug; 20(4): 316–328.
doi: 10.5863/1551-6776-20.4.316
PMCID: PMC4557722
PMID: 26380572
Unlicensed and Off-Label Drug Use in Children Before and After Pediatric Governmental Initiatives
Jennifer Corny, PharmD, Candidate,1 Denis Lebel, BPharm, MSc,1 Benoit Bailey, MD, MSc,2 and Jean-François Bussières, BPharm, MSc, MBA 1,3
Author information Copyright and License information Disclaimer
This article has been cited by other articles in PMC.
Go to:
Abstract
OBJECTIVES: Governmental agencies (US Food and Drug Administration and European Medicines Agency) implemented initiatives to improve pediatric clinical research, starting in 1997 and 2007, respectively. The aim of this review was to quantify the unlicensed and off-label drug uses in children before and after these implementations.
METHODS: Literature review of unlicensed and off-label drug uses was performed on PubMed and Google-Scholar from 1985 to 2014. Relevant titles/abstracts were reviewed, and articles were included if evaluating unlicensed/off-label drug uses, with a clear description of health care setting and studied population. Included articles were divided into 3 groups: studies conducted in United States (before/after 2007), in Europe (before/after 2007), and in other countries.
RESULTS: Of the 48 articles reviewed, 27 were included. Before implementation of pediatric initiatives, global unlicensed drug use rate in Europe was found to be 0.2% to 36% for inpatients and 0.3% to 16.6% for outpatients. After implementation, it marginally decreased to 11.4% and 1.26% to 6.7%, respectively. Concerning off-label drug use rates, it was found to be 18% to 66% for inpatients and 10.5% to 37.5% for outpatients before the implementation. After implementation, it decreased marginally to 33.2% to 46.5% and to 3.3% to 13.5%, respectively. In other countries, unlicensed and off-label drug use rates were found to be, respectively, 8% to 27.3% and 11% to 47%.
CONCLUSIONS: Governmental initiatives to improve clinical research conducted in children seem to have had a marginal effect to decrease the unlicensed and off-label drug uses prevalence in Europe.
INDEX TERMS: off-label use, pediatrics, review
Go to:
INTRODUCTION
Before a drug can be approved for sale in a given market, governmental authorities in each country have to assess its safety, efficacy, and quality. At the end of this process, pharmaceutical companies are granted market authorization, and the drug gets a license for marketing in the country (e.g., Notice of Compliance in Canada). The drug also has a label (i.e. drug monograph), specifying the details for drug use (e.g., target population, dose, indication, specific use).
Virtually all drugs that get an approval for use in adults should also get an approval for use in children; this is often not the case considering the paucity of clinical research for that population. Therefore, drug monographs are frequently silent about the use of the drug in children. However, in most legislation, clinicians can prescribe to children a drug approved for adult (i.e., an off-label use). In some case, clinicians must also import from another country a drug that has not obtained a license for marketing (i.e., an unlicensed use). Both situations expose clinicians and patients to delays, costs, and risks. In response to these challenges, governmental authorities have established various strategies and regulations to oversee and promote clinical research in children and hopefully to decrease both unlicensed and off-label drug uses.
In 1997, the US Food and Drug Administration (FDA) adopted the FDA Modernization Act (FDAMA),1 followed in 2002 by the Best Pharmaceuticals for Children Act (BPCA),2 which provided an incentive for drug companies to conduct FDA-requested pediatric studies. In 2003, the FDA also created the Pediatric Research Equity Act (PREA), which requires drug companies to study their products in children under certain circumstances.3 In Europe, the European Medicines Agency (EMA) created the European (EU) Pediatric Regulation, in 2007.4 Its objective was to improve the health of children in Europe by facilitating the development and availability of medicines for that population. In other countries, such as in Canada, the Pediatric Expert Advisory Committee was created in 2009 to provide advice to Health-Canada in the development, licensing, and post-approval monitoring of drugs.5
Our hypothesis was that even though these initiatives were not implemented to decrease unlicensed or off-label drug use rates, they probably would have a favorable consequence on those uses. Ten years after the first regulations, we could expect that the prevalence of unlicensed and off-label prescriptions in children would have decreased. Thus, we reviewed the literature to explore the effect of the regulatory changes.
The primary objective of this literature review was to determine the effect of governmental initiatives to improve clinical research in children on unlicensed and off-label drug uses in inpatient and outpatient settings in the world. The secondary objective was to determine the unlicensed and off-label drug use rates in countries where no governmental initiatives to improve clinical research in children have been implemented.
Panther, S. G., Knotts, A. M., Odom-Maryon, T., Daratha, K., Woo, T., & Klein, T. A. (2017). Off-label prescribing trends for ADHD medications in very young children. The Journal of Pediatric Pharmacology and Therapeutics, 22(6), 423–429. doi:10.5863/1551-6776-22.6.423

Assignment: Assessing and Treating Clients with With Bipolar Disorder
Bipolar disorder is a unique disorder that causes shifts in mood and energy, which results in depression and mania for clients. Proper diagnosis of this disorder is often a challenge for two reasons: 1) clients often present as depressive or manic, but may have both; and 2) many symptoms of bipolar disorder are similar to other disorders. Misdiagnosis is common, making it essential for you to have a deep understanding of the disorder’s pathophysiology. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with bipolar disorder.
Learning Objectives
Students will:
• Assess client factors and history to develop personalized plans of bipolar therapy for clients
• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring bipolar therapy
• Evaluate efficacy of treatment plans
• Analyze ethical and legal implications related to prescribing bipolar therapy to clients across the lifespan
To prepare for this Assignment:
• Review this week’s Learning Resources. Consider how to assess and treat clients requiring bipolar therapy.
The Assignment
Examine Case Study: An Asian American Woman With Bipolar Disorder. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
At each decision point stop to complete the following:
• Decision #1
o Which decision did you select?
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
• Decision #2
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
• Decision #3
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients.
Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.
NOTE
SEE ATTACHED FOR THE DECISIONS OPTIONS 1, 2 OR 3. READ AND SEE WHICH OPTION IS BEST FOR YOU. I THINK THE BEST ONE IS OPTION-1
ALL RREFERENCES 5 YEARS OR LESS. TRY TO INCLUDE THE TEXT BOOK FROM STAHL WHICH YOU ARE READING FROM.
THE ACCESS TO STAHL BOOK ONLINE IS AS FOLLOWS:
www.stahlonline.org
USER NAME: owusuk784
PASSWORD: michael3910
PROVIDE INTRODUCTION BRIEF, PURPOSE AND CONCLUSION

Legal Ramifications for Exceeding One’s Duties FO
You have been the evening charge nurse in the emergency department at Memorial Hospital for the last 2 years. Besides yourself, you have two LVNs and four RNs working in your department. Your normal staffing is to have two RNs and one LVN on duty Monday through Thursday and one LVN and three RNs on during the weekend. It has become apparent that one of the LVNs, Maggie, resents the recently imposed limitations of LVN duties because she has had 10 years of experience in nursing, including a tour of duty as a medic in the first Gulf War. The emergency department physicians admire her and are always asking her to assist them with any major wound repair. Occasionally, she has exceeded her job description as an LVN in the hospital, although she has done nothing illegal of which you are aware. You have given her satisfactory performance evaluations in the past, even though everyone is aware that she sometimes pretends to be a “junior physician.” You also suspect that the physicians sometimes allow her to perform duties outside her licensure, but you have not investigated this or actually seen it yourself. Tonight, you come back from supper and find Maggie suturing a deep laceration while the physician looks on. They both realize that you are upset, and the physician takes over the suturing. Later, the doctor comes to you and says, “Don’t worry! She does a great job, and I’ll take responsibility for her actions.” You are not sure what you should do. Maggie is a good employee, and taking any action will result in unit conflict.
ASSIGNMENT: What are the legal ramifications of this case? Discuss what you should do, if anything. What responsibility and liability exist for the physician, Maggie, and yourself? Use appropriate rationale to support your decision.
ORDER A PLAGIARISM-FREE PAPER HERE !!
Solution
Brief Summary of the Case
In this paper, I will be seeking to solve the case of the legal ramifications for exceeding one’s duty. In the case study presented, the LVN on duty, which is known as Maggie, is caught by the charge nurse performing duties that are outside her licensure, as the supervising physician looks on. Maggie has also been accused numerous times of pretending to be a junior physician in the healthcare facility.
Legal Ramifications
The legal ramifications in the case where an LVN is caught performing duties that are outside her licensure include malpractice lawsuits that can befall a healthcare facility. In the case that the LVN performs activities that are not under their licensure and patients experience adverse outcomes, such patients can decide to sue a healthcare facility for malpractice. The malpractice lawsuit will therefore be directed to the supervising physician who would be liable for delegating duties to professionals that do not have the necessary qualifications and license to perform such duties. In the case of adverse outcomes among patients as a result of having received inadequate healthcare services from qualified staff such as LVN, the liability that exists for the charge nurse would be related to deciding to cover up for the irregularities noted (Renkema et al., 2016). If the charge decided not to report an LVN who performs duties and responsibilities that are beyond her licensure, they would also be liable for malpractice. On the other hand, the supervising physician would also be liable for malpractice as they allowed a junior staff member such as an LVN to perform duties beyond their licensure. Finally, the LVN would be liable for malpractice for knowingly performing duties and roles beyond their licensure (Renkema et al., 2016).
Integrated Ethical Problem-Solving Model
As a charge nurse in the emergency department, I would utilize the integrated ethical problem-solving model to determine the actions that I will take in the case where an LVN is caught performing roles that are outside her licensure. Utilizing the integrated ethical problem-solving model, the first step would therefore be to determine whether there is an ethical issue or dilemma (Park, 2017). The case study presented ethical issues related to beneficence, and nonmaleficence, which would therefore be noted (Stone, 2018). In the case study, the LVN would therefore endanger the patient by performing duties that she’s not qualified for and be going against the principles of beneficence and nonmaleficence. The LVN would also be abusing the principle of autonomy of patients by pretending to be a junior physician. In my professional judgment, I would therefore rank the ethical principles of beneficence and nonmaleficence as being the most important and most relevant to the ethical dilemma (Park, 2017). As a charge nurse, I would also develop an action plan based on the different ethical priorities that have been determined central to the ethical dilemma. The ethical principles of beneficence and nonmaleficence would be central to my action plan. Considering the lack of principles of beneficence and nonmaleficence, the charge nurse should therefore consider the option of reporting the LVN to the responsible authorities in a workplace. This would be done through drafting an incidence occurrence report which would imply that the reported incident would be stopped immediately and the involved parties committed to following ethical principles. Finally, I would reflect on the ethical decision-making process and evaluate the consequences of the process involved for the different stakeholders such as patients, healthcare practitioners, and the healthcare facility in general (Stone, 2018).
References
Park, E. J. (2017). An integrated ethical decision-making model for nurses. Nursing Ethics, 19(1), 139–159. https://doi.org/10.1177/0969733011413491
Renkema, E., Broekhuis, M., & Ahaus, K. (2016). Conditions that influence the impact of malpractice litigation risk on physicians’ behavior regarding patient safety. BMC Health Services Research, 14(1). https://doi.org/10.1186/1472-6963-14-38
Stone, E. (2018). Evidence-Based Medicine and Bioethics: Implications for Health Care Organizations, Clinicians, and Patients. The Permanente Journal. Published. https://doi.org/10.7812/tpp/18-030