Patient Presentation of Dementia, Delirium, and Depression
With the prevalence of dementia, delirium, and depression in the growing geriatric population, you will likely care for elderly patients with these disorders. While many symptoms of dementia, delirium, and depression are similar, it is important that you are able to identify those that are different and properly diagnose patients. A diagnosis of one of these disorders is often difficult for patients and their families. In your role as the advanced practice nurse, you must help patients and their families manage the disorder by facilitating necessary treatments, assessments, and follow-up care. Consider the patient presentations in the following case studies. What distinct symptoms or factors would lead you to a diagnosis of dementia, delirium, or depression?
Case Study 1:
HPI: Mrs. Mayfield is a 75-year-old woman who is brought to the emergency room by the police at 11 p.m. She was found wandering and confused in a local neighborhood. The police were called when Mrs. Mayfield tried to use her key on a neighbor’s door. When confronted by the police she became abusive, confused, and frightened and looked very pale and agitated. The police could not establish her correct address and they subsequently brought her to the emergency room.
Review of Symptoms (ROS): Unable to obtain at this time.
Objective Data:
PE:
VS: Pulse 96 and regular; B/P 150/90; Axillary temperature 99°F.
General: She appears clean and well nourished, with no signs of injury, trauma, or neglect.
Her physical exam is unremarkable except –
Neuro: No gross focal neurological signs, but she is only intermittently cooperative. Her mental status fluctuates and a full neurological evaluation is not possible at this time.
Psych: A & O x 1 to person only. She has episodes of agitation and alternating withdrawal/somnolence. During the examination, it takes several attempts to gain Mrs. Mayfield’s attention to answer questions, but once focused, she rambles on in a disorganized and incoherent way.
Case Study 2:
CC: “irritable and forgetful”
HPI: Mrs. White, a 78-year-old married woman, is brought to the office of her primary care provider by her husband because of increasing forgetfulness and irritability over the past 3 months. Mr. White claims that his wife has had problems for several years now, but has just gotten “worse in her memory” in the past few months. She recently misplaced her purse and accused her son of stealing it.
On three occasions, she left the stove on and boiled a pot dry, nearly causing a fire. She recently put a container of ice cream into the washing machine instead of into the freezer and her husband did not discover it for more than a week. Mrs. White claims her family wants to take her money and leave her with nothing. “No matter what they say, there is nothing wrong with me,” she states.
Past Medical History (PMH) includes: hypothyroidism, treated with Synthroid, and successful treatment of breast cancer approximately 15 years prior. She also takes over-the-counter ibuprofen for chronic lower back pain and occasional Benadryl to help her sleep at night.
Objective data: Her physical examination is within normal limits.
Case Study 3:
HPI: Mr. George is a 72-year-old male who has lived alone since his wife died approximately 1 year ago. He has lived in the same house for 45 years. He is brought in by his son who is concerned that his father has lost more than 35 pounds over the past year. Mr. George admits to not eating well because “I don’t know how to cook for myself.”
PMH: He has been in good health with the exception of hypertension, which is well controlled.
Social history: He spends most of his time watching sports on television. He occasionally drinks one or two cans of beer when he is watching TV. He does go to his son’s house to visit with his grandchildren about once a week, and he says he enjoys that. He does not receive any social services, he still drives but only in the daytime, and he does not participate in any other leisure activities.
Objective data: His physical examination is normal. He responds correctly to questions, although he appears to have a flat affect.
To prepare:
- Review Chapters 6–8 of the Holroyd-Leduc and Reddy text.
- Select one of the three case studies. Reflect on the way the patient presented in the case study you selected, including whether the patient might be presenting with dementia, delirium, or depression.
- Think about how you would further evaluate the patient based on medical history, current drug treatments, and the patient’s presentation. Consider whether you would modify drug treatments, use additional assessment tools, and/or refer the patient to a specialist.
Post on or before Day 3 an explanation of whether you suspect the patient in the case study you selected is presenting with dementia, delirium, or depression and why. Then, explain how you would further evaluate the patient in the case study based on medical history, current drug treatments, and the way the patient presented. Include whether you would modify drug treatments, use additional assessment tools, and/or refer the patient to a specialist
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Application – Best Practices
/in Uncategorized /by JosephAssignment 1: Application – Best Practices
For over 20 years, the Women’s Health Initiative (WHI) study has conducted research trials to examine factors that impact risks and development of conditions that impact women such as heart disease, breast and colorectal cancer, and osteoporotic fractures in postmenopausal women. Health care providers use results from these trials to develop guidelines for delivering care to patients. In your role in clinical settings, you must be familiar with these guidelines, and you must be aware that through clinical practice, guidelines frequently evolve and change. Often, what is considered a best practice today might not be a best practice in the future. For this Assignment, you compare guidelines outlined in the WHI study to current best practices for assessing and managing conditions.
By Day 7 of Week 11
To Prepare:
To Complete:
Write a 2- to 3-page paper that addresses the following:
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Patient Presentation of Dementia, Delirium, and Depression
/in Uncategorized /by JosephPatient Presentation of Dementia, Delirium, and Depression
With the prevalence of dementia, delirium, and depression in the growing geriatric population, you will likely care for elderly patients with these disorders. While many symptoms of dementia, delirium, and depression are similar, it is important that you are able to identify those that are different and properly diagnose patients. A diagnosis of one of these disorders is often difficult for patients and their families. In your role as the advanced practice nurse, you must help patients and their families manage the disorder by facilitating necessary treatments, assessments, and follow-up care. Consider the patient presentations in the following case studies. What distinct symptoms or factors would lead you to a diagnosis of dementia, delirium, or depression?
Case Study 1:
HPI: Mrs. Mayfield is a 75-year-old woman who is brought to the emergency room by the police at 11 p.m. She was found wandering and confused in a local neighborhood. The police were called when Mrs. Mayfield tried to use her key on a neighbor’s door. When confronted by the police she became abusive, confused, and frightened and looked very pale and agitated. The police could not establish her correct address and they subsequently brought her to the emergency room.
Review of Symptoms (ROS): Unable to obtain at this time.
Objective Data:
PE:
VS: Pulse 96 and regular; B/P 150/90; Axillary temperature 99°F.
General: She appears clean and well nourished, with no signs of injury, trauma, or neglect.
Her physical exam is unremarkable except –
Neuro: No gross focal neurological signs, but she is only intermittently cooperative. Her mental status fluctuates and a full neurological evaluation is not possible at this time.
Psych: A & O x 1 to person only. She has episodes of agitation and alternating withdrawal/somnolence. During the examination, it takes several attempts to gain Mrs. Mayfield’s attention to answer questions, but once focused, she rambles on in a disorganized and incoherent way.
Case Study 2:
CC: “irritable and forgetful”
HPI: Mrs. White, a 78-year-old married woman, is brought to the office of her primary care provider by her husband because of increasing forgetfulness and irritability over the past 3 months. Mr. White claims that his wife has had problems for several years now, but has just gotten “worse in her memory” in the past few months. She recently misplaced her purse and accused her son of stealing it.
On three occasions, she left the stove on and boiled a pot dry, nearly causing a fire. She recently put a container of ice cream into the washing machine instead of into the freezer and her husband did not discover it for more than a week. Mrs. White claims her family wants to take her money and leave her with nothing. “No matter what they say, there is nothing wrong with me,” she states.
Past Medical History (PMH) includes: hypothyroidism, treated with Synthroid, and successful treatment of breast cancer approximately 15 years prior. She also takes over-the-counter ibuprofen for chronic lower back pain and occasional Benadryl to help her sleep at night.
Objective data: Her physical examination is within normal limits.
Case Study 3:
HPI: Mr. George is a 72-year-old male who has lived alone since his wife died approximately 1 year ago. He has lived in the same house for 45 years. He is brought in by his son who is concerned that his father has lost more than 35 pounds over the past year. Mr. George admits to not eating well because “I don’t know how to cook for myself.”
PMH: He has been in good health with the exception of hypertension, which is well controlled.
Social history: He spends most of his time watching sports on television. He occasionally drinks one or two cans of beer when he is watching TV. He does go to his son’s house to visit with his grandchildren about once a week, and he says he enjoys that. He does not receive any social services, he still drives but only in the daytime, and he does not participate in any other leisure activities.
Objective data: His physical examination is normal. He responds correctly to questions, although he appears to have a flat affect.
To prepare:
Post on or before Day 3 an explanation of whether you suspect the patient in the case study you selected is presenting with dementia, delirium, or depression and why. Then, explain how you would further evaluate the patient in the case study based on medical history, current drug treatments, and the way the patient presented. Include whether you would modify drug treatments, use additional assessment tools, and/or refer the patient to a specialist
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Health Data Standards
/in Uncategorized /by JosephHealth Data Standards Discussion
What are health data standards and how do they relate to your role as an informaticist? Health data standards are the agreed upon representations of nursing data. From the coding of medical processes to documentation formats and terminology definitions, health data standards help to align nursing language. Being knowledgeable in health data standards is imperative to the data aggregation and informatics system selection process. It is the informaticist’s responsibility to not only understand the nursing domains of each standard, but also to be educated on the standards development organizations (SDO) that create, maintain, and approve these standards.
In this Discussion, you explore one health data standard of your choosing. For the purposes of this Discussion, do not focus on the standardization of nursing terminologies, as you will examine those in next week’s Discussion.
To prepare:
By Day 3
Post a description of the health data standards(1 or 2) your setting(VHA “Veterans Health Administration) uses and how these standards impact documentation and your specific nursing role (ICU RN Nurse). Explain how standard development organizations impact your health care setting.
*** please read the part “prepare”. APA Style, 500-600 words minimum.
Due Date: April 11, 2018 at 8pm
***Master Degree Quality ***
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focus on strategies for facilitating the group process
/in Uncategorized /by JosephGroups
The dynamic and increasingly complex world of health care often requires nurses to work collaboratively on interprofessional teams. In the group environment, individuals with unique skills and expertise come together to focus on a common goal; however, groups must become cohesive before they can become effective.
Your experiences working with groups—whether you perceive them as positive, negative, or neutral—can be used to facilitate insight and development. Health care, with its focus on interprofessional teamwork and collaboration, offers ample opportunities and an imperative for continuous learning.
For this Discussion, you focus on strategies for facilitating the group process.
To prepare:
Review the information in this week’s Learning Resources regarding the stages of group formation, problematic roles individuals play in groups, and strategies for facilitating and maintaining positive group collaboration. In particular, review Learning Exercise 19.12 on page 464 of the course text.
Reflect on various groups with which you have been or are currently involved. Select one specific group to analyze for the purposes of this Discussion. Identify the purpose or task that the group is or was meant to perform.
Consider the four stages of group formation (forming, storming, norming, and performing). How would you describe the progression between stages? Is there a stage in which you believe your group is or was “stuck”?
Consider the task or group-building role you normally play in a group setting. How could you apply the information from the Learning Resources to improve your group participation and facilitation, as well as the functioning of the group as a whole?
In addition, think about which individuals within your group (including yourself) may fall into problematic roles such as the Dominator, the Aggressor, or the Blocker. How have you and your group members addressed the enactment of these roles and its impact on interactions? With information from the Learning Resources in mind, what strategies would you apply now or going forward?
Post– (1) a description of a group with which you have been or are currently involved. (2) Assess where the group is in terms of the four stages of group formation. (3) If you are reflecting on a past experience, explain if your group moved through all four stages. (4) Describe the task or group-building role you typically play, or played, in this group. Then, (5) explain what strategies you, as a leader, can apply to better facilitate the group process and address any problematic individual roles in the group.
REQUIRED RESOURCES
Readings
Chapter 19 covers many aspects of the communication process, including group communication. As you read this chapter, focus on the stages of group development (forming, storming, norming, performing) and group dynamics (group task roles, group building and maintenance roles, problematic roles). Consider how you can apply these concepts as you engage in group work.
Retrieved from the Walden Library databases.
In this article, the authors report on the effects of individual behaviors on project teams and provide a model that identifies the progress of social and behavioral development. For each stage, the authors provide recommendations for managing team members.
This study theorizes and empirically investigates the relationships among the psychological needs of group members, intragroup conflict, and group performance.
Teamwork and communication are the focus of this article and include the use of the TeamStepps model for Quality Improvement.
Retrieved from the Walden Library databases.
The authors of this article introduce a theory on intergroup leadership that is based on social theory and intergroup relations. This theory purports that intergroup performance relies on a leader’s capacity to create intergroup relational identities.
Retrieved from the Walden Library databases.
Kaufman examines the impact of dysfunctional working relationships in an organization. She provides managers with tips that will allow them to identify early warning signs of dysfunctional behavior and to minimize its effects in the workplace.
This web article discusses stages of team development and provides strategies for moving through the early stages effectively.
This web page features helpful information about team charters. Before you begin work on the Week 7 Assignment, you may find it helpful to create a charter that can guide your group’s work together.
This article examines the relationship between team-level learning and performance in nursing teams, and the role of beliefs about the interpersonal context in this relationship.
Patrick Lencioni is recognized worldwide for his work on teams. Under the Patrick Lencioni link, download and read articles related to addressing team dysfunctions.
Optional Resources
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Research Critiques And PICOT Statement Final Draft
/in Uncategorized /by JosephDetails:
Prepare this assignment as a 1,500-1,750 word paper using the instructor feedback from the Topic 1, 2, and 3 assignments and the guidelines below.
PICOT Statement
Revise the PICOT statement you wrote in the Topic 1 assignment.
The final PICOT statement will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).
Research Critiques
In the Topic 2 and Topic 3 assignments you completed a qualitative and quantitative research critique. Use the feedback you received from your instructor on these assignments to finalize the critical analysis of the study by making appropriate revisions.
The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT statement.
Refer to “Research Critique Guidelines.” Questions under each heading should be addressed as a narrative in the structure of a formal paper.
Proposed Evidence-Based Practice Change
Discuss the link between the PICOT statement, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes.
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.
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community health directives
/in Uncategorized /by JosephCry
One of the strengths of the community such as in the community health directives is that the community gives a positive response and works in tandem with the community health workers as they transform public health in the society. Some of the assets that the community owns are the playgrounds, healthcare centers, and shopping centers. The assets of a community enable the community health providers to work effectively in the transformation of the public health standards.
The community has various needs as far as healthcare and nursing is concerned. Some of the needs of the community include access to the healthcare arrangements that the authorities such as the state and federal governments provide. The community also needs enough financial resources to afford maintenance of high standards in healthcare. Some of the goals of the community towards the same are the collaboration with the community-based organizations to provide affordable health care, to improve the quality of health care and increase the access points for community engagement and especially in healthcare.
The key stakeholders in the healthcare and nursing project are the individuals in the community, the community-based organizations and the various leadership authorities such as the state and the federal government (Bourcier et al., 2015). The healthcare institutions in the community are also part of the stakeholders in the community engagement with the public health initiatives (Bourcier et al., 2015).
Some of the goals in care to the community, according to Kangovi et al. (2014), are as follows. Firstly, the community-based organizations are targeting towards individualizing healthcare and bringing it closer to the populace (Kangovi et al., 2014). The other goal in care is to develop a comprehensive and diverse workforce that will be instrumental to the healthcare observance in the community (Kangovi et al., 2014). Partnership with the community is the other goal in care to improve the social and health wellbeing of the community members (Kangovi et al., 2014).
Some of the initiatives underway are the development of the community-based organizations to act as bridges to access of health care by the public. The other initiative is the diversification of the healthcare and nursing professionals to equip them with skills that will enable them to be some of the key players in the provision of health care to the community.
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Deliverable 01 – English Composition
/in Uncategorized /by JosephDeliverable 01 – English Composition
Competency
Identify and illustrate steps of the writing process in composing written exercises.
Instructions
Compose a single body descriptive paragraph in formal written English. Be sure to include the following:
Reminder: Descriptive refers to a style of writing. Choose your sentences for your descriptive paragraph from the following sentences, and use them together to construct your descriptive paragraph. They will not all be appropriate for this paragraph, so choose only the sentences that result in a complete descriptive paragraph as listed above. Use a topic sentence that provides the main idea for a single well-organized paragraph using the steps of the writing process.
Choose the best sentences to construct your descriptive paragraph, and put them together to make ONE well-organized descriptive paragraph. Remember that not all sentences need to be used.
As night falls and my father drives the old beat-up car towards home, most of us finish up the cheese sandwiches and chips and doze off after a day of fun.
Deliverable 01 – English Composition
Competency
Identify and illustrate steps of the writing process in composing written exercises.
Instructions
Compose a single body descriptive paragraph in formal written English. Be sure to include the following:
Reminder: Descriptive refers to a style of writing. Choose your sentences for your descriptive paragraph from the following sentences, and use them together to construct your descriptive paragraph. They will not all be appropriate for this paragraph, so choose only the sentences that result in a complete descriptive paragraph as listed above. Use a topic sentence that provides the main idea for a single well-organized paragraph using the steps of the writing process.
Choose the best sentences to construct your descriptive paragraph, and put them together to make ONE well-organized descriptive paragraph. Remember that not all sentences need to be used.
Deliverable 01 – English Composition
Competency
Identify and illustrate steps of the writing process in composing written exercises.
Instructions
Compose a single body descriptive paragraph in formal written English. Be sure to include the following:
Reminder: Descriptive refers to a style of writing. Choose your sentences for your descriptive paragraph from the following sentences, and use them together to construct your descriptive paragraph. They will not all be appropriate for this paragraph, so choose only the sentences that result in a complete descriptive paragraph as listed above. Use a topic sentence that provides the main idea for a single well-organized paragraph using the steps of the writing process.
Choose the best sentences to construct your descriptive paragraph, and put them together to make ONE well-organized descriptive paragraph. Remember that not all sentences need to be used.
Competency
Identify and illustrate steps of the writing process in composing written exercises.
Instructions
Compose a single body descriptive paragraph in formal written English. Be sure to include the following:
Reminder: Descriptive refers to a style of writing. Choose your sentences for your descriptive paragraph from the following sentences, and use them together to construct your descriptive paragraph. They will not all be appropriate for this paragraph, so choose only the sentences that result in a complete descriptive paragraph as listed above. Use a topic sentence that provides the main idea for a single well-organized paragraph using the steps of the writing process.
Choose the best sentences to construct your descriptive paragraph, and put them together to make ONE well-organized descriptive paragraph. Remember that not all sentences need to be used.
Deliverable 01 – English Composition
Competency
Identify and illustrate steps of the writing process in composing written exercises.
Instructions
Compose a single body descriptive paragraph in formal written English. Be sure to include the following:
Reminder: Descriptive refers to a style of writing. Choose your sentences for your descriptive paragraph from the following sentences, and use them together to construct your descriptive paragraph. They will not all be appropriate for this paragraph, so choose only the sentences that result in a complete descriptive paragraph as listed above. Use a topic sentence that provides the main idea for a single well-organized paragraph using the steps of the writing process.
Choose the best sentences to construct your descriptive paragraph, and put them together to make ONE well-organized descriptive paragraph. Remember that not all sentences need to be used.
Competency
Identify and illustrate steps of the writing process in composing written exercises.
Instructions
Compose a single body descriptive paragraph in formal written English. Be sure to include the following:
Reminder: Descriptive refers to a style of writing. Choose your sentences for your descriptive paragraph from the following sentences, and use them together to construct your descriptive paragraph. They will not all be appropriate for this paragraph, so choose only the sentences that result in a complete descriptive paragraph as listed above. Use a topic sentence that provides the main idea for a single well-organized paragraph using the steps of the writing process.
Choose the best sentences to construct your descriptive paragraph, and put them together to make ONE well-organized descriptive paragraph. Remember that not all sentences need to be used.
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Health Statistics and Populations
/in Uncategorized /by JosephHealth Statistics and Populations
Professional Competency addressed in this Assignment:
PC-4.3: Apply concepts of multiculturalism and diversity to become an agent of change.
Directions
Select a health topic of interest such as breastfeeding, coronary heart disease, or juvenile diabetes that affects a specific population such as older adults or women of reproductive age or race. Locate health statistics for your selections. You must include national and state data. Your work may also include local county or city data if available.
Additionally, research content regarding concepts of multiculturalism and diversity, and include interventions that address health disparities.
Input your responses using a table similar to the one below. You may recreate the table in Word©. Excel© files are not accepted. Include a title page and reference page. Length of Assignment should be 2- 3 pages. Content section will expand as you describe your findings in a comprehensive manner.
Data Search Directions
Summarize Your Findings
Identify the population of interest and health condition/event to your practice. Specify how you define the population (e.g. age, gender, health status, etc.).
Summarize your search process. Specify what sources, organizations and agencies for health statistics were searched to find relevant health statistics. Be specific and thorough in your search.
Provide the health information obtained in the search. Include any significant statistics and information on risk factors and trends in epidemiology data on your topic.
Interpret your findings and determine if there is any evidence of health disparities based on the population examined. Be sure you understand what health disparities are and address if your topic is or is not impacted. Provide several examples and include interventions that would improve this disparity.
DUE: to Dropbox on end of Day 7 of Unit 6.
To view the Grading Rubric for this Assignment, please visit the Grading Rubrics section of the Course Resources.
How to Submit:
When you are ready to submit your Assignment, select the unit Dropbox and then attach your file. Make sure to save a copy of the Assignment you submit.
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Explain the factors that affect the health of communities.
/in Uncategorized /by JosephITS IMPORTANT TO MEET THE COMPETENCES !
Develop a 6–8 page, APA-formatted article on a global health topic for publication. Describe the factors that impact health and health care delivery, and the interventions that have been implemented. Explain the influence of altruism on global health, and identify evidence-based interventions to address the global health topic.
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
Assessment Instructions
Preparation
Suppose you have been asked to submit an article for publication in your organization’s newsletter, about a global health topic and how policies and practices at the local level can affect global health. Choose one global health topic from the list (or use another of your choice):
Look in the Capella library and on the Internet for very recent peer-reviewed articles, statistics, and professional nursing information on the global health topic you selected.
Requirements
For this assessment, develop an APA-formatted research review article that covers one global health topic of your choice. In this assessment:
Additional Requirements
Complete your assessment using the following specifications:
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Assignment: Assessing A Healthcare Program/Policy Evaluation
/in Uncategorized /by JosephProgram/policy evaluation is a valuable tool that can help strengthen the quality of programs/policies and improve outcomes for the populations they serve. Program/policy evaluation answers basic questions about program/policy effectiveness. It involves collecting and analyzing information about program/policy activities, characteristics, and outcomes. This information can be used to ultimately improve program services or policy initiatives.
Nurses can play a very important role assessing program/policy evaluation for the same reasons that they can be so important to program/policy design. Nurses bring expertise and patient advocacy that can add significant insight and impact. In this Assignment, you will practice applying this expertise and insight by selecting an existing healthcare program or policy evaluation and reflecting on the criteria used to measure the effectiveness of the program/policy.
To Prepare:
The Assignment: (2–3 pages)
Based on the program or policy evaluation you selected, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following:
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