In order to gain an insight into the world of elder adults, it is important to understand how they view themselves and the values they hold. Additionally it is important to assess and determine his/her needs and establish appropriate interventions for this individual.

By the due date assigned, choose an older adult to interview. This cannot be a patient in your clinical setting. You can use a friend, family member, or co-worker. The older adult should be 65 years or older. Use the format provided to record the responses. A list of questions is available for you to start with. Include 2–3 questions of your own to get a complete picture of the older adult. Summarize your findings and also contrast the responses with findings in your readings and other current literature.

Download a patient questionnaire. This form should be used as an example.

After gaining permission, conduct a physical and mental functional assessment of the older adult you have chosen. Review your readings for the process of functional assessment.

Make use of the tools discussed this week to complete a comprehensive assessment of your patient. Search the Internet for resources on these tools.

1. Tinetti Balance and Gait Evaluation
2. Katz Index of Activities of Daily Living
3. Assessment of Home Safety
4. The Barthel Index

Make sure the older adult is clearly identified on the tools. Do not include their name, but do include professional or other designation, and age. Your name should also be identified on the tool. (This should be a part of your Appendix.)

Compare and contrast the age-related changes of the older person you interviewed and assessed with those identified in this week’s reading assignment. During this data analysis process provide at least 4–6 preliminary issues that you have identified. Identify three alterations in health that you would propose and describe them. Identify a minimum of three comprehensive interventions for each problem.

Make sure that you integrate personal cultural awareness and cultural competency.

Paper should be 5–6 pages, not including the questionnaire or tools used. These should be attached as an Appendix. Remember to use headings to identify the different sections in your paper.

On a separate references page, cite all sources using APA format.

• Use this APA Citation Helper as a convenient reference for properly citing resources.
• This handout will provide you the details of formatting your essay using APA style.
• You may create your essay in this APA-formatted template.

 

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Nursing 

Week 2: Therapy for Pediatric Clients With Mood Disorders

Mood disorders can impact every facet of a child’s life, making the most basic activities difficult for clients and their families. This was the case for 13-year-old Kara, who was struggling at home and at school. For more than 8 years, Kara suffered from temper tantrums, impulsiveness, inappropriate behavior, difficulty in judgment, and sleep issues. As a psychiatric mental health nurse practitioner working with pediatric clients, you must be able to assess whether these symptoms are caused by psychological, social, or underlying growth and development issues. You must then be able recommend appropriate therapies.

This week, as you examine antidepressant therapies, you explore the assessment and treatment of pediatric clients with mood disorders. You also consider ethical and legal implications of these therapies.

Photo Credit: GettyLicense_185239711.jpg

  

Assignment: Assessing and Treating Pediatric Clients With Mood Disorders

When pediatric clients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult clients with the same disorders, but they also metabolize medications much differently. As a result, psychiatric mental health nurse practitioners must exercise caution when prescribing psychotropic medications to these clients. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting with mood disorders.

Note: This Assignment is the first of 10 assignments that are based on interactive client case studies. For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients.

Learning Objectives

Students will:

· Assess client factors and history to develop personalized plans of antidepressant therapy for pediatric clients

· Analyze factors that influence pharmacokinetic and pharmacodynamic processes in pediatric clients requiring antidepressant therapy

· Evaluate efficacy of treatment plans

· Analyze ethical and legal implications related to prescribing antidepressant therapy to pediatric clients

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

• Chapter      6, “Mood Disorders”
• Chapter      7, “Antidepressants”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Review the following medications:

• amitriptyline
• bupropion
• citalopram
• clomipramine
• desipramine
• desvenlafaxine
• doxepin
• duloxetine
• escitalopram
• fluoxetine
• fluvoxamine
• imipramine
• ketamine
• mirtazapine
• nortriptyline
• paroxetine
• selegiline
• sertraline
• trazodone
• venlafaxine
• vilazodone
• vortioxetine

 

Magellan Health, Inc. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. Retrieved from http://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdf

Rao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787–791. doi:10.1002/da.22171

Note: Retrieved from Walden Library databases.

Vitiello, B. (2012). Principles in using psychotropic medication in children and adolescents. In J. M. Rey (Ed.), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from http://iacapap.org/wp-content/uploads/A.7-PSYCHOPHARMACOLOGY-072012.pdf

Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.

Note: Retrieved from Walden Library databases.

Required Media

Laureate Education (2016e). Case study: An African American child suffering from depression [Interactive media file]. Baltimore, MD: Author.

Note: This case study will serve as the foundation for this week’s Assignment.

Optional Resources

El Marroun, H., White, T., Verhulst, F., & Tiemeier, H. (2014). Maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes: A systematic review. European Child & Adolescent Psychiatry, 23(10), 973–992. doi:10.1007/s00787-014-0558-3

Gordon, M. S., & Melvin, G. A. (2014). Do antidepressants make children and adolescents suicidal? Journal of Pediatrics and Child Health, 50(11), 847–854. doi:10.1111/jpc.12655

Seedat, S. (2014). Controversies in the use of antidepressants in children and adolescents: A decade since the storm and where do we stand now? Journal of Child & Adolescent Mental Health, 26(2), iii–v. doi:10.2989/17280583.2014.938497

To prepare for this Assignment:

· Review this week’s Learning Resources. Consider how to assess and treat pediatric clients requiring antidepressant therapy.

The Assignment

Examine Case Study: An African American Child Suffering From Depression. 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:

o Decision #1

§ Which decision did you select?

§ Why did you select this decision? Support your response with evidence and references to the Learning Resources.

§ What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

§ Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

o Decision #2

§ Why did you select this decision? Support your response with evidence and references to the Learning Resources.

§ What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

§ Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

o Decision #3

§ Why did you select this decision? Support your response with evidence and references to the Learning Resources.

§ What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

§ 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.

 

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Addictive disorders can be particularly challenging for clients. Not only do these disorders typically interfere with a client’s ability to function in daily life, but they also often manifest as negative and sometimes criminal behaviors. Sometime clients with addictive disorders also suffer from other mental health issues, creating even greater struggles for them to overcome. In your role, you have the opportunity to help clients address their addictions and improve outcomes for both the clients and their families. For this Assignment, as you examine the Levy Family video in this week’s Learning Resources, consider how you might assess and treat clients presenting with addiction.

  

N: B EACH OF THE 5 EPISODES TO WATCH (REQIURED MEDIA) FOR THIS ASSIGNGMENT IS DOWNLOADEDN IN WORD FORMAT AS A TRANSCRIPT AND ATTACHED TO THIS ASSIGNMENT. 

 

  

Learning Objectives

Students will:

· Assess clients presenting with addictive disorders

· Analyze therapeutic approaches for treating clients with addictive disorders

· Evaluate outcomes for clients with addictive disorders

To prepare:

· Review this week’s Learning Resources and consider the insights they provide.

· Review the Levy Family video Episodes 1 through 5.

  

The Assignment

In a 2- to 3-page paper, address the following:

· After watching Episode 1, describe:

o What is Mr. Levy’s perception of the problem?

o What is Mrs. Levy’s perception of the problem?

o What can be some of the implications of the problem on the family as a whole?

· After watching Episode 2, describe:

o What did you think of Mr. Levy’s social worker’s ideas?

o What were your thoughts of her supervisor’s questions about her suggested therapies and his advice to Mr. Levy’s supervisor?

· After watching Episode 3, discuss the following:

o What were your thoughts about the way Mr. Levy’s therapist responded to what Mr. Levy had to say?

o What were your impressions of how the therapist worked with Mr. Levy? What did you think about the therapy session as a whole?

o Informed by your knowledge of pathophysiology, explain the physiology of deep breathing (a common technique that we use in helping clients to manage anxiety). Explain how changing breathing mechanics can alter blood chemistry.

o Describe the therapeutic approach his therapist selected. Would you use exposure therapy with Mr. Levy? Why or why not? What evidence exists to support the use of exposure therapy (or the therapeutic approach you would consider if you disagree with exposure therapy)?

· In Episode 4, Mr. Levy tells a very difficult story about Kurt, his platoon officer.

o Discuss how you would have responded to this revelation.

o Describe how this information would inform your therapeutic approach. What would you say/do next?

· In Episode 5, Mr. Levy’s therapist is having issues with his story.

o Imagine that you were providing supervision to this therapist, how would you respond to her concerns?

· Support your approach with evidence-based literature. AND INCLUDE INTRODUCTION, CONCLUSION WITH REFERENCES.

Required Readings

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

• Chapter 7, “Motivational Interviewing” (pp. 299–312)
• Chapter      16, “Psychotherapeutic Approaches for Addictions and Related Disorders”      (pp. 565–596)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Albrecht, U., Kirschner, N. E., & Grusser, S. M. (2007). Diagnostic instruments for behavioral addiction: An overview. German Medical Science Psycho-Social-Medicine, 4, 1–11. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2736529/

Fisher, M. A. (2016). The ethical ABCs of conditional confidentiality. In Confidentiality limits in psychotherapy: Ethics checklists for mental health professionals (pp. 13–25). Washington, DC: American Psychological Association. doi:10.1037/14860-002

  

Required Media 

N: B EACH OF THE 5 EPISODES TO WATCH (REQIURED MEDIA) FOR THIS ASSIGNGMENT IS DOWNLOADEDN IN WORD FORMAT AS A TRANSCRIPT AND ATTACHED TO THIS ASSIGNMENT. 

Laureate Education (Producer). (2013c). Levy family: Episodes 1 [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 2 minutes.

Laureate Education (Producer). (2013c). Levy family: Episodes 2 [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 2 minutes.

Laureate Education (Producer). (2013c). Levy family: Episodes 3 [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 6 minutes.

Laureate Education (Producer). (2013c). Levy family: Episodes 4 [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 5 minutes.

Laureate Education (Producer). (2013c). Levy family: Episodes 5 [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 2 minutes.

Laureate Education (Producer). (2012c). In their own words [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 23 minutes

  

   

 

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Purpose

This week’s graded topics relate to the following Course Outcomes (COs).

• CO 1 – Utilize prior knowledge of theories and principles of nursing and related disciplines to explain expected client behaviors, while differentiating between normal findings, variations, and abnormalities. (PO 1)
• CO 4 – Utilize effective communication when performing a health assessment. (PO 3)

The Assignment

A 10-year-old child named Elizabeth is brought into the emergency department by her mother. The mother appears anxious but sits quietly next to her daughter in the waiting room. When called into the triage area, the mother gives a history of coming home from work to find Elizabeth sitting on the couch watching television. Elizabeth did not go to the door to greet her or look toward her when she said hello. The mother thought the daughter’s behavior was odd because she always greeted her at the door with a hug. As she approached Elizabeth, she noticed that she was clutching her right arm as if in pain. The mother asked what was wrong, but Elizabeth remained silent. Then she said “Nothing is wrong.” The father is sleeping upstairs. The mother gives a family history of having an alcoholic husband who usually drinks himself to sleep. She said he has abused Elizabeth physically and psychologically in the past, and she brought her to the emergency room because she fears he has hurt her. When Elizabeth is asked about the abuse she appears scared, insecure, and withdrawn.

1. What considerations should be made by the nurse, to provide a physically and emotionally safe environment for the interview and assessment of this client who has experienced domestic abuse?
2. In your response, include some special considerations that should be taken when interviewing a child.

 

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