BACKGROUND INFORMATION
The client is a 70 year-old Hispanic American male who came to the United States when he was in high school with his father. His mother died back in Mexico when he was in school. He presents today to your office for an initial appointment for complaints of depression. The client was referred by his PCP after “routine” medical work-up to rule out an organic basis for his depression. He has no other health issues with the exception of some occasional back pain and “stiff” shoulders which he attributes to his current work as a laborer in a warehouse.
SUBJECTIVE
During today’s clinical interview, client reports that he always felt like an outsider as he was “teased” a lot for being “black” in high school. States that he had few friends, and basically kept to himself. He describes his home life as “good.” Stating “Dad did what he could for us, there were 8 of us.” He also reports a remarkably diminished interest in engaging in usual activities, states that he has gained 15 pounds in the last 2 months. He is also troubled with insomnia which began about 6 months ago, but have been progressively getting worse. He does report poor concentration which he reports is getting in “trouble” at work.
MENTAL STATUS EXAM
The client is alert, oriented to person, place, time, and event. He is casually dressed. Speech is clear, but soft. He does not readily make eye contact, but when he does, it is only for a few moments. He is endorsing feelings of depression. Affect is somewhat constricted, but improves as the clinical interview progresses. He denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment and insight appear grossly intact. He is currently denying suicidal or homicidal ideation. You administer the “Montgomery- Asberg Depression Rating Scale (MADRS)” and obtained a score of 51 (indicating severe depression).
RESOURCES
§ Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389.
For this Discussion, you will select an interactive media piece to practice decision making when treating patients with psychological disorders ( Selected above) You will recommend the most effective pharmacotherapeutic to treat the psychological disorder presented and examine potential impacts of pharmacotherapeutics on a patient’s pathophysiology.
To Prepare
· Review this week’s interactive media pieces and select one to focus on for this Discussion.
· Reflect on the decision steps in the interactive media pieces, and consider the potential impacts from the administration of the associated pharmacotherapeutics on the patient’s pathophysiology.
·
Post a brief explanation of the psychological disorder presented( depression) and the decision steps you applied in completing the interactive media piece for the psychological disorder you selected ( as below) Then, explain how the administration of the associated pharmacotherapeutics you recommended may impact the patient’s pathophysiology. How might these potential impacts inform how you would suggest treatment plans for this patient? Be specific and provide examples.
Decision steps taken:
Decision point 1
Begin Zoloft 25mg orally daily. ( pt came back in not feeling better and c/o erectile dysfunction)
Decision point 2
Decrease dose of Zoloft ( pt still feels better but still same complain)
Decision point 3
d/c zoloft and start on paxil ( SSRIs should be first line of treatment while MOAIs last line of treatment for depression( from research, say why this decision will be best for this patient with three references)
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Demographic And Epidemiological Assessment 19406907
/in Uncategorized /by developerPurpose
This week’s graded topics relate to the following Course Outcome (CO).
Discussion
For this discussion, you will collect assessment data about your city or county. This post will include information about demographics (general characteristics). You will then find epidemiological data (disease or health behavior rates) about one priority health problem in your community.
County Health Rankings and Roadmaps. (2018). Explore rankings. Retrieved from http://www.countyhealthrankings.org/
U.S. Census Bureau. (2018). State and county QuickFacts. Retrieved from https://www.census.gov/quickfacts/
Professor’s comment:
Hello Class,
This week, we will look at Epidemiology which is the science that public health is based on. Based on terms of demographic and epidemiological data, please consider the following questions in your posts.
references: American Psychological Association. (2010). Publication manual of the American Psychological Association (6th ed.). Washington, DC: Author.
Nies, M. A., & McEwen, M. (2019). Community/public health nursing: Promoting the health of populations (7 ed.). St. Louis, MO: Elsevier.
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Demographic And Epidemiological Assessment
/in Uncategorized /by developerPurpose
This week’s graded topics relate to the following Course Outcome (CO).
Discussion
For this discussion, you will collect assessment data about your city or county. This post will include information about demographics (general characteristics). You will then find epidemiological data (disease or health behavior rates) about one priority health problem in your community.
County Health Rankings and Roadmaps. (2018). Explore rankings. Retrieved from http://www.countyhealthrankings.org/
U.S. Census Bureau. (2018). State and county QuickFacts. Retrieved from https://www.census.gov/quickfacts/ (Links to an e
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Depression 19252355
/in Uncategorized /by developerIn 3–4 pages, write a treatment plan for your client in which you do the following:
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Depression Decision Tree
/in Uncategorized /by developerBACKGROUND INFORMATION
The client is a 70 year-old Hispanic American male who came to the United States when he was in high school with his father. His mother died back in Mexico when he was in school. He presents today to your office for an initial appointment for complaints of depression. The client was referred by his PCP after “routine” medical work-up to rule out an organic basis for his depression. He has no other health issues with the exception of some occasional back pain and “stiff” shoulders which he attributes to his current work as a laborer in a warehouse.
SUBJECTIVE
During today’s clinical interview, client reports that he always felt like an outsider as he was “teased” a lot for being “black” in high school. States that he had few friends, and basically kept to himself. He describes his home life as “good.” Stating “Dad did what he could for us, there were 8 of us.” He also reports a remarkably diminished interest in engaging in usual activities, states that he has gained 15 pounds in the last 2 months. He is also troubled with insomnia which began about 6 months ago, but have been progressively getting worse. He does report poor concentration which he reports is getting in “trouble” at work.
MENTAL STATUS EXAM
The client is alert, oriented to person, place, time, and event. He is casually dressed. Speech is clear, but soft. He does not readily make eye contact, but when he does, it is only for a few moments. He is endorsing feelings of depression. Affect is somewhat constricted, but improves as the clinical interview progresses. He denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment and insight appear grossly intact. He is currently denying suicidal or homicidal ideation. You administer the “Montgomery- Asberg Depression Rating Scale (MADRS)” and obtained a score of 51 (indicating severe depression).
RESOURCES
§ Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389.
For this Discussion, you will select an interactive media piece to practice decision making when treating patients with psychological disorders ( Selected above) You will recommend the most effective pharmacotherapeutic to treat the psychological disorder presented and examine potential impacts of pharmacotherapeutics on a patient’s pathophysiology.
To Prepare
· Review this week’s interactive media pieces and select one to focus on for this Discussion.
· Reflect on the decision steps in the interactive media pieces, and consider the potential impacts from the administration of the associated pharmacotherapeutics on the patient’s pathophysiology.
·
Post a brief explanation of the psychological disorder presented( depression) and the decision steps you applied in completing the interactive media piece for the psychological disorder you selected ( as below) Then, explain how the administration of the associated pharmacotherapeutics you recommended may impact the patient’s pathophysiology. How might these potential impacts inform how you would suggest treatment plans for this patient? Be specific and provide examples.
Decision steps taken:
Decision point 1
Begin Zoloft 25mg orally daily. ( pt came back in not feeling better and c/o erectile dysfunction)
Decision point 2
Decrease dose of Zoloft ( pt still feels better but still same complain)
Decision point 3
d/c zoloft and start on paxil ( SSRIs should be first line of treatment while MOAIs last line of treatment for depression( from research, say why this decision will be best for this patient with three references)
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Dermatology Case Stidy Db6 Continuation
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DERMATOLOGY CASE STUDYChief complaint:  “ My right great toe has been hurting for about 2 months and now it’s itchy, swollen and yellow. I can’t wear closed shoes and I was fine until I started going to the gymâ€.HPI: E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain, itching, inflammation, and “yellow†right great toe. She noticed that the toe was moderately itching after she took a shower at the gym. She did not pay much attention. About two weeks after the itching became intense and she applied Benadryl cream with only some relief.  She continued going to the gym and noticed that the itching got worse and her toe nail started to change color. She also indicated that the toe got swollen, painful and turned completely yellow 2 weeks ago. She applied lotrimin  AF cream and it did not help relief her symptoms. She has not tried other remedies. Denies associated symptoms of fever and chills. PMH:Diabetes Mellitus, type 2.Surgeries: NoneAllergies: AugmentinMedication: Metformin 500mg PO BID.Vaccination History:  Immunization is up to date and she received her flu shot this year.Social history:College graduate married and no children. She drinks 1 glass of red wine every night with dinner. She is a former smoker and quit 6 years ago.Family history:Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, HTN.ROS:Constitutional: Negative for fever. Negative for chills.Respiratory: No Shortness of breath. No OrthopneaCardiovascular: Regular rhythm.Skin: Right great toe swollen, itchy, painful and discolored.Psychiatric: No anxiety. No depression.Physical examination:Vital SignsHeight: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0, P 88 R 22, non-laboredHEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness.NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.LUNGS: No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.HEART: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally.ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred.MUSCULOSKELETAL: Slow gait but steady. No Kyphosis.SKIN: Right great toe with yellow-brown discoloration in the proximal nail plate. Marked periungual inflammation. + dryness. No pus. No neuro deficit.PSYCH: Normal affect. Cooperative.Labs: Hgb 13.2, Hct 38%, K+ 4.2, Na+138, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98. A:Primary Diagnosis: Proximal subungual onychomycosisDifferential Diagnosis:  Irritant Contact Dermatitis, Lichen Planus, Nail PsoriasisSpecial Lab: Fungal culture confirms fungal infection. Please see below:     Now that you have identified the treatment for onychomycosis and labs for baseline and follow up therapy.
Q
For Week 6, please address the following:
1- Specify when to refer the patient after therapy and why? Provide rationale.
2- According to the recommended guidelines, what are the non-pharmacological approaches to  Onychomycosis ?
3-Provide patient education. Keep in mind the past medical history of this patient
hypertension ,, diabetes mellitus 2 , salt intake , obesity
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Describe 19394843
/in Uncategorized /by developerDescribe and discuss the differences between research, research utilization, and evidence-based practice. Provide examples.
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Describe A Existing Manual Or Electronic System With Which You Are Familiar
/in Uncategorized /by developerAssignment description is attached below. should include a data flow diagrams regarding how the data flows in the proposed system as show in the attachment. word count can be 2500.
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Describe A Healthcare Problem That Can Be Used To Develop A Pico Question
/in Uncategorized /by developerView the attached file, Please follow all specific instructions on the attached file.
Research evidence must not be more than five years old.
Note: Upload a copy of the full text of the articles with your submission.
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Describe A Minimum Of 3 Strategies That Can Be Used In Preventing Poly Pharmacy In Older Adults
/in Uncategorized /by developerDescribe a minimum of 3 strategies that can be used in preventing poly-pharmacy in older adults?
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Describe An Example Of Systems Thinking Applied In Public Health
/in Uncategorized /by developerDescribe an example of systems thinking applied in public health. What are the strengths and weaknesses of this approach?
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