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  • [Solved] Comprehensive Integrated Psychiatric Assessment

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    – ## ComprehensiveIntegratedCComprehensiveIntegratedPsychiatricAssessment1.docx **## ComprehensiveIntegratedCComprehensiveIntegratedPsychiatricAssessment1.docx** ### Comprehensive Integrated CComprehensive Integrated Psychiatric Assessment Comprehensive Integrated Psychiatric AssessmenPsychiatric As…

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    – ## ComprehensiveIntegratedCComprehensiveIntegratedPsychiatricAssessment1.docx

    **## ComprehensiveIntegratedCComprehensiveIntegratedPsychiatricAssessment1.docx**

    ### Comprehensive Integrated CComprehensive Integrated Psychiatric Assessment

    Comprehensive Integrated Psychiatric AssessmenPsychiatric Assessment

    ![A child looking at a person AI-generated content may be incorrect.](https://www.sweetstudy.com/questions/comprehensive-integrated-psychiatric-assessment-20951465)

    Many assessment principles are the same for children and adults; however, unlike with adults/older adults, where consent for participation in the assessment comes from the actual client, with children it is the parents or guardians who must make the decision for treatment. Issues of confidentiality, privacy, and consent must be addressed. When working with children, it is not only important to be able to connect with the pediatric patient, but also to be able to collaborate effectively with the caregivers, other family members, teachers, and school counselors/psychologists, all of whom will be able to provide important context and details to aid in your assessment and treatment plans.

    Some children/adolescents may be more difficult to assess than adults, as they can be less psychologically minded. That is, they have less insights into themselves and their motivations than adults (although this is not universally true). The PMHNP must also take into consideration the child’s culture and environmental context. Additionally, with children/adolescents, there are lower rates of neurocognitive disorders superimposed on other clinical conditions, such as depression or anxiety, which create additional diagnostic challenges.

    In this Discussion, you review and critique the techniques and methods of a mental health professional as the practitioner completes a comprehensive, integrated psychiatric assessment of an adolescent. You also identify rating scales and treatment options that are specifically appropriate for children/adolescents.

    Resources

    Be sure to review the Learning Resources before completing this activity.
    Click the weekly resources link to access the resources.

    [**WEEKLY RESOURCES**](https://waldenu.instructure.com/courses/199680/modules/items/8310466)

    To Prepare

    · Review the Learning Resources and consider the insights they provide on comprehensive, integrated psychiatric assessment. Watch the
    _Mental Status Examination B-6_ and
    _Simulation Scenario-Adolescent Risk Assessment_ videos.

    · Watch the YMH Boston
    _Vignette 5_ video and take notes; you will use this video as the basis for your Discussion post.

    By Day 3 of Week 1

    Based on the YMH Boston
    _Vignette 5_ video, post answers to the following questions:

    · What did the practitioner do well? In what areas can the practitioner improve?

    · At this point in the clinical interview, do you have any compelling concerns? If so, what are they?

    · What would be your
    _next_  question, and why?

    Then, address the following. Your answers to these prompts do not have to be tailored to the patient in the YMH Boston video.

    · Explain why a thorough psychiatric assessment of a child/adolescent is important.

    · Describe two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.

    · Describe two psychiatric treatment options for children and adolescents that may not be used when treating adults.

    · Explain the role parents/guardians play in assessment.

    Support your response with at least three peer-reviewed, evidence-based sources and explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

    Upload a copy of your discussion writing to the draft Turnitin for plagiarism check.  Your faculty holds the academic freedom to not accept your work and grade at a zero if your work is not uploaded as a draft submission to Turnitin as instructed.

    **Read** a selection of your colleagues’ responses.

    By Day 6 of Week 1

    **Respond** to at least
    **two** of your colleagues on
    **2 different days** by offering additional insights or alternative perspectives on their analysis of the video, other rating scales that may be used with children, or other treatment options for children not yet mentioned. Be specific and provide a rationale with evidence.

    **Note:** For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues' postings. Begin by clicking on the
    **Reply** button to complete your initial post. Remember, once you click on
    **Post Reply**, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on
    **Post Reply**!

    · Symptom Media. (2014).
    [_Mental status exam B-6_ Links to an external site.](https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/mental-status-exam-b-6/cite?context=channel:volume-2-new-releases-assessment-tools-mental-status-exam-series). [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/mental-status-exam-b-6/cite?context=channel:volume-2-new-releases-assessment-tools-mental-status-exam-series

    · Western Australian Clinical Training Network. (2016, August 4).
    [_Simulation scenario-adolescent risk assessment_ Links to an external site.](https://www.youtube.com/watch?v=wNF1FIKHKEU) [Video]. YouTube. https://www.youtube.com/watch?v=wNF1FIKHKEU
    [Links to an external site.](https://www.youtube.com/watch?v=wNF1FIKHKEU)

    · YMH Boston. (2013, May 22).
    [_Vignette 5 – Assessing for depression in a mental health appointment_ Links to an external site.](https://www.youtube.com/watch?v=Gm3FLGxb2ZU) [Video]
    _._  YouTube. https://www.youtube.com/watch?v=Gm3FLGxb2ZU

    ## image1.jpeg

    **## ComprehensiveIntegratedCComprehensiveIntegratedPsychiatricAssessment1.docx**

    ### Comprehensive Integrated CComprehensive Integrated Psychiatric Assessment

    Comprehensive Integrated Psychiatric AssessmenPsychiatric Assessment

    ![A child looking at a person AI-generated content may be incorrect.](https://www.sweetstudy.com/questions/comprehensive-integrated-psychiatric-assessment-20951465)

    Many assessment principles are the same for children and adults; however, unlike with adults/older adults, where consent for participation in the assessment comes from the actual client, with children it is the parents or guardians who must make the decision for treatment. Issues of confidentiality, privacy, and consent must be addressed. When working with children, it is not only important to be able to connect with the pediatric patient, but also to be able to collaborate effectively with the caregivers, other family members, teachers, and school counselors/psychologists, all of whom will be able to provide important context and details to aid in your assessment and treatment plans.

    Some children/adolescents may be more difficult to assess than adults, as they can be less psychologically minded. That is, they have less insights into themselves and their motivations than adults (although this is not universally true). The PMHNP must also take into consideration the child’s culture and environmental context. Additionally, with children/adolescents, there are lower rates of neurocognitive disorders superimposed on other clinical conditions, such as depression or anxiety, which create additional diagnostic challenges.

    In this Discussion, you review and critique the techniques and methods of a mental health professional as the practitioner completes a comprehensive, integrated psychiatric assessment of an adolescent. You also identify rating scales and treatment options that are specifically appropriate for children/adolescents.

    Resources

    Be sure to review the Learning Resources before completing this activity.
    Click the weekly resources link to access the resources.

    [**WEEKLY RESOURCES**](https://waldenu.instructure.com/courses/199680/modules/items/8310466)

    To Prepare

    · Review the Learning Resources and consider the insights they provide on comprehensive, integrated psychiatric assessment. Watch the
    _Mental Status Examination B-6_ and
    _Simulation Scenario-Adolescent Risk Assessment_ videos.

    · Watch the YMH Boston
    _Vignette 5_ video and take notes; you will use this video as the basis for your Discussion post.

    By Day 3 of Week 1

    Based on the YMH Boston
    _Vignette 5_ video, post answers to the following questions:

    · What did the practitioner do well? In what areas can the practitioner improve?

    · At this point in the clinical interview, do you have any compelling concerns? If so, what are they?

    · What would be your
    _next_  question, and why?

    Then, address the following. Your answers to these prompts do not have to be tailored to the patient in the YMH Boston video.

    · Explain why a thorough psychiatric assessment of a child/adolescent is important.

    · Describe two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.

    · Describe two psychiatric treatment options for children and adolescents that may not be used when treating adults.

    · Explain the role parents/guardians play in assessment.

    Support your response with at least three peer-reviewed, evidence-based sources and explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

    Upload a copy of your discussion writing to the draft Turnitin for plagiarism check.  Your faculty holds the academic freedom to not accept your work and grade at a zero if your work is not uploaded as a draft submission to Turnitin as instructed.

    **Read** a selection of your colleagues’ responses.

    By Day 6 of Week 1

    **Respond** to at least
    **two** of your colleagues on
    **2 different days** by offering additional insights or alternative perspectives on their analysis of the video, other rating scales that may be used with children, or other treatment options for children not yet mentioned. Be specific and provide a rationale with evidence.

    **Note:** For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues' postings. Begin by clicking on the
    **Reply** button to complete your initial post. Remember, once you click on
    **Post Reply**, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on
    **Post Reply**!

    · Symptom Media. (2014).
    [_Mental status exam B-6_ Links to an external site.](https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/mental-status-exam-b-6/cite?context=channel:volume-2-new-releases-assessment-tools-mental-status-exam-series). [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/mental-status-exam-b-6/cite?context=channel:volume-2-new-releases-assessment-tools-mental-status-exam-series

    · Western Australian Clinical Training Network. (2016, August 4).
    [_Simulation scenario-adolescent risk assessment_ Links to an external site.](https://www.youtube.com/watch?v=wNF1FIKHKEU) [Video]. YouTube. https://www.youtube.com/watch?v=wNF1FIKHKEU
    [Links to an external site.](https://www.youtube.com/watch?v=wNF1FIKHKEU)

    · YMH Boston. (2013, May 22).
    [_Vignette 5 – Assessing for depression in a mental health appointment_ Links to an external site.](https://www.youtube.com/watch?v=Gm3FLGxb2ZU) [Video]
    _._  YouTube. https://www.youtube.com/watch?v=Gm3FLGxb2ZU

    ## image1.jpeg

  • [Solved] Advance Psychiatric

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    – ## Clinicalpaper.docx **## Clinicalpaper.docx** **Please follow APA format, add citations and references within 5 years old. Document will be verified for plagiarism and AI use. Thank you!** Instructions: 1. Identify a clinical healthcare problem in mental health care. These problems can be eithe…

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    Assignment Prompt & Instructions

    – ## Clinicalpaper.docx

    **## Clinicalpaper.docx**

    **Please follow APA format, add citations and references within 5 years old. Document will be verified for plagiarism and AI use. Thank you!**

    Instructions:

    1. Identify a clinical healthcare problem in mental health care. These problems can be either from your clinical site location, personal clinical experiences, or a review of the literature.

    2. Critically examine the problem within the context of the most current evidence-based research. All references must be within the last 5 years and at least 5 references are required to support your findings. Your clinical practice paper should include the following headers: 1. Description of the Problem; 2. Background Information; and 3. Significance to Advanced Practice Psychiatric Nursing.

    3. Write a scholarly paper in APA format (7th ed.) that is well organized, succinct, and proficient in grammar and composition. References must be within the last 5 years and at least 5 references are required to support your findings or arguments.

    4. The paper has a 3-page limit (1 page per header). This does not include the Title Page or References. Any paper that exceeds 3 pages in length will get a 1-point deducted per extra page.

    **## Clinicalpaper.docx**

    **Please follow APA format, add citations and references within 5 years old. Document will be verified for plagiarism and AI use. Thank you!**

    Instructions:

    1. Identify a clinical healthcare problem in mental health care. These problems can be either from your clinical site location, personal clinical experiences, or a review of the literature.

    2. Critically examine the problem within the context of the most current evidence-based research. All references must be within the last 5 years and at least 5 references are required to support your findings. Your clinical practice paper should include the following headers: 1. Description of the Problem; 2. Background Information; and 3. Significance to Advanced Practice Psychiatric Nursing.

    3. Write a scholarly paper in APA format (7th ed.) that is well organized, succinct, and proficient in grammar and composition. References must be within the last 5 years and at least 5 references are required to support your findings or arguments.

    4. The paper has a 3-page limit (1 page per header). This does not include the Title Page or References. Any paper that exceeds 3 pages in length will get a 1-point deducted per extra page.

  • [Solved] Nursing POLICY ASSIGNMENT

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    **TOPIC: Reducing Hospital Readmissions Through Improved Transitional Care Policies.** **Assignment Objectives:** 1. Explore and analyze health indicators in the community. 2. Identify a problematic area of interest to advanced nursing practice. 3. Evaluate and analyze three health policy options/al…

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    Assignment Prompt & Instructions

    **TOPIC: Reducing Hospital Readmissions Through Improved Transitional Care Policies.**
    **Assignment Objectives:**
    1. Explore and analyze health indicators in the community.
    2. Identify a problematic area of interest to advanced nursing practice.
    3. Evaluate and analyze three health policy options/alternatives for improvement supported by evidence (using a selected policy analysis tool)
    4. Prioritize and recommend one health policy to address the healthcare issue.
    **Purpose:** To investigate & integrate knowledge of advanced nursing practice, scholarly inquiry, & leadership by examining a policy at the level of clinical practice, health care systems, or public/social health policy.
    **Assignment Instructions:**
    5 PAGES excluding title page and reference pages.
    ASSIGNMENT must be organized according to the guidelines provided below (remember to follow the grading rubric) and need to include all the identified sections and information as it is outlined in the grading rubric and assignment instructions.
    Completed in APA format and contain current scholarly sources dated from 2019 until current.
    **Introduction** This part of the assignment should introduce the topics the student will be discussing and provide a bit of context about the approach. This is specific to the student content to be presented and not general to the assignment itself.
    **Step 1:** Identify the Policy Problem/Issue & Provide ContextThe first thing the student needs identify is a healthcare issue that, in your opinion, is a problem that calls for a policy solution, so the first step is to determine the policy issue of interest.
    **Step 2:** Provide the LandscapeIdentify the key stakeholders/ and or key factors of previous efforts to address the policy issue These are the individuals and groups likely to affect or be affected by new policies taken in response to the policy issue under discussion. Identify key factors such as political, social, economic, practical, legal or quality-of-care factors.
    **Conclusion** The conclusion summarizes the findings and recommendations of the entire analysis. This focuses on the student’s paper outlining key points that have been learned and assessed throughout the Assignment in a comprehensive and succinct manner.
    5 PAGES
    APA FORMAT INCLUDING REFERENCES AND IN-TEXT CITATIONS
    NO MORE THAN 10% PLAGIARISM IS ALLOWED, THIS ASSIGNMENT WILL BE SUBMITTED VIA TURNIN.
    DUE DATE NOVEMBER 26, 2025
    CHECK YOUR GRAMMAR AND SPELLING PLEASE
    \
    RUBRIC-POLICY.pdf](https://www.sweetstudy.com/files/rubric-policy-pdf-10458749 "RUBRIC-POLICY.pdf")

  • [Solved] Nursing Nursing homework help

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    In-depth study guidance and analytical solution covering Nursing Nursing homework help.

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    Assignment Prompt & Instructions

    Full assignment prompt and step-by-step guidance are included in the downloadable solution file.

  • [Solved] NUR514CL discussion 6

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    Please answer case study questions and questions below in 500 words thank you. – ## NUR514CLdiscussion6.docx **## NUR514CLdiscussion6.docx** ![A screenshot of a medical exam AI-generated content may be incorrect.](https://www.sweetstudy.com/questions/nur514cl-discussion-6) ![A white background with …

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    Please answer case study questions and questions below in 500 words thank you.

    – ## NUR514CLdiscussion6.docx

    **## NUR514CLdiscussion6.docx**

    ![A screenshot of a medical exam AI-generated content may be incorrect.](https://www.sweetstudy.com/questions/nur514cl-discussion-6)

    ![A white background with black text AI-generated content may be incorrect.](https://www.sweetstudy.com/questions/nur514cl-discussion-6)

    ## image1.png

    ## image2.png

    **## NUR514CLdiscussion6.docx**

    ![A screenshot of a medical exam AI-generated content may be incorrect.](https://www.sweetstudy.com/questions/nur514cl-discussion-6)

    ![A white background with black text AI-generated content may be incorrect.](https://www.sweetstudy.com/questions/nur514cl-discussion-6)

    ## image1.png

    ## image2.png

  • [Solved] nur514CL discussion 6 c

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    – ## NUR514CLdiscussion6.docx **## NUR514CLdiscussion6.docx** ![A close-up of a paper AI-generated content may be incorrect.](https://www.sweetstudy.com/questions/nur514cl-discussion-6-c) ## image1.png **## NUR514CLdiscussion6.docx** ![A close-up of a paper AI-generated content may be incorrect.](ht…

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    – ## NUR514CLdiscussion6.docx

    **## NUR514CLdiscussion6.docx**

    ![A close-up of a paper AI-generated content may be incorrect.](https://www.sweetstudy.com/questions/nur514cl-discussion-6-c)

    ## image1.png

    **## NUR514CLdiscussion6.docx**

    ![A close-up of a paper AI-generated content may be incorrect.](https://www.sweetstudy.com/questions/nur514cl-discussion-6-c)

    ## image1.png

  • [Solved] COPD exacerbation

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    After reviewing the materials you created to research a specific diagnosis in the first two assessments, apply the PICO(T) process to develop a research question and research it. Your initial goal is to define the population, intervention, comparison, and outcome. In some cases, a time frame is rele…

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    After reviewing the materials you created to research a specific diagnosis in the first two assessments, apply the PICO(T) process to develop a research question and research it.
    Your initial goal is to define the population, intervention, comparison, and outcome. In some cases, a time frame is relevant and you should include that as well, when writing a question you can research related to your issue of interest. After you define your question, research it, and organize your initial findings, select the two sources of evidence that seem the most relevant to your question and analyze them in more depth. Specifically, interpret each source's specific findings and best practices related to your chosen diagnosis, and explain how the evidence would help you plan and make decisions related to your question.
    If you need some structure to organize your initial thoughts and research, the PICO(T) Question and Library Search template (accessible from the [Create PICO(T) Questions](https://capellauniversity.libguides.com/EBP/picot) page) might be helpful.
    In your submission, make sure you address the following:
    – Review      the PICO(T) process.
    – Explain      your diagnosis from Assessment 1 in terms of outcomes, risks, and      complications. In your explanation, be sure to include the risks and      complications for vulnerable populations or those affected by healthcare      disparities and the impact of those disparities.
    – Consider      your diagnosis from Assessment 1. Develop a research question using the      PICO(T) process to address an issue of your choosing related to your      diagnosis.
    – Properly      format your PICO(T) question to guide your search of the literature.
    – Describe      your search of the literature, noting search engines, key words, and      credibility factors.
    – Locate      evidence that explores your intervention and comparison of your PICO(T)      question with an emphasis on your specific outcome (at least three      diagnosis-issue-specific sources of evidence (scholarly articles)).
    – Explain      the content of each of your scholarly articles.
    – Explain      the credibility and relevance of each of the articles you chose to your      diagnosis issue.
    – Analyze      the evidence. Determine the answer to your PICO(T) question based on your      analysis of the evidence.
    – **Length of submission**: Create a 3–5-page submission focused on defining a      research question and interpreting evidence relevant to answering it.
    – **Number of references**: Cite a minimum of four sources of scholarly or      professional evidence that support your findings and considerations.      Resources should be no more than 5 years old

  • [Solved] FHP

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    – HolisticAssessment-FHP.docx **HolisticAssessment-FHP.docx** This file is too large to display. [View in new window](https://www.sweetstudy.com/files/holisticassessment-fhp-docx-10458615) **HolisticAssessment-FHP.docx** This file is too large to display. [View in new window](https://www.sweetstudy….

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    – HolisticAssessment-FHP.docx

    **HolisticAssessment-FHP.docx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/holisticassessment-fhp-docx-10458615)

    **HolisticAssessment-FHP.docx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/holisticassessment-fhp-docx-10458615)

  • [Solved] APN Business Planning

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    Discuss the process of Advanced Practice Nurse (APN) business planning from a system approach.

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    Discuss the process of Advanced Practice Nurse (APN) business planning from a system approach.

  • [Solved] assistant

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    – ## ClinicalIISIM4CaseStudies.docx **## ClinicalIISIM4CaseStudies.docx** **_Nursing Program_** ![A blue and yellow logo Description automatically generated](https://www.sweetstudy.com/questions/assistant-20951443) **Clinical II – SIM 4 – Case Studies** *to be done early in the semester **Case Stud…

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    – ## ClinicalIISIM4CaseStudies.docx

    **## ClinicalIISIM4CaseStudies.docx**

    **_Nursing Program_**

    ![A blue and yellow logo Description automatically generated](https://www.sweetstudy.com/questions/assistant-20951443)

    **Clinical II – SIM 4 – Case Studies**

    *to be done early in the semester

    **Case Study 1**

    **Scenario**

    P.M., 24-year-old house painter, too ill to work the past 3 days. Arrived at your outpatient clinic with his girlfriend, he seems alert but acutely ill, with an average build & a deep tan over the exposed areas of skin. He reports headaches, joint pain, a low-grade fever, cough, anorexia, & nausea and vomiting (N/V), especially after eating any fatty food.

    P.M. describes vague abdominal pain that started about the same time as the other problems. He states that he has been using “a lot of Tylenol” for his pain. His past medical history reveals he has no health problems, is a nonsmoker, & drinks “a few” beers each evening to relax.

    Vital signs are 128/84, 88, 26, 100.6 ° F (38.1 ° C); awake, alert, & oriented × 3; moves all extremities well with complaints of aching pain in his muscles; very slight scleral jaundice present; heart & lung sound clear & without adventitious sounds; bowel sounds clear throughout abdomen & pelvis; & abdomen soft & palpable without distinct masses. You note moderate hepatomegaly measured at the midclavicular line; liver edge is easily palpated & tender to palpation. P.M. mentions that his urine has been getting darker over the past 2 days.

    **1.** **Your institution uses electronic charting. Based on the health history and assessment described in the scenario, which of the following systems would you mark as “abnormal” as you document your findings? Mark abnormal findings with an X and provide a brief narrative.**

    X Abnormal

    ☐ Neurologic:

    ☐ Respiratory:

    ☐ Cardiovascular:

    ☐ Gastrointestinal:

    ☐ Genitourinary:

    ☐ Musculoskeletal:

    ☐ Skin:

    ☐ Pain:

    **Case Study Progress**

    P.M. is manifesting key signs of hepatitis. Laboratory work is requested for identification of his precise problem.

    **2. Which key diagnostic tests will determine exactly what type of hepatitis is present?**

    **Laboratory Test Results**

    | | |
    | — | — |
    | Sodium  <br>Potassium  <br>Chloride  <br>CO2  <br>BUN  <br>Creatinine  <br>Platelets  <br>Indirect bilirubin  <br>Total bilirubin  <br>Albumin  <br>Total protein  <br>ALT  <br>AST <br>LDH  <br>ALP  <br>PT/INR  <br>aPTT  <br>Urine urobilinogen  <br>Anti-HAV  <br>IgM  <br>HBsAg | 140 mEq/L  <br>3.9 mEq/L  <br>102 mEq/L  <br>26 mEq/L  <br>10 mg/dL  <br>1.3mg/dL  <br>210,000/mm3  <br>1.6 mg/dL  <br>2.3 mg/dL  <br>3.8 g/dL  <br>6.5 g/dL  <br>66 units/L  <br>52 units/L <br>245 units/L  <br>176 units/L  <br>12 sec/1.06  <br>32 sec  <br>1.6 IU/L  <br>Negative  <br>Negative <br>Positive |

    **3. Which of P.M.’s laboratory results specifically indicate liver disease?**

    **4. What is the difference between the hepatitis B surface antigen (HbsAg) and the hepatitis B surface antibody (HbsAb)?**

    **5. What factors in his history could have compounded the increased ALT levels?**

    **6. Considering the basic pathology of hepatitis, what type of diet will you strongly encourage P.M. to follow?**

    **7. For each characteristic below, identify whether it describes hepatitis A (A) or hepatitis B (B).**

    ______a. Fecal-oral transmission.

    ______ b. Transmitted by sharing needles.

    ______ c. Transmitted by blood transfusions.

    ______ d. Vaccination is a three-shot series.

    ______ e. Illness is usually mild, similar to a flulike infection.

    ______ f. Symptoms include anorexia, nausea, vomiting, fever, fatigue, and jaundice.

    **8. In P.M.’s case, the HbsAg is positive. This result indicates that P.M. is infected with hepatitis B and is in the acute period of the disease. Is this disease contagious? What precautions would you take while he is in the hospital?**

    **9. Pruritus is usually associated with jaundice. What will you do to ease this problem for P.M.? Name five interventions.**

    **10. How will you explain to P.M. the likely progression of his disease?**

    **11. P.M. is living at home with his parents and four younger siblings. The youngest is 4 years old. His parents ask how to prevent the rest of the family from getting hepatitis. What specific instructions will you give?**

    **12. How will you know that these instructions are understood?**

    **13. Given P.M.’s lifestyle, what specific patient teaching points must you emphasize?**

    **Case Study Progress**

    P.M. is ready for discharge in a few days, & he confides to you that he feels so “guilty” about having hepatitis and endangering his girlfriend and family. He tells you he was at a party and did not think the one-time needle use could hurt him. He has lost his job because he is not able to go back to work & he hopes his family is not too afraid to have him return home.

    **14. What action will you take?**

    **Case Study 2**

    As a senior student you are assigned to work with a preceptor in the emergency department. It is a remarkably busy day, & it seems as if every patient, regardless of chief complaint, has an issue with fluid, electrolyte, and or acid-base balance.

    The first patient you see is a thirty-seven-year-old landscaper who is brought to the ED after collapsing on a job at the local country club. He is slightly confused but can tell you he feels dizzy & weak. His skin is flushed, dry, and with poor turgor. He has dry, sticky mucous membranes. The nurse identifies a nursing diagnosis of deficient fluid volume.

    **1. Describe how each of the following would change and the rationale for the change in the presence of deficient fluid volume**

    | | | |
    | — | — | — |
    | **Parameter** | **Expected Change** | **Rationale** |
    | Heart rate | | |
    | Blood pressure | | |
    | Serum hematocrit | | |
    | Urinary output | | |
    | Urine specific gravity | | |
    | Weight | | |

    2.
    **What is usually the first indicator that an individual needs more fluids?**

    3.
    **The ED physician orders IV fluids for this patient. What types of fluids are indicated for a fluid volume deficit due to dehydration?**

    The preceptor tells you to go ahead & initiate an IV site and start the fluids. The fluid order is to start 1000 mL of fluid as ordered at 150 mL/hr. The infusion tubing has a drop factor of 15 gtt/mL.

    4.
    **This infusion will run by gravity rather than an infusion pump. How many drops per minute should you time the infusion at to ensure the correct hourly rate? (See Chapter 22 in “Calculate with Confidence)**

    5.
    **The patient has a “full sleeve” tattoo on both arms. Discuss the implications of this finding and how you will initiate the intravenous site.**

    6.
    **You have difficulty finding a vein in the presence of the deficient fluid volume. What strategies can you employ to help make a vein more visible/palpable?**

    7.
    **After 30 minutes of the infusion, the patient states, “My arm where the needle is feels funny.” What should you do first? What further data do you need from the patient?**

    Several hours later the patient is feeling better & is now oriented x 3. The ED physician wants the patient to be drinking oral fluids without difficulty prior to being discharged from the ED.

    8.
    **Discuss the strategies to increase fluid intake that are most appropriate to this setting.**

    9
    **The patient is discharged after adequate hydration. Discharge teaching includes ways to prevent this from happening again on the job. What key points should the nurse include in the teaching applicable to the job site?**

    **_*Turn in to SIM4 Case Study Folder in D2L Dropbox_**

    LAST UPDATED 12/22/23
    ![A blue and yellow logo Description automatically generated](https://www.sweetstudy.com/questions/assistant-20951443) Page 1 | 1

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    **## ClinicalIISIM4CaseStudies.docx**

    **_Nursing Program_**

    ![A blue and yellow logo Description automatically generated](https://www.sweetstudy.com/questions/assistant-20951443)

    **Clinical II – SIM 4 – Case Studies**

    *to be done early in the semester

    **Case Study 1**

    **Scenario**

    P.M., 24-year-old house painter, too ill to work the past 3 days. Arrived at your outpatient clinic with his girlfriend, he seems alert but acutely ill, with an average build & a deep tan over the exposed areas of skin. He reports headaches, joint pain, a low-grade fever, cough, anorexia, & nausea and vomiting (N/V), especially after eating any fatty food.

    P.M. describes vague abdominal pain that started about the same time as the other problems. He states that he has been using “a lot of Tylenol” for his pain. His past medical history reveals he has no health problems, is a nonsmoker, & drinks “a few” beers each evening to relax.

    Vital signs are 128/84, 88, 26, 100.6 ° F (38.1 ° C); awake, alert, & oriented × 3; moves all extremities well with complaints of aching pain in his muscles; very slight scleral jaundice present; heart & lung sound clear & without adventitious sounds; bowel sounds clear throughout abdomen & pelvis; & abdomen soft & palpable without distinct masses. You note moderate hepatomegaly measured at the midclavicular line; liver edge is easily palpated & tender to palpation. P.M. mentions that his urine has been getting darker over the past 2 days.

    **1.** **Your institution uses electronic charting. Based on the health history and assessment described in the scenario, which of the following systems would you mark as “abnormal” as you document your findings? Mark abnormal findings with an X and provide a brief narrative.**

    X Abnormal

    ☐ Neurologic:

    ☐ Respiratory:

    ☐ Cardiovascular:

    ☐ Gastrointestinal:

    ☐ Genitourinary:

    ☐ Musculoskeletal:

    ☐ Skin:

    ☐ Pain:

    **Case Study Progress**

    P.M. is manifesting key signs of hepatitis. Laboratory work is requested for identification of his precise problem.

    **2. Which key diagnostic tests will determine exactly what type of hepatitis is present?**

    **Laboratory Test Results**

    | | |
    | — | — |
    | Sodium  <br>Potassium  <br>Chloride  <br>CO2  <br>BUN  <br>Creatinine  <br>Platelets  <br>Indirect bilirubin  <br>Total bilirubin  <br>Albumin  <br>Total protein  <br>ALT  <br>AST <br>LDH  <br>ALP  <br>PT/INR  <br>aPTT  <br>Urine urobilinogen  <br>Anti-HAV  <br>IgM  <br>HBsAg | 140 mEq/L  <br>3.9 mEq/L  <br>102 mEq/L  <br>26 mEq/L  <br>10 mg/dL  <br>1.3mg/dL  <br>210,000/mm3  <br>1.6 mg/dL  <br>2.3 mg/dL  <br>3.8 g/dL  <br>6.5 g/dL  <br>66 units/L  <br>52 units/L <br>245 units/L  <br>176 units/L  <br>12 sec/1.06  <br>32 sec  <br>1.6 IU/L  <br>Negative  <br>Negative <br>Positive |

    **3. Which of P.M.’s laboratory results specifically indicate liver disease?**

    **4. What is the difference between the hepatitis B surface antigen (HbsAg) and the hepatitis B surface antibody (HbsAb)?**

    **5. What factors in his history could have compounded the increased ALT levels?**

    **6. Considering the basic pathology of hepatitis, what type of diet will you strongly encourage P.M. to follow?**

    **7. For each characteristic below, identify whether it describes hepatitis A (A) or hepatitis B (B).**

    ______a. Fecal-oral transmission.

    ______ b. Transmitted by sharing needles.

    ______ c. Transmitted by blood transfusions.

    ______ d. Vaccination is a three-shot series.

    ______ e. Illness is usually mild, similar to a flulike infection.

    ______ f. Symptoms include anorexia, nausea, vomiting, fever, fatigue, and jaundice.

    **8. In P.M.’s case, the HbsAg is positive. This result indicates that P.M. is infected with hepatitis B and is in the acute period of the disease. Is this disease contagious? What precautions would you take while he is in the hospital?**

    **9. Pruritus is usually associated with jaundice. What will you do to ease this problem for P.M.? Name five interventions.**

    **10. How will you explain to P.M. the likely progression of his disease?**

    **11. P.M. is living at home with his parents and four younger siblings. The youngest is 4 years old. His parents ask how to prevent the rest of the family from getting hepatitis. What specific instructions will you give?**

    **12. How will you know that these instructions are understood?**

    **13. Given P.M.’s lifestyle, what specific patient teaching points must you emphasize?**

    **Case Study Progress**

    P.M. is ready for discharge in a few days, & he confides to you that he feels so “guilty” about having hepatitis and endangering his girlfriend and family. He tells you he was at a party and did not think the one-time needle use could hurt him. He has lost his job because he is not able to go back to work & he hopes his family is not too afraid to have him return home.

    **14. What action will you take?**

    **Case Study 2**

    As a senior student you are assigned to work with a preceptor in the emergency department. It is a remarkably busy day, & it seems as if every patient, regardless of chief complaint, has an issue with fluid, electrolyte, and or acid-base balance.

    The first patient you see is a thirty-seven-year-old landscaper who is brought to the ED after collapsing on a job at the local country club. He is slightly confused but can tell you he feels dizzy & weak. His skin is flushed, dry, and with poor turgor. He has dry, sticky mucous membranes. The nurse identifies a nursing diagnosis of deficient fluid volume.

    **1. Describe how each of the following would change and the rationale for the change in the presence of deficient fluid volume**

    | | | |
    | — | — | — |
    | **Parameter** | **Expected Change** | **Rationale** |
    | Heart rate | | |
    | Blood pressure | | |
    | Serum hematocrit | | |
    | Urinary output | | |
    | Urine specific gravity | | |
    | Weight | | |

    2.
    **What is usually the first indicator that an individual needs more fluids?**

    3.
    **The ED physician orders IV fluids for this patient. What types of fluids are indicated for a fluid volume deficit due to dehydration?**

    The preceptor tells you to go ahead & initiate an IV site and start the fluids. The fluid order is to start 1000 mL of fluid as ordered at 150 mL/hr. The infusion tubing has a drop factor of 15 gtt/mL.

    4.
    **This infusion will run by gravity rather than an infusion pump. How many drops per minute should you time the infusion at to ensure the correct hourly rate? (See Chapter 22 in “Calculate with Confidence)**

    5.
    **The patient has a “full sleeve” tattoo on both arms. Discuss the implications of this finding and how you will initiate the intravenous site.**

    6.
    **You have difficulty finding a vein in the presence of the deficient fluid volume. What strategies can you employ to help make a vein more visible/palpable?**

    7.
    **After 30 minutes of the infusion, the patient states, “My arm where the needle is feels funny.” What should you do first? What further data do you need from the patient?**

    Several hours later the patient is feeling better & is now oriented x 3. The ED physician wants the patient to be drinking oral fluids without difficulty prior to being discharged from the ED.

    8.
    **Discuss the strategies to increase fluid intake that are most appropriate to this setting.**

    9
    **The patient is discharged after adequate hydration. Discharge teaching includes ways to prevent this from happening again on the job. What key points should the nurse include in the teaching applicable to the job site?**

    **_*Turn in to SIM4 Case Study Folder in D2L Dropbox_**

    LAST UPDATED 12/22/23
    ![A blue and yellow logo Description automatically generated](https://www.sweetstudy.com/questions/assistant-20951443) Page 1 | 1

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