case study

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THE ASSIGNMENT: 5 PAGES

Examine 
Case Study: A Puerto Rican Woman With Comorbid Addiction. 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, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

· Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

· Which decision did you select?

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

· Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

BACKGROUND

Mrs. Maria Perez is a 53 year old Puerto Rican female who presents today due to a rather “embarrassing problem.”

SUBJECTIVE

Mrs. Perez admits that she has had “problems” with alcohol since her father died in her late teens. She reports that she has struggled with alcohol since her 20’s and has been involved with Alcoholics Anonymous “on and off” for the past 25 years. She states that for the past 2 years, she has been having more and more difficulty maintaining her sobriety since the opening of the new “Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during its grand opening at which point she was “hooked.” She states that she gets “such a high” when she is gambling. While gambling, she “enjoys a drink or two” to help calm her during high-stakes games. She states that this often gives way to more drinking and more reckless gambling. She also reports that her cigarette smoking has increased over the past 2 years and she is concerned about the negative effects of the cigarette smoking on her health.

She states that she attempts to abstain from drinking but she gets such a “high” from the act of gambling that she needs a few drinks to “even out.” She also notices that when she drinks, she doesn’t smoke “as much,” but she enjoys smoking when she is playing at the slot machines. She also reports that she has gained weight from drinking so much. She currently weights 122 lbs., which represents a 7 lb. weight gain from her usual 115 lb. weight.

Mrs. Perez is quite concerned today because she borrowed over $50,000 from her retirement account to pay off her gambling debts, and her husband does not know.

MENTAL STATUS EXAM

The client is a 53 year old Puerto Rican female who is alert and oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. Her speech is clear, coherent, and goal directed. Her eye contact is somewhat avoidant during the clinical interview. When you make eye contact with her, she looks away or looks down. She demonstrates no noteworthy mannerisms, gestures, or tics. Her self-reported mood is “sad.” Affect is appropriate to content of conversation and self-reported mood. She denies visual or auditory hallucinations, and no delusional or paranoid thought processes are readily appreciated. Insight and judgment are grossly intact; however, impulse control is impaired. She is currently denying suicidal or homicidal ideation.

Diagnosis: Gambling disorder, alcohol use disorder

Decision Point One

Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks

RESULTS OF DECISION POINT ONE

·
 Client returns to clinic in four weeks

·
 Mrs. Perez says she feels “wonderful” as she has not “touched a drop” of alcohol since receiving the injection

·
 Client reports that she has not been going to the casino, as frequently, but when she does go she “drops a bundle” (meaning, spends a lot of money gambling)

·
 Client She is also still smoking, which has her concerned. She is also reporting some problems with anxiety, which also has her concerned

Decision Point Two

Add on Valium (diazepam) 5 mg orally TID/PRN/anxiety

RESULTS OF DECISION POINT TWO

·
 Client returns to clinic in four weeks

·
 Mrs. Perez reports that when she first received the Valium, it helped her tremendously. She states “I was like a new person. This is a miracle drug!” However, she reports that she has trouble “waiting” between drug administration times and sometimes takes her Valium early

·
 She is asking today for an increase the Valium dose or frequency

Decision Point Three

Continue current dose of Vivitrol, increase Valium to 10 mg orally TID/PRN/anxiety. Refer to counseling for her ongoing gambling issue

Guidance to Student

Anxiety is a common side effect of Vivitrol. Mrs. Perez reports that she is doing well with this medication, and like other side effects, the anxiety associated with this medication may be transient. The psychiatric mental health nurse practitioner should never initiate benzodiazepines in a client who already has issues with alcohol, or other substance dependencies. Additionally, benzodiazepines are not to be used long-term. Problems associated with long-term benzodiazepine use include the need to increase the dose in order to achieve the same therapeutic effect. This is what we are seeing in Mrs. Perez’s case.

The most appropriate course of action in this case would be to continue the current dose of Vivitrol, while decreasing the Valium with the goal of discontinuation of the drug within the next two weeks. At that point, you would need to evaluate whether or not the side effect of anxiety associated with Vivitrol persists.

Increasing the dose of Valium would not be appropriate, neither would maintaining her on the current dose of Valium. Additionally, the client should be referred for counseling to help with her gambling addiction, as there are no FDA approved medications gambling disorder.

Medication should never be added treat side effect of another medication, unless that side effect is known to be transient (for instance, benzodiazepines are sometimes prescribed to overcome the initial problem of “activation” associated with initiation of SSRI, or SNRI therapy). However, in a client with multiple addictive disorders, benzodiazepines should never be used (unless they are only being used for a limited duration of therapy such as acute alcohol detoxification to prevent seizures).

Additionally, it should be noted that Mrs. Perez continues to engage in problematic gambling, at considerable personal financial cost. Mrs. Perez needs to be referred to a counselor who specializes in the treatment of gambling disorder, and should also be encouraged to establish herself with a local chapter of gamblers anonymous.

You need to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions, and to enhance her overall health.

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Response

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 Due 10/13/23 @ 1600 EST

Respond by sharing ideas for how shortcomings discovered in their evaluations and/or their examples of incivility could have been managed more effectively. 

using APA, at least 2 scholarly references 

 

The results show that the organization encourages collaborative decision-making, where multiple stakeholders, including employees, have a say in important matters. This can lead to a more inclusive and democratic decision-making process. Members are actively involved in creating and shaping workplace policies. This involvement ensures that policies reflect the needs and preferences of those who work within the organization. The organization recognizes the importance of periodically reviewing its policies to remain relevant and practical. This proactive approach helps in identifying areas that may need improvement or adjustment. The organization is also open to revising policies as necessary. This flexibility allows for adaptation to changing circumstances or feedback from members.

Members of the organization share a vision and mission based on trust, respect, and collegiality. Communication at all levels of the organization is transparent, direct, and respectful. The organizational culture is assessed on an ongoing basis, and measures are taken to improve it based on the results of that assessment.

surprisingly “Most employees did not recommend the organization as a good or great place to work to their family and friends.” This suggests that despite some positive aspects mentioned in the assessment, many employees are dissatisfied to the point where they would not recommend the organization to others. This could indicate a significant issue with the workplace culture or conditions that may need urgent attention.

Another surprising thing is that “Individual and collective achievements are not celebrated and publicized equitably.” This lack of recognition and celebration of achievements can harm employee morale and motivation. It is surprising because recognizing and celebrating accomplishments is common in many organizations to boost employee engagement and satisfaction.

Before the assessment, I had an idea that “Communication at all levels of the organization is transparent, direct, and respectful.” the assessment confirms this aspect as it indicates that the organization values open and respectful communication and is seen as a positive sign, as effective communication is crucial for building trust and a healthy workplace culture (Dempsey & Assi, 2018).

It is evident from the findings that my workplace is civil because it values employees, fosters a positive and inclusive culture, invests in employee development, and prioritizes their well-being. Such an environment will likely attract and retain talented individuals and contribute to the organization’s long-term success.

The assessment also shows that my workplace is characterized by trust, respect, engagement, and a positive culture providing a healthy working environment. However, it is essential to continue monitoring and addressing any potential areas for improvement to sustain this healthy and civil work environment.

The concepts presented in the articles appear to be related to organizational culture and employee satisfaction. A healthy organizational culture that aligns with employees’ values and supports their well-being is more likely to result in higher employee satisfaction. When employees feel that they fit into the culture, are respected, and have opportunities for growth and development, their satisfaction increases. The assessment evaluates various aspects of an organization’s work environment, including trust, communication, employee engagement, leadership, and more (Cummings et al., 2018). These factors collectively contribute to the organizational culture and can significantly impact employee satisfaction and overall well-being.

In summary, the theory of organizational culture and employee satisfaction closely aligns with the assessment criteria in my workplace. A positive organizational culture, characterized by trust, communication, recognition, and employee well-being, will likely result in higher employee satisfaction, engagement, and morale (Cummings et al., 2018). Conversely, a negative culture can lead to dissatisfaction and a lack of employee recommendations. 

To apply the theory of organizational culture and employee satisfaction to improve organizational health and create stronger work teams, an organization can take several specific actions and initiatives:

Define and Communicate Clear Values and Mission by holding regular meetings or workshops to reinforce the organization’s mission and values. Ensure that all employees understand and can articulate these core principles.

Foster Trust and Open Communication by Implementing regular “town hall” meetings where leadership provides updates and encourages questions from all employees. Create anonymous feedback channels for employees to express concerns or suggestions.

Recognize and Celebrate Achievements through establishing an employee recognition program that acknowledges outstanding contributions and achievements. Celebrate milestones and successes as a team.

Employee engagement and morale through Conducting regular employee engagement surveys to gather feedback on job satisfaction and areas for improvement. Act on the survey results by implementing changes based on employee input.

The organization seems to prioritize a positive and inclusive culture where trust, respect, and collegiality are fundamental principles. This is a commendable approach that can contribute to a healthy work environment. Committing to transparent and respectful communication at all levels is crucial for maintaining trust and ensuring all employees feel heard and valued. Open and honest communication is key to a thriving organization. Recognizing employees as valuable partners rather than liabilities is essential as it fosters a sense of belonging and motivates employees to contribute to the organization (Atrizka et al., 2020). Encouraging shared governance, teamwork, and collaboration reflects a commitment to involving employees in decision-making processes, which can lead to better solutions and more significant employee investment in the organization’s success. Notably, most employees did not recommend the organization as a good or excellent place to work to their family and friends. This indicates a potential area for improvement and suggests that the organization should actively address any concerns or issues that employees may have.

In summary, the organization seems to have many positive elements for creating a healthy and supportive work environment. However, it should pay attention to the feedback provided by its employees to address any areas that need improvement and enhance overall employee satisfaction and advocacy.

                                                                                                              References

Atrizka, D., Lubis, H., Simanjuntak, C. W., & Pratama, I. (2020). Ensuring Better Affective Commitment and Organizational Citizenship Behavior through Talent Management and Psychological Contract Fulfillment: An Empirical Study of Indonesia Pharmaceutical Sector. Systematic Reviews in Pharmacy, 11(1).

Cummings, G. G., Tate, K., Lee, S., Wong, C. A., Paananen, T., Micaroni, S. P., & Chatterjee, G. E. (2018). Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review. International journal of nursing studies, 85, 19-60.

Dempsey, C., & Assi, M. J. (2018). The impact of nurse engagement on quality, safety, and the experience of care: what nurse leaders should know. Nursing administration quarterly, 42(3), 278-283.

Discussion

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1) Review your state’s Nurse Practice Act and rules and regulations.

2) As a coworker, what are you required to do if you believe a nurse has a problem with chemical dependency? As the nurse manager, what are your obligations? Please cite the Nurse Practice Act. 

Nursing Nutrition class assignment

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Please see the attached document with the instructions for this assigment

Must be completed as requested

6 pages required exclude cover and reference page

all documentation APA 7th edition formal, check grammar for proper use

no more than 10% plague allowed will be submitted by turnin in

Due date September 28, 2023 no later

Theoretical framework

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Please see the attachment for instructions

week 7

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Our Struggle for Freedom, Civil Liberties And Political Equality

Discussion

Required Resources

Read/review the following resources for this activity:

· Textbook: Chapter 15, 16

· Lesson: Read this Week's Lesson which is located in the Modules tab.

· Initial Post: minimum of 2 scholarly sources (must include your textbook for one of the sources). Follow-Up Post: minimum of 1 scholarly source for your Follow-Up Post.

· Your Initial Post and your Follow-Up Post must be based on the same Option that you chose in order to receive credit for both posts. 

Initial Post Instructions

For the initial post, respond to one of the following options, and label the beginning of your post indicating either Option 1 or Option 2:

·
Option 1: The Equal Rights Amendment was first proposed almost a century ago and has still not been added to the United States Constitution. It is supposed to guarantee equal legal rights for all American citizens regardless of sex. It was first introduced to Congress by Alice Paul, leader of women's suffrage movement in 1923. Compare/contrast the Equal Rights Amendment with the Fourteenth Amendment. Did they deal with separate concepts? Explain your answer.

·
Option 2: The Bill of Rights is not only included with the United States Constitution but also state constitutions. All states have provisions in their constitutions that protect individual rights. Go online and look up your state constitution concerning amendments that are included in the Bill of Rights. How does your state constitution protect your individual rights?

Be sure to make connections between your ideas and conclusions and the research, concepts, terms, and theory we are discussing this week.

Writing Requirements

· Minimum of 2 posts (1 initial & 1 follow-up)

· Minimum of 2 sources cited (assigned readings/online lessons and an outside source) for your Initial Post, and 1 scholarly source for your Follow-Up Post.

· APA format for in-text citations and list of references

· Ebook:
https://bookshelf.vitalsource.com/reader/books/9780135246849/pageid/11

· The Struggle for Democracy, 2018 Elections and Updates Edition

· Or
[email protected]

· PWD: Bryanthierry@09

·

Reply

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Hello Professor and Class, 

In Eukaryotic cells are found in plants, animals, fungi, and protists. In the Eukaryotic cells the nucleus is what is found in them. The nucleus is a compact sphere that is the most prominent organelle in eukaryotic cells (Cowan 2020 pg. 115).  The nucleus is what is called a “control center” and it is what protects the DNA. 

The DNA in eukaryotes is stored within the nucleus, while DNA is stored in the cytoplasm of prokaryotes. Additionally, DNA in eukaryotic cells is stored in double-stranded chromosomes that are condensed by histones (Tarantino).  This would contain the cell’s genetic information and controls the cell’s growth and reproduction.

Cowan, M. K., & Smith, H. (2020). Microbiology: A Systems Approach (6th ed.). McGraw-Hill Higher Education (US). https://ambassadored.vitalsource.com/books/9781260451290Links to an external site.

Tarantino, C. (n.d.). Eukaryotic Cell:What Is It, Difference from Prokaryotic Cells, and More. Osmosis From Elsevier. https://www.osmosis.org/answers/eukaryotic-cellLinks to an external site.  

Reply

DIscussion asignment

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Discuss the safety and effectiveness of alternative and complementary medicine for the treatment of specific

illnesses such as cancer, diabetes, and hypertension.  Share your opinions about holistic and allopathic care.

Would have any conflicts or concerns supporting a patient who chooses holistic or allopathic medicine?

500 words

n4t

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ARTHRITIS

This paper should integrate HP2030 and CDC information into your paper.

Link to HP2030Links to an external site.

1. Identify your target population (for instance, age or other demographic, aggregate population); this must be in your city or state.

2. Discuss population-based health education interventions for your target population that is aimed at reducing morbidity and mortality for the problem. Be sure to review the research literature and HP2030 for interventions.

3. Identify how and what data for interventions is being tracked.

4. In a four (4) page paper, address the following. Refer to rubric for expanded details related to grading expectations.

·

· Identify the problem in the introduction section.

· Provide an overview of the problem in your state/national.

· Review of descriptive epidemiological and demographic data on mortality/morbidity and risk.

· HP2030: Present the goal, overview and objectives of Healthy People 2030 for the paper topic.

· Population level prevention and health promotion review. Describe population and/or primary health care focused interventions. Use of scholarly literature and HP2030 is required. There should be direct correlation to evidence for all strategies.

Networking

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 Post a brief introduction of yourself to your colleagues. Include an explanation as to how Walden’s vision, mission, goals, and social change initiatives relate to your professional and academic goals and to your becoming a scholar-practitioner. Also include an explanation for how the Walden MSN Program Outcomes and perspectives relate to your professional and academic goals and to your becoming a scholar-practitioner. Finally, explain why networking is important and how it may help you achieve your professional and academic goals