Case StudyA 74-year-old African American woman, Ms. Richardson, was brought to the hospital emergency room by the police.  She is unkempt, dirty, and foul-smelling.  She does not look at the interviewer and is apparently confused and unresponsive to most of his questions.  She knows her name and address, but not the day of the month. She is unable to describe the events that led to her admission.  

The police reported that they were called by neighbors because Ms. Richardson had been wandering around the neighborhood and not taking care of herself.  The medical center mobile crisis unit went to her house twice but could not get in and presumed she was not home. Finally, the police came and broke into the apartment, where they were met by a snarling German shepherd.  They shot the dog with a tranquilizing gun and then found Ms. Richardson hiding in the corner, wearing nothing but a bra. The apartment was filthy, the floor littered with dog feces.  The police found a gun, which they took into custody. The following day, while Ms. Richardson was awaiting transfer to a medical unit for treatment of her out-of-control diabetes, the psychiatric provider attempted to interview her.  Her facial expression was still mostly unresponsive, and she still didn’t know the month and couldn’t say what hospital she was in.  She reported that the neighbors had called the police because she was “sick,” and indeed she had felt sick and weak, with pains in her shoulder; in addition, she had not eaten for 3 days.  She remembered that the police had shot her dog with a tranquilizer and said the dog was now in “the shop” and would be returned to her when she got home.  She refused to give the name of a neighbor who was a friend, saying, “he’s got enough troubles of his own.” She denied ever being in a psychiatric hospital or hearing voices but acknowledged that she had at one point seen a psychiatrist “near downtown” because she couldn’t sleep.  He had prescribed medication that was too strong, so she didn’t take it.  She didn’t remember the name, so the interviewer asked if it was Thorazine.  She said no, it was “allal.”  ‘Haldol?”, ask the interviewer. She nodded.  

The interviewer was convinced that was the drug, but other observers thought she might have said yes to anything that sounded remotely like it, such as “Elavil.” When asked about the gun, she denied, with some annoyance, that it was real and said it was a toy gun that had been brought to the house by her brother, who had died 8 years ago.  She was still feeling weak and sick, complained of pain in her shoulder, and apparently had trouble swallowing.  She did manage to smile as the team left her bedside.Questions:Remember to answer these questions from your textbooks and clinical guidelines to create your evidence-based treatment plan. At all times, explain your answers. 

Summarize the clinical case including the significant subjective and objective data.

Generate a primary and two differential diagnoses.  Use the DSM5 to support the assessment.  Include the DSM5 and ICD 10 codes.

Discuss a pharmacological treatment would you prescribe? Use the clinical guidelines to support the rationale for this treatment.

Discuss non-pharmacological treatment would you prescribe?  Use the clinical guidelines to support the rationale for this treatment.

Describe a health promotion intervention that would be appropriate for this patient.

Discussion  

What really motivates people?

We have studied compensation this week.  Is it the dollars that motivate you to work in healthcare?

How do you, as a future leader, understand and utilize motivation to engage your staff to do their best work?

1. Watch the video.
2. As a future or current healthcare leader, what are your two or three key takeaways from this video?
3. Why might this information be important to you given our current situation related to the pandemic and the plight of our healthcare workers?

 for example   I think working in healthcare is a person motivation rather than monetary gains. You need to have the heart to take care of and understand patients. One also must possess strong willpower because working in healthcare can be draining, mainly because of the long hours and random requests to take extra shifts. When you eventually get used to the work, monetary gains will then follow, and at the time, I don’t think it will be much of a priority.            As a future leader, I understand that motivation is key to getting better performance from the employees. I know that when a person receives rewarded or is motivated, especially by their superiors or managers, they tend to feel inclined to show that they appreciate what you have done for them. In this case, I will motivate my employees, especially the nonperforming ones, to ensure they level up and perform as well as the performing employees. But also, not forget the well-performing employees to make sure they keep up with their commendable work.            As a future healthcare leader, I have learned that motivators don’t work and often do harm most of the time. For example, people promised high rewards tend not to utilize their full potential. Instead, they struggle to do the required task at hand to get the promised reward. This might be a bad thing in the healthcare sector, considering that this is a severe sector, and rewards should not be the motivator of a healthcare worker.Another key takeaway is that rewards usually narrow people’s focus and might hurt their performance. Therefore, working to be rewarded is negative because the employee might not work correctly due to clouded thoughts. For instance, if an employee motivated by rewards is not cited as they wanted, they might perform even worse without caring because they feel as if they are not appreciated enough as they would like.The information is beneficial because I have seen that if rewards were the leading force for the healthcare workers to continue working, then the pandemic would have been hard to tackle. This is because no amount of reward would be enough for the healthcare workers, the long hours they had to endure, and the risks they had to take because of the seriousness of the pandemic. Therefore, if rewards were the main factor, most of them would have decided to quit when the pandemic was at its worst.  An example of how I might utilize one of the takeaways is by not always relying on rewards because they mostly cloud judgment. I should only focus on the task at hand and ensure that I do it to my utmost best, even if there are no rewards.ReferencesPink, D. (2009, August 24). The puzzle of motivation [Video]. TED Talks. https://www.ted.com/talks/dan_pink_the_puzzle_of_motivation?language=en#

Dan Pink: The puzzle of motivation | TED Talk

The Mid-CGE Learning Agreement is due, with progress updates and signatures, by Saturday at 11:59 p.m. (MT) of Week 8.

Students are given the opportunity to request an extension on assignments for emergent situations. Supporting documentation must be submitted to the assigned faculty. If the student’s request is not approved, the assignment is graded and a late penalty is applied as follows:

• One (1) day late = 10% of total possible point reduction
• Two (2) days late = 20% of total possible point reduction
• Three (3) days late = 30% of total possible point reduction

If the student’s request is approved, the student will be informed of the revised due date.

Learning Agreement Guidelines

Directions

For Week 1, complete the Learning Agreement with self-identified goals to meet Course Outcomes and initial plans to meet those self-identified goals; review the TIPS document to help you and discuss your goals and plans with your mentor. Your mentor must sign the Learning Agreement for your Week 1 submission.

The agreement should be revised each week to reflect completed goals, additional goals, and changes to the plan dictated by the actual experience or revisions suggested by faculty or the mentor. At the end of the practicum experience, evaluate success with your mentor and obtain the mentor’s signature at the bottom of agreement. Save this form as a Word document and enter required information directly onto it; submit the completed Learning Agreement, signed by your mentor, on the Saturday of Week 8. See the Learning Agreement Grading Rubric for grading details.

The Learning Agreement consists of three sections.

1. Student Learning Outcomes table (Week 1)
2. Signatures approving plan (Week 1)
3. Signatures and mentor verification (Week 8)

Course Outcomes

This assignment enables the student to meet the following Course Outcomes (COs):

CO 1: Apply evidence-based leadership skills and concepts in the planning of an executive-level practice change project. (PO 4, 5)

CO 3: Exemplify professional values and scholarship that support the role of a student in a practicum setting during the planning phases of a practice change project. (PO 4)

Due Dates

1. Initial signed Learning Agreement submitted by 11:59 p.m. MT on Sunday at the end of Week 1
2. Completed signed Learning Agreement submitted by 11:59 p.m. MT on Saturday of Week 8

A minimum of 72 hours practicum experience is required by the end of NR 631.

I. Student Learning Outcomes

Psychosis and schizophrenia greatly impact the brain’s normal processes, which interfere with the ability to think clearly. When symptoms of these disorders are uncontrolled, patients may struggle to function in daily life. However, patients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with psychosis and schizophrenia.

TO PREPARE FOR THIS ASSIGNMENT:

Review this week’s Learning Resources, including the Medication Resources indicated for this week.

Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with schizophrenia-related psychoses.

• THE ASSIGNMENT: 5 PAGES
• Examine Case Study: Pakistani Woman With Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’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)

Musculoskeletal Function: 

G.J. is a 71-year-old overweight woman who presents to the Family Practice Clinic for the first time complaining of a long history of bilateral knee discomfort that becomes worse when it rains and usually feels better when the weather is warm and dry. “My arthritis hasn’t improved a bit this summer though,” she states. Discomfort in the left knee is greater than in the right knee. She has also suffered from low back pain for many years, but recently it has become worse. She is having difficulty using the stairs in her home. The patient had recently visited a rheumatologist who tried a variety of NSAIDs to help her with pain control. The medications gave her mild relief but also caused significant and intolerable stomach discomfort. Her pain was alleviated with oxycodone. However, when she showed increasing tolerance and began insisting on higher doses of the medication, the physician told her that she may need surgery and that he could not prescribe more oxycodone for her. She is now seeking medical care at the Family Practice Clinic. Her knees started to get significantly more painful after she gained 20 pounds during the past nine months. Her joints are most stiff when she has been sitting or lying for some time and they tend to “loosen up” with activity. The patient has always been worried about osteoporosis because several family members have been diagnosed with the disease. However, nonclinical manifestations of osteoporosis have developed.

Case Study Questions

1. Define osteoarthritis and explain the differences with osteoarthrosis. List and analyze the risk factors that are presented on the case that contribute to the diagnosis of osteoarthritis.
2. Specify the main differences between osteoarthritis and rheumatoid arthritis, make sure to include clinical manifestations, major characteristics, joints usually affected and diagnostic methods.
3. Describe the different treatment alternatives available, including non-pharmacological and pharmacological that you consider are appropriate for this patient and why.
4. How would you handle the patient concern about osteoporosis? Describe your interventions and education you would provide to her regarding osteoporosis.

Neurological Function:
H.M is a 67-year-old female, who recently retired from being a school teacher for the last 40 years. Her husband died 2 years ago due to complications of a CVA. Past medical history: hypertension controlled with Olmesartan 20 mg by mouth once a day. Family history no contributory. Last annual visits with PCP with normal results. She lives by herself but her children live close to her and usually visit her two or three times a week.
Her daughter start noticing that her mother is having problems focusing when talking to her, she is not keeping things at home as she used to, often is repeating and asking the same question several times and yesterday she has issues remembering her way back home from the grocery store.

Case Study Questions

1. Name the most common risks factors for Alzheimer’s disease
2. Name and describe the similarities and the differences between Alzheimer’s disease, Vascular Dementia, Dementia with Lewy bodies, Frontotemporal dementia.
3. Define and describe explicit and implicit memory.
4. Describe the diagnosis criteria developed for the Alzheimer’s disease by the National Institute of Aging and the Alzheimer’s Association
5. What would be the best therapeutic approach on C.J.