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.

POWER POINT

The purpose of this assignment is to conduct an internal audit of organizational strengths and weaknesses and an external analysis of opportunities and threats as part of the strategic planning process.

Review the “Learning Exercise” located at the end of Chapter 2 in the textbook. Using a health care organization that no one in the group is researching as the focus for the assignment, you will collaborate to complete a multi-part analysis of the organization’s strategic assets. The findings will be presented in a 20-25 slide PowerPoint presentation. Keep the size of graphic files condensed and minimize special effects to ensure the file size does not exceed the 10 MB maximum for file submission to the LMS. Speaker notes should be included for each slide to provide talking points and relevant supporting details for the presentation of slide content.

Part 1: Internal Audit of a Health Care Organization

Research the organization and prepare a topical outline that addresses the following elements:

• Organization Description: Identify the mission, vision, location, size, scope of services, etc.
• Financial Performance and Condition: Describe historical financial performance and current financial condition. Include specific data that illustrates profits and losses, etc.
• Major Resources and Competencies: Identify tangible and intangible assets that are unique to the organization or give it competitive advantage and explain how each can be a strength or weakness for the organization.
• Internal Value Chain: Create a diagram similar to the examples provided in the textbook. Explain how each identified activity adds value to the customer and the organization.

Part 2: External Analysis of a Health Care Organization

Conduct an external environmental analysis using general, publicly available resources. When researching, identify 2-3 specific examples for each category. Add to the topic outline by addressing the following elements:

• Political/Government: Explain election results and current political mood along with the effects of government spending, policies on health care research, government regulation and enforcement of health care industry laws, and the government’s role in addressing critical societal challenges and how this affects the organization.
• Legal: Discuss systems (laws or statutes, regulations, administrative rulings, and court decisions) and explain how events and decisions in these areas can affect regulation, risk, reimbursement, new projects, taxes, and competitive advantage for the organization.
• Professional/Industry: Describe the effect of positions and initiatives of professional and industry trade associations on the organization.
• Economic: Identify the current economic status at the regional, national, and global level and describe the effect on the organization.
• Demographics: Includes gender, age, income levels, ethnicity, race, education, family size, and composition, geographic place of residence, employment status, birth rates, and life expectancies.
• Sociocultural: Describe characteristics of important people in an organization’s external environment (i.e. traditions, lifestyles, values, attitudes, beliefs, opinions, tastes, political views, and behavioral patterns, etc.). Consider people such as immediate and prospective customers, customer influencers, end users, suppliers, shareholders, government regulators, medical, general public, and other stakeholders. Include discussion about how external sociocultural factors affect services provided by the organization.
• Technology: Explain how the organization is using new technology.

Part 3: Market Segments

• Compile a list of segments that could be defined within the organization’s overall market.
• Determine the most likely bases for differentiated product or service offerings.

Part 4: Five Force Analysis

Conduct a five force analysis of the organization.

Refer to the resource, “Creating Effective PowerPoint Presentations,” located in the Student Success Center, for additional guidance on completing this assignment in the appropriate style.

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.

Submission Instructions:

• You must complete both case studies.
• Your initial post should be at least 500 words per case study, formatted and cited in current APA style with support from at least 2 academic sources.

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.