Client Profile

Betty, a 50-year-old woman, came to this country with her parents when she was 7 years old. The family members worked as migrant farm workers until they had enough money to open a restaurant. Betty married young. She and her husband worked in the family restaurant and eventually bought it from the parents. They raised seven children, all grown and living on their own. Betty and her husband live in a mobile home close to the restaurant. She does not work in the family restaurant anymore because she worries excessively about doing a poor job. Betty no longer goes out if she can help it. She stays at home worrying about how she looks, what people think or say, the weather or road conditions, and many other things. Betty is not sleeping at night and keeps her husband awake when she roams the house. She keeps her clothing and belongings in perfect order while claiming she is doing a poor job of it. She does not prepare large family dinners anymore, though she still cooks the daily meals; one daughter has taken over the family dinners. This daughter has become concerned about Betty being isolated at home and worrying excessively and calls the community mental health center for an appointment for Betty.

Betty presents at the community mental health center accompanied by her husband, her children and their spouses, several grandchildren, and a few cousins. When Betty’s name is called and she is told that the nurse is ready to see her, she frowns and says: “What will I say? I don’t know what to say. I think my slip is showing. My hem isn’t straight.”

Betty says she wants her whole family to go in to see the nurse with her. The nurse notices that Betty is extremely well groomed and dressed in spite of concerns she has been voicing about her appearance. Before the psychiatric nurse inter- views Betty alone, she hears from the daughter that Betty “worries all the time” and although she has always been known to be a worrier, the worrying has become worse over the past six or eight months. The husband shares that his wife is keeping him awake at night with her inability to get to sleep or stay asleep.

The nurse interviews Betty alone. The nurse notices that Betty casts her eyes downward, speaks in a soft voice, does not smile, and seems restless as she taps her foot on the floor, drums her fingers on the table, and seems on the verge of getting out of her chair. Themes in the interview include: being tired, getting tired easily, not being able to concentrate, not getting work done, trouble sleeping, worrying about whether her husband loves her anymore and whether she and her husband have enough money, and not having the energy to attend to the housework or her clothing.

The nurse has the impression that Betty’s anxiety floats from one worry to another. There is no convincing Betty that she looks all right. Any attempt to convince her that she need not worry about something in particular leads to a different worry before coming back to the earlier worry.

The community mental health psychiatrist examines Betty and, after a thorough physical examination and lab studies, finds nothing to explain her fatigue and difficulty sleeping other than anxiety. Betty produces her medicine bottles and says she is currently taking only vitamins, hormone replacement, and calcium. The psychiatrist asks the nurse to contact Betty’s family health care provider to get information on any medical or psychiatric conditions he is treating her for; the report comes back that she has no medical diagnoses and the family health care provider thinks she suffers from anxiety. The psychiatrist prescribes buspirone (BuSpar) for Betty.

Two weeks later, during a home visit to Betty, the nurse learns, with some probing, that Betty is upset with her husband for loaning all their savings to the daughter and her husband to build a new home, while they continue to live in an older mobile home. At the end of the nurse’s home visit, Betty’s daughter arrives and tells the nurse that she wonders if Betty is making any progress. Betty also worries she is not getting better and asks the nurse about taking some herbal medicines containing Kava and Passaflora that her sister got from a curandara (folk healer); her sister wants to take her to see the curandara and have her do a ritual to cure the evil eye that was placed on Betty and made her sick.

Questions

1. What behaviors does this client have that match the criteria for a diagnosis of Generalized Anxiety Disorder?

2. How common is the diagnosis of Generalized Anxiety Disorder? Is it common for clients with GAD to have comorbidity, and should this client be assessed for any particular condition?

3. What explanation do you have for the number of family members coming to the community mental health center with this client? If you were the nurse, how would you deal with Betty’s request for her whole family to accompany her to see you?

4. Before the nurse, or any other staff at the community mental health center, can talk with Betty’s family health care provider, what do they need to do?

5. What does the nurse need to know about buspirone? What teaching needs to be done with the client in regard to buspirone? What medications other than buspirone are being used in the treatment of GAD, and how effective are they?

6. What are some of the interventions, in addition to antianxiety drugs, that are being used with clients who have GAD?

7. At one point the daughter says that she thinks Betty is not showing progress. What progress, if any, do you think has been made? What can you tell the daughter?

8. What do you think about Betty’s sister using herbal remedies and rituals for driving out evil spirits in trying to cure Betty? Do herbal remedies work?

9. What nursing diagnoses would you write for Betty related to her Generalized Anxiety Disorder?

Jane Doe has a promising career at University Hospital. In six months of working, she has been promoted to Associate Director and tasked with overseeing consumer quality and satisfaction, which will be used to support the hospital’s new vision and mission. This is Jane’s first big assignment, which is to develop a campaign aimed toward adult learners across several departments. However, her project is at risk due to a 32-year veteran on her team, named John Doster, who is reluctant to participate.

Jane must find a way to leverage power and influence in order to encourage and motivate John to increase his performance and participation to ensure success of the project.

Discuss the following:

• What are the sources of power for Jane? And for John?
• What influence tactics can Jane utilize in order to get John on board?
• Which power bases should Jane draw on to help her influence John?
• How does Jane use influence to get John to be more concerned about the organizational success than his own needs or desires?

1A. Describe the phases of pharmacokinetics: Absorption, Distribution, Metabolism, Excretion. (ATI and Pharm book).

Perform a data base search on urinary tract infection. There are various levels of evidence. Select the article that have the best level of evidence. Describe why this article was selected and how it meets the criteria to be considered the best level of evidence. Describe if this is a peer review article . Why is it significant to find peer review versus non peer reviewed articles for research. . There are several ways to obtain funding for the research project .Describe one method you would use to obtain funding for this research project if you were to implement it.

1. A nurse says that her conscience clearly dictates that she should not assist at aparticular operation. One of the doctors present says that he went to a Catholic medical school and he would assure her that the operation is not immoral.Should the nurse follow her conscience or the advice of the doctor?

2. “Most moralists/ ethicists do not understand medical terminology and medical problems,” is the remark of health-care provider. “As long as I am not certain that anything I do is morally wrong, then I go ahead and do it.” Is the health- care professional acting correctly?

3. Statement: “All men do not agree on the so-called principles of natural law. This proves that they are not universal principles.” What is your reaction about this statement?

Research one of the alternative therapies, identify the therapy, provide history, list and describe at least 3 advantages, and list and disadvantages/concerns.

• Discuss the advantages of teamwork and shared risk management responsibility in achieving risk management objectives.

How would a risk manager build a cohesive team that promotes a culture of patient safety through effective risk management in the health organization?

1. Explain what an endocrine disorder is and what affects it may have on the body. Are they the same as autoimmune disorders?

2. Compare and Contrast Cushing’s disease and Addison’s disease (make sure to include: the gland and hormone involved/causes, characteristics/symptoms, treatment)

3. Differentiate between hypothyroidism, hyperthyroidism, cretinism, and myxedema. (do not just write their definitions.)

4. Back in the day, surgeons would perform a thyroidectomy on patients with thyroid disorders. When they removed the full thyroid gland, their patients would develop neuromuscular disorders and die. Turns out there were these very small and important glands on the posterior aspect of the thyroid called parathyroid glands. Explain what happened when the surgeons unknowingly removed these.

1. Tests and measures useful for indications which ambulatory assistive device is appropriate include:

Select one:

a. balance assessment

b. six minute walk test

c. lower extremity goniometry

d. quality of life survey

Post an explanation of how competing needs, such as the needs of the workforce, resources, and patients, may impact the development of policy. Then, describe any specific competing needs that may impact the national healthcare issue/stressor you selected. What are the impacts, and how might policy address these competing needs? Be specific and provide examples.

1. An outbreak of salmonellosis occurred after an epidemiology department luncheon, which was attended by 485 faculty and staff. Assume everyone ate the same food items. Sixty-five people had fever and diarrhea; five of these people were severely affected. Subsequent laboratory tests on everyone who attended the luncheon revealed an additional 72 cases. Foods served at the luncheon included home-canned olives, chicken salad, homemade flavored drink mix, freshly baked rolls, and raw vegetables. Based on your understanding of foods that potentially are capable of transmitting salmonella, the most likely source of the outbreak was:

   	A.	freshly baked rolls.
   	B.	raw vegetables.
   	C.	home-canned olives.
   	D.	undercooked chicken.
   	E.	drink mix.

The Late Preterm Infant

Marie is a 32-year-old G3 P2002 who arrived at the hospital in active labor at 35 weeks. She is 7 cm dilated and quickly progresses to delivery of a 5-pound male infant with Apgar scores of 9 and 9.

1. What additional risk factors does this infant have compared with an infant born at 39 weeks?

2. What nursing interventions are indicated in the delivery room with the late preterm infant?

3. What should the mother be taught regarding infant feeding?

4. Marie states she would like to go home the next day. She states that her other children need her and it seems like the baby is doing fine. She states the baby has breastfed a couple of times, but he is just tired. What education is appropriate at this time?

5. Marie is now being discharged home with her infant at 2 days postpartum. The infant has been feeding well and has experienced no complications. What is priority teaching for this family?

Recent studies support the potential of a drug that is derived from the metal iridium to effectively treat cancer. This experimental drug, Drug ZL105, has not been tested for efficacy and toxicity. Imagine that you are the one responsible for approving or denying the use of this drug within the United States. Your job is to propose the testing that is needed for this drug to be determined as safe and effective for the treatment of cancer in humans. In your research and discussion, you should address the questions below.

1. What model(s) will you use for testing (i.e., animal, cell cultures, computer simulations)? Explain the choice of model, and provide support for the reliability of the model. Discuss the pros and cons of your choice.
2. In determining the safety and effectiveness of the drug, would it be necessary to test efficacy, toxicity, and lethality? Explain what each of these tests are for and whether or not one or more of the tests are necessary for your determination.
3. Provide your thoughts on what information you hope to gather from your tests and whether or not the same protocol should be used for various categories of products such as drugs, cosmetics, and herbal medicines.

Your case study assignment should be three to four pages in length, not including the title or reference page, and utilize at least three reliable references. Use APA style guidelines in writing this assignment, following APA rules for formatting, quoting, paraphrasing, citing, and referencing.