NUR 650

NUR650 Discussions

Submission Instructions:

Your initial post should be at least 500 words, formatted and cited in the current APA style

Provide support for your work from at least 2 academic sources less than 5 years old.

Wk1 Tom’s Parents are Fighting

After studying Module 1: Lecture Materials & Resources, discuss the following:

Tom is a 16-year-old who comes to you to evaluate his lack of attention because his grades are progressively getting worse. When you ask about stress in his life, he notes that his parents are always fighting, and this upsets him. He believes that they fight more when they have been drinking, and he believes that his father is the heavier drinker of the two, but he cannot quantify either parent's use.

• What information would be most critical for the group leader to collect in the first visit? • What is the primary goal for group treatment of this patient’s family problem based on

US group therapy best practices? • Which harm reduction strategies would you recommend? • Identify your city. Then refer this patient to three support groups near you that promote

positive health outcomes for this patient. What was your rationale for choosing these three agencies?

W2 Harriet Needs Surgery

After studying Module 2: Lecture Materials & Resources, discuss the following:

Harriet is a 51-year-old married woman with a past history of alcohol and cocaine abuse. She has been attending AA and NA meetings regularly and does not report urges to drink or use drugs during the 4 years you have been her psychiatric mental health nurse practitioner. She needs carpal tunnel surgery and the typical regimen during recovery is oxycodone 15 mg per day.

• What information would be most critical for the group leader to collect in the first visit? • What is the primary goal for the treatment of this patient’s family problem, based on the

US clinical guidelines?

• Discuss one curative factor the group would observe during the initial, middle and termination phases in group therapy?

• Identify your city. Then refer this patient to three agencies near you that would support positive health outcomes for this patient. (These agencies must not have been used in past discussion posts). What was your rationale for choosing these three agencies?

W3 Motivational Interview with Mary

After studying Module 3: Lecture Materials & Resources, discuss the following:

Mary is 27 years old and has had a history of alcohol dependence for several years. Mary has a daughter Kylie, aged 3 years, who displays signs of fetal alcohol syndrome. Social work services have been involved with Mary and Kylie since her birth, culminating in Kylie being looked after by the local authority as a result of Mary arriving to collect Kylie from the local nursery while significantly under the influence of alcohol. Mary has demonstrated ambivalence regarding her ability to control her alcohol use. Mary has referred herself to a local counseling agency as suggested by the social worker and her PCP.

• Discuss how you might use the principles of motivational interviewing with Mary. • Provide a detailed overview of how the interview may progress. Include each step of

motivational interviewing in your discussion. • Describe how a provider would recognize this patient is ready to change. Use principles

of motivational interviewing to support your answer.

W4 Richard is Motivated

After studying Module 4: Lecture Materials & Resources, discuss the following:

Richard is a 62-year-old single man who says that his substance dependence and his bipolar disorder both emerged in his late teens. He says that he started to drink to “feel better” when his episodes of depression made it hard for him to interact with his peers. He also states that alcohol and cocaine are a natural part of his manic episodes. He also notes that coming off the cocaine and binge drinking contribute to low mood, but he has not responded well to referrals to AA and past inpatient stays have led to only temporary abstinence. Yet, Richard is now trying to forge a closer relationship with his adult children, and he says he is especially motivated to get a better handle on both his bipolar disorder and his substance use. He has been more compliant with his mood stabilizing and antidepressant medication, and his psychiatric provider would like his dual diagnoses addressed with psychotherapy.

• What diagnostic information would be most critical to collect in the first visit?

• Which diagnostic measures are recommended by the US clinical guidelines for the treatment of this patient’s family problem?

• Which evidence based harm reduction strategies would you recommend to treat this patient?

• Identify your city. Then refer this patient to three agencies near you that would support positive health outcomes for this patient. (These agencies must not have been used in past discussion posts). What was your rationale for choosing these three agencies?

W5 Pretty Serious Partying

After studying Module 5: Lecture Materials & Resources, discuss the following:

Jackie is a 31-year-old pregnant patient (2nd child, two different fathers) single mother of a 6- year-old who is coming for prenatal care since she suspects she is pregnant. She is no longer with the father of Robby, her firstborn. She indicates "pretty serious partying" with the likely father of the baby. By pretty serious partying she means 10-12 drinks per occasion, one to two times per week, plus intermittent methamphetamine use.

• Which clinical information would be most critical for you to collect in the first visit? • What are the greatest risk factors for substance use disorder for this patient? • Which harm reduction strategies would you recommend? • Identify your city. Then refer this patient to three agencies near you that would support

positive health outcomes for this patient. (These agencies must not have been used in past discussion posts). What was your rationale for choosing these three agencies?

W6 Toneika

After studying Module 6: Lecture Materials & Resources, discuss the following:

Tomeika is a three-year-old girl. She was recently diagnosed with autism spectrum disorder (ASD). Tomeika is able to make many vocalizations and is able to say one recognizable word. Tomeika will say “juice”, which she pronounces as “oos.” Throughout the day, Tomeika cries and falls to the floor to gain access to food, obtain a favorite toy, or when she wants to be picked up. Her parents, Mr. and Mrs. Williams, would like for Tomeika to communicate her desires with words, but do not know how to help her. Tomeika recently began attending an early childhood special education classroom for learners with ASD in the County Public School System for six hours a day, four days a week. On Wednesdays, Tomeika and her peers do not go to school. Instead, on this day, Tomeika’s interventionist, Mrs. Dell, has parent conferences in her students’ homes.

During the conferences, Mrs. Dell discusses educational programming, learner progress, areas of concern, and also provides training to parents.

• Which diagnostic information would be most critical for you to collect in the first visit? • What is the primary goal for the treatment of this patient’s family problem based on

current US clinical practice guidelines? • Which complementary and alternative medication treatments would you recommend? • Identify your city. Then refer this patient to three agencies near you that would support

positive health outcomes for this patient. (These agencies must not have been used in past discussion posts). What was your rationale for choosing these three agencies?

W7 Hip Fracture

After studying Module 7: Lecture Materials & Resources, discuss the following:

The patient is a 71-year-old widowed man who is seen regularly in the clinic for health maintenance and follow-up of his chronic insomnia and anxiety. He has regular prescriptions for triazolam (Halcion) and clonazepam (Klonopin) for these problems. Recently he has been reporting frequent episodes of losing his balance and falling, and eight weeks ago was hospitalized for a hip fracture sustained during one of these falls resulting in hip surgery. On this visit, he also complains of becoming increasingly confused.

• What information would be most critical for you to collect in the first visit? • What is the primary goal for the treatment of this patient? • Identify potential obstacles for change. Which educational approach would the PMHNP

provide to overcome these obstacles? • How would you teach the patient about the Beers list and Halcion? • Discuss a medication in detail that could be safely substituted to treat insomnia in

geriatric patients.

NUR650 Discussions

Submission Instructions:

Your initial post should be at least 500 words, formatted and cited in the current APA style

Provide support for your work from at least 2 academic sources less than 5 years old.

Wk1 Tom’s Parents are Fighting

After studying Module 1: Lecture Materials & Resources, discuss the following:

Tom is a 16-year-old who comes to you to evaluate his lack of attention because his grades are progressively getting worse. When you ask about stress in his life, he notes that his parents are always fighting, and this upsets him. He believes that they fight more when they have been drinking, and he believes that his father is the heavier drinker of the two, but he cannot quantify either parent's use.

• What information would be most critical for the group leader to collect in the first visit? • What is the primary goal for group treatment of this patient’s family problem based on

US group therapy best practices? • Which harm reduction strategies would you recommend? • Identify your city. Then refer this patient to three support groups near you that promote

positive health outcomes for this patient. What was your rationale for choosing these three agencies?

W2 Harriet Needs Surgery

After studying Module 2: Lecture Materials & Resources, discuss the following:

Harriet is a 51-year-old married woman with a past history of alcohol and cocaine abuse. She has been attending AA and NA meetings regularly and does not report urges to drink or use drugs during the 4 years you have been her psychiatric mental health nurse practitioner. She needs carpal tunnel surgery and the typical regimen during recovery is oxycodone 15 mg per day.

• What information would be most critical for the group leader to collect in the first visit? • What is the primary goal for the treatment of this patient’s family problem, based on the

US clinical guidelines?

• Discuss one curative factor the group would observe during the initial, middle and termination phases in group therapy?

• Identify your city. Then refer this patient to three agencies near you that would support positive health outcomes for this patient. (These agencies must not have been used in past discussion posts). What was your rationale for choosing these three agencies?

W3 Motivational Interview with Mary

After studying Module 3: Lecture Materials & Resources, discuss the following:

Mary is 27 years old and has had a history of alcohol dependence for several years. Mary has a daughter Kylie, aged 3 years, who displays signs of fetal alcohol syndrome. Social work services have been involved with Mary and Kylie since her birth, culminating in Kylie being looked after by the local authority as a result of Mary arriving to collect Kylie from the local nursery while significantly under the influence of alcohol. Mary has demonstrated ambivalence regarding her ability to control her alcohol use. Mary has referred herself to a local counseling agency as suggested by the social worker and her PCP.

• Discuss how you might use the principles of motivational interviewing with Mary. • Provide a detailed overview of how the interview may progress. Include each step of

motivational interviewing in your discussion. • Describe how a provider would recognize this patient is ready to change. Use principles

of motivational interviewing to support your answer.

W4 Richard is Motivated

After studying Module 4: Lecture Materials & Resources, discuss the following:

Richard is a 62-year-old single man who says that his substance dependence and his bipolar disorder both emerged in his late teens. He says that he started to drink to “feel better” when his episodes of depression made it hard for him to interact with his peers. He also states that alcohol and cocaine are a natural part of his manic episodes. He also notes that coming off the cocaine and binge drinking contribute to low mood, but he has not responded well to referrals to AA and past inpatient stays have led to only temporary abstinence. Yet, Richard is now trying to forge a closer relationship with his adult children, and he says he is especially motivated to get a better handle on both his bipolar disorder and his substance use. He has been more compliant with his mood stabilizing and antidepressant medication, and his psychiatric provider would like his dual diagnoses addressed with psychotherapy.

• What diagnostic information would be most critical to collect in the first visit?

• Which diagnostic measures are recommended by the US clinical guidelines for the treatment of this patient’s family problem?

• Which evidence based harm reduction strategies would you recommend to treat this patient?

• Identify your city. Then refer this patient to three agencies near you that would support positive health outcomes for this patient. (These agencies must not have been used in past discussion posts). What was your rationale for choosing these three agencies?

W5 Pretty Serious Partying

After studying Module 5: Lecture Materials & Resources, discuss the following:

Jackie is a 31-year-old pregnant patient (2nd child, two different fathers) single mother of a 6- year-old who is coming for prenatal care since she suspects she is pregnant. She is no longer with the father of Robby, her firstborn. She indicates "pretty serious partying" with the likely father of the baby. By pretty serious partying she means 10-12 drinks per occasion, one to two times per week, plus intermittent methamphetamine use.

• Which clinical information would be most critical for you to collect in the first visit? • What are the greatest risk factors for substance use disorder for this patient? • Which harm reduction strategies would you recommend? • Identify your city. Then refer this patient to three agencies near you that would support

positive health outcomes for this patient. (These agencies must not have been used in past discussion posts). What was your rationale for choosing these three agencies?

W6 Toneika

After studying Module 6: Lecture Materials & Resources, discuss the following:

Tomeika is a three-year-old girl. She was recently diagnosed with autism spectrum disorder (ASD). Tomeika is able to make many vocalizations and is able to say one recognizable word. Tomeika will say “juice”, which she pronounces as “oos.” Throughout the day, Tomeika cries and falls to the floor to gain access to food, obtain a favorite toy, or when she wants to be picked up. Her parents, Mr. and Mrs. Williams, would like for Tomeika to communicate her desires with words, but do not know how to help her. Tomeika recently began attending an early childhood special education classroom for learners with ASD in the County Public School System for six hours a day, four days a week. On Wednesdays, Tomeika and her peers do not go to school. Instead, on this day, Tomeika’s interventionist, Mrs. Dell, has parent conferences in her students’ homes.

During the conferences, Mrs. Dell discusses educational programming, learner progress, areas of concern, and also provides training to parents.

• Which diagnostic information would be most critical for you to collect in the first visit? • What is the primary goal for the treatment of this patient’s family problem based on

current US clinical practice guidelines? • Which complementary and alternative medication treatments would you recommend? • Identify your city. Then refer this patient to three agencies near you that would support

positive health outcomes for this patient. (These agencies must not have been used in past discussion posts). What was your rationale for choosing these three agencies?

W7 Hip Fracture

After studying Module 7: Lecture Materials & Resources, discuss the following:

The patient is a 71-year-old widowed man who is seen regularly in the clinic for health maintenance and follow-up of his chronic insomnia and anxiety. He has regular prescriptions for triazolam (Halcion) and clonazepam (Klonopin) for these problems. Recently he has been reporting frequent episodes of losing his balance and falling, and eight weeks ago was hospitalized for a hip fracture sustained during one of these falls resulting in hip surgery. On this visit, he also complains of becoming increasingly confused.

• What information would be most critical for you to collect in the first visit? • What is the primary goal for the treatment of this patient? • Identify potential obstacles for change. Which educational approach would the PMHNP

provide to overcome these obstacles? • How would you teach the patient about the Beers list and Halcion? • Discuss a medication in detail that could be safely substituted to treat insomnia in

geriatric patients.