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NR 601 Week 2 Case Study Discussions Physical Examination (Part-1) NEW

Discussion Part One (graded)

B.J., a 70-year-old Caucasian female has been seen in the clinic several times over the last 3 years. However, she missed her last annual appointment-last appointment was 18 months ago and today you are the nurse practitioner seeing her. She arrived to the clinic alone and states she is “here for my check-up”.  

Background:

The patient reports that “my feet just burn and tingle all the time and it is so much worse at night that I can hardly sleep at all”. She also indicates that “I need some new pillows; I use 3 of them now to just get comfortable at night to sleep. Those pillows help me catch my breath so I can sleep better”.  She also reports dyspnea just walking to the bathroom, but it only happens when her legs are “swole up” and also states, “the coughing also keeps me up at night”.  To be honest, “I’m just tired in general whether my feet are “swole” or not”. She also indicates that she cannot see well, especially at night. She also reported that at her last visit to the clinic, she was told that she had a “heart beat problem” and that she is supposed to be taking aspirin every day. She said she thinks all of her “heart pains” went away after she started taking the aspirin and “putting that pill under the tongue”.  One of her concerns she has today is that since her husband died last year, she tells you, “I just don’t like doing things that I liked to do before my husband died. We used to like to do all sorts of stuff, but anymore….I just feel blue all the time”.

PMH:

Chronic back pain

Hypertension

Previous history of MI in 2010

Diabetes?

Hypothyroidism?

Constipation?

Congestive Heart Failure?

Current medications: 

            Coreg 6.25 mg PO BID

            Colace 100 mg PO BID

            Glucotrol XL 10 mg PO daily

            Lantus insulin 20 units at HS

            K-dur 20 mEq PO QD

            Furosemide 40 mg PO QD

            L-Thyroxine 112 mcg PO QD

Aspirin?

Nitroglycerine?

Surgeries:

2010-Left Anterior Descending (LAD) cardiac stent placement Allergies: Amoxicillin

Vaccination History:

She receives an annual flu shot. Last flu shot was this year Has never had a Pneumovax

Has not had a Td in over 20 years

Has not had the herpes zoster vaccine

Other:

Has not seen a dentist in over 15 years, the time she got her dentures

Last colorectal screening was 11 years ago

Last mammogram was 5 years ago

Has never had a DEXA/Bone Density Test

Last dilated eye exam was 4 years ago

Labs from last year’s visit: Hgb 12.2, Hct 37%, Hgb A1C 8.2%, K+ 4.2, Na+140,Cholesterol 186, Triglycerides 188, HDL 37, LDL 98, TSH 3.7, ALT/AST WNL.

Social history:

She graduated from high school, and thought about college, but got married right away and then had kids a short time later. Her two sons and their wives live with her, take her to church and to the local senior center; they do all the cleaning, run errands, and do grocery shopping. Family history:

Both parents are deceased. Father died of a heart attack; mother died of natural causes.  She had one brother who died of a heart attack 20 years ago at the age of 52.

Habits:

Patient is a current tobacco user and has smoked 1 pack of cigarettes daily for the last 50 years and reports having no desire to quit. She uses occasional chew.  She drinks one 4 ounce glass of red wine daily.

  Discussion Part One:

 Provide differential diagnoses (DD) with rationale.

Further ROS questions needed to develop DD.

Based on the patient data provided, choose geriatric assessment tools that would be appropriate to use in conducting a thorough geriatric assessment. Provide a rationale on why you are choosing these particular tools.

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PSY 490 Week 4 DQ 2

Which subdiscipline or subdisciplines within psychology do you believe will become increasingly important in the future? Why? What role do you think pop psychology plays in our future in psychology?

PSY 490 Week 4 Individual Pay it Forward

 Perform an anonymous act of kindness. Examples include helping someone carry groceries, paying for a stranger’s coffee, donating time or money to a cause you believe in, and so forth.

Write a 600-800 word summary of your experience.

Address the following:

 ·      Compare the respective roles of altruism, personal and professional social responsibility, and codependency.

·      How does altruism apply to psychology or psychological principles?

·      How does altruism improve the human condition? Are there limits to altruism?

·      What are some personal and professional responsibilities related to altruism?

·      What is the future of psychology, specifically in relation to altruism, in contemporary society?

PSY 490 Week 4 Summary

Write and present a summary of how this week’s readings and activities have affected your thought process regarding any aspect of this week’s Capstone course. (300 – 500 Words)

PSY 490 Week 5 DQ 1

Consider this scenario below with the following criteria in mind: 1.  How would you diagnose the child (use documentation such as the DSM). 2.  What treatment plan would you recommend?  Why ?  Support your answer. 3. Be prepared to respond to you classmates and I in discussion as I present more clues!! Scenario: First set of Clues Six year old male child.  Child is acting out in class with the following behaviors:  hitting other children when teacher is not looking; licking desk for no apparent reason; taking teacher's cell phone and trying to call home; standing in desk seat when teacher turns back; rushing through assignments; happy to lay with head on desk.

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PSY 330 Week 2 DQ 1 Neurobiology

Select one of the following options for this discussion.  Indicate in your post which option you are responding to. Option A:  Review this week’s reading, which introduced the role of neurotransmitters in human behavior and personality.  Use the Ashford University Online Library to locate one peer-reviewed research study which was published in the last five years and that implicates a neurotransmitter as the cause of an abnormal behavior (psychological disorder).  Clearly indicate in your discussion:

a.   The abnormal behavior being studied. b.   The neurotransmitter that is implicated. c.   The role of the neurotransmitter in the expression of the abnormal behavior.  

Your initial post should be a minimum of 250 words and utilize at least one peer-reviewed source that was published within the last five years, cited according to APA guidelines as outlined in the Ashford Writing Center. Guided Response: Review several of your classmates’ posts.  Respond substantively to two peers who chose a different neurotransmitter or abnormal behavior than you did.  Address the role of the neurotransmitter in the expression of the abnormal behavior that they each selected.  Are there other possible explanations for the cause of this abnormal behavior?  Which explanation do you think makes the most sense?  Why?    Option B: Review this week’s reading, which introduced the impact of early trauma on function and personality development.  Use the Ashford University Online Library to locate a peer-reviewed research study which was published within the last five years and that examines the impact of brain trauma on the function and development of personality.  Clearly indicate in your discussion:

a.   The trauma that occurred. b.   The duration between the time of the trauma and the research study. c.   The impact of the trauma on overall function. d.   The impact of the trauma on personality and behavior.

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