Nursing  as attached

2 parts each 4 long pargraphs

 
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Nursing  Psychology

Compose a 400 words or less discussion to respond the following:Discuss senescence and how does it affect adults as they age.Read your partners posts and reply to at least two of them:  What do you think is correct or incorrect about your partner’s choices.

 
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Nursing  assignment week 3

Details:In this assignment, you will select a program, quality improvement initiative, or other project from your place of employment. Assume you are presenting this program to the board for approval of funding. Write an executive summary (850-1,000 words) to present to the board, from which they will make their decision to fund your program or project. The summary should include:The      purpose of the program or project.The      target population or audience.The      benefits of the program or projectThe      cost or budget justification.The      basis upon which the program or project will be evaluated.Share your written proposal with your manager, supervisor or other colleague in a formal leadership position within a health care organization. Request their feedback using the following questions as prompts:Do      you believe the proposal would be approved if formally proposed?What      are some strengths and weaknesses of the proposal?Submit the written proposal along with the “Executive Summary Feedback Form.”Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

 
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Nursing  Compliance and Reimbursement

Define compliance and reimbursement and discuss their financial relevance in healthcare organizations. What accounting methods are applicable and why?Health insurance and reimbursement methodologies are some of the basic foundations of understanding health care finance. Health care administrators must have a basic understanding of these areas to successfully run their respective departments and/or organizations. Interestingly enough, most consumers have no concept of how their benefits are designed, implemented, and paid for. Understanding health insurance from a financial perspective is one aspect to review. Aligning the insurance with networks, co-pays, co-insurance, and deductibles from a structural perspective and connecting the dots with providers and payors complicates matters even further. Hopefully, this section will clarify these complexities.Three to five pages, APA formatted ,describing the critical areas of reimbursement and how they function? Journal and/or peer reviewed articles required. Industry terminology must be used. Current research, within the last five years preferred.

 
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Nursing  ADHD

I NEED A RESPONSE TO THIS ASSIGNMENT1 PAGE3REFERENCESZERO PLAGIARISMCase 2: Volume 1, Case #14: The scatter-brained mother whose daughter has ADHD, like mother, like daughterThis is a 26-year-old female patient with a recent diagnosis of ADHD and GAD after finding out that her 8-year-old daughter had ADHD. The patient reported symptoms of missing appointments and late for appointments, disorganized behavior, feeling overwhelmed from taking care of her two children and life in general, and unable to maintain a regular schedule. The patient reported that she always had poor academic performances, intimidated by exams, always worried about the future, and says sometimes mentally “freezes when it gets to be too much.” She reports exhibiting the same symptoms as her 8-year-old daughter who also had ADHD during her childhood. The patient had a history of dropping out of high school after getting pregnant. She was married at age 17 and divorced at age 19 which led to two children ages 8 and 6. She worries a lot about the children’s future and education. The children’s father is not involved with their care children. The patient is adopted, therefore her biological parents’ past medical and mental histories are not known. The patient smokes cigarettes but denies alcohol and drug use. She has a full-time job in a retail store3 QuestionsThe mental healthcare nurse practitioner needs to ask this patient what exactly makes her worry about the future of her children. Obtaining this information would alert the mental health nurse if she has any intension of harming herself or others. The patient is worried about her children’s future. She has ADHD and GAD. Maintaining safety should always be the #1 priority of the mental health professional. Untreated ADHD can also lead to, or contribute to depressive disorder. It is estimated that 20% of patients diagnosed with ADHD also have major depressive disorder and depression (Kulacaoglu, & Kose, n.d.). The mental health nurse should ask this patient if she was abused growing up. This patient was adopted and was not brought up by her biological parents. Obtaining this information would alert the mental healthcare nurse to know the kind of upbringing that she had. Information on how long she has been experiencing these symptoms should be obtained; Untreated or under-treated adult ADHD may result in impaired occupational functioning and interpersonal and legal difficulties. ADHD in adults is associated with higher separation and divorce rates and more frequent job change (Gentile, Atiq, & Gillig, 2006).People in the Patient’s LifeObtaining information from the patient’s immediate family members like her adopted parents or any close relative, people she had lived with growing up, co-workers who work with her, her teachers who taught her in schools, her ex-husband including her 2 children, and close friends if any. Questions such as what kind of person she is? What kind of student was she like at school? What kind of employee is she? and how was her behavior like growing up? What kind of mother and wife is she? I believe that her immediate family members can uncover some of her personality, past physical and mental histories, and social behaviors that would assist the healthcare practitioner to properly diagnosed and provide the treatment needed. The patient’s coworkers, I believe would provide this patient’s social history, how she interacts with them at work; is she outgoing, lonely, depressed, lovely, reserved, etc. Furthermore, obtaining the patient’s medical record from her primary care physician would be beneficial to know the patient’s medical condition and mental condition when she was younger. This would alert the healthcare practitioner if manifested any symptoms of ADHD before the age of 12 years.Physical Exams and Diagnostic TestsIt would be beneficial for the healthcare nurse practitioner to in-addition to obtaining this patient physical assessment, mental assessment including past and present, to also obtain her accurate medication history to properly diagnose and treat her and to get a baseline of her present condition. Several disorders such as seizure disorder, encephalopathy, developmental disorder, and Lyme disease can mimic the symptoms of ADHD. Laboratory testing; thyroid levels. Studies have shown that low thyroid and high thyroid levels can cause a decrease in memory, attention, and concentration. Low cerebral blood flow in the brain region that arbitrate attention and decision-making effectively, and reduced hippocampal capacity, consequently the cognitive profile in these patients can look like and can be confused with those of ADHD patients (Gentile, Atiq, & Gillig, 2006). Urine drug screen; several illicit and anticholinergic drugs can mimic symptoms seen in ADHD. Blood sugar to rule out hypoglycemia. Genetic testing can be useful here to rule out DRD4 7 since there is a possibility that this patient might not know her family medical history and according to our reading, ADHD has a significant genetic influence especially if both parents have this disorder the child has a 75% chance of being affected by it. Studies also suggest that genetics plays a major role in ADHD approximately half of parents who have been diagnosed with ADHD themselves will have a child with this disorder. The clinician-rated Conner’s Adult ADHD Rating Scale, the ADHD Rating Scales or psychological tests to rule out brain injury will be helpful for proper diagnosis and sleep disorders can produce chronic tiredness that affects attention, concentration, and cognitive functioning. Studies have shown that sleep deprivation is associated with attention difficulties due to changes in the brain that would also be beneficial to make an accurate diagnosis of ADHD (Gentile, Atiq, & Gillig, 2006).3 Differential DiagnosesBorderline personality disorder (BPD)is a serious mental illness that usually begins in the 20s. More women have it than men. There’s no known cause, but it’s believed to be a combination of the brain mechanism and the experience in life. Some of the characteristics include emotion dysregulation, impulsivity, and unsta­ble relationship. These symptoms often result in impulsive actions and problems in relationships with other people. The individual may experience episodes of anger, depression, and anxiety that may last from a few hours to days. Studies believed that People who have a close family member with the disorder may be at a higher risk of developing borderline personality disorder or borderline personality disorder traits Studies also show that people with this disorder can have structural and functional changes in the brain especially in the areas that control impulses and emotional regulation. Furthermore, many people with borderline personality disorder report experiencing traumatic life events, such as abuse, abandonment, or adversity during childhood. Others may have been exposed to unstable, invalidating relationships, and hostile conflicts. Because borderline personality disorder often occurs with other mental illnesses, it makes difficult to diagnose and treat especially if symptoms of other illnesses overlap with the symptoms of borderline personality disorder. The comorbidity of ADHD has been reported in 20% of BPD patients in several studies since impulsivity is a central feature of BPD and ADHD, impulsivity has been examined as part of adult ADHD symptomatology in BPD patients. According to Philipsen et al., ADHD should be considered as a potential risk factor in patients with BPD with impulsivity. A recent study on the association between impulsivity and ADHD in BPD patients, it was reported that higher comorbidity of ADHD in the BPD group, and motor impulsiveness has been shown as a potential predictor of ADHD symptoms in BPD group. In terms of the relationship between BPD, ADHD, and impulsivity, BPD-ADHD has been considered a severe, more impulsive, and homogeneous subtype of BPD (Kulacaoglu, & Kose, n.d.). This patient exhibited most if not all the symptoms here, making the #1 differential diagnosis on my list.Chronic stress disorder, also known as complex post-traumatic stress disorder (C-OTSD) is a serious psychological condition that often stems from being a witness to a, particularly traumatic incident. As a result of that traumatic incident, chronic stress disorder sufferers lose control, power, and then begin to feel trapped. Although chronic stress disorder is very like posttraumatic stress disorder (PTSD), it is not one the same. PTSD, according to many researchers, does not encompass all the symptoms that a case of chronic stress disorder typically carries within itself. Even though numerous mainstream journals and authors have written about chronic stress disorder, it is not recognized formally in more prominent diagnostics systems. This disorder can manifest itself from the following symptoms difficulties regulating emotions, forgetting traumatic events, reliving traumatic events, or having episodes of dissociation, anxiety or worry, feeling of inability to deal with problems, difficulty performing completing daily activities, and the feeling of inability to plan ahead of time. It has been estimated that between 5-20% of the population that has been assisted by psychological problems suffer an adaptation disorder. Stress can facilitate the onset of psychoactive substance use (Matheson, & Weightman, 2019). This patient is a single mother of 2 children, was adopted, always worried about the future of her 2 children. All these symptoms placed her on the #2 list of my differential diagnoses.Bipolar Disorder (BD)is a persistent kind of change in mood between thoughts of deep mania and severe depression. This disorder can cause one not to have unhappiness and interrupt the individual’s ability to function normally. It has been reported to be frequently comorbid with ADHD approximating 6% and 15% of female and male sufferers respectively, and rates higher than 20% have even been reported in some studies. Several studies have shown that BD is found in approximately 20% of individuals suffering from ADHD and could even reach as much as 50% of ADHD cases if bipolar symptoms are considered. Symptoms, such as mood lability, distractibility or increased activity, some doubt has been cast on the usefulness of self-report questionnaires for the detection of ADHD in BD subjects (Perroud, Cordera, Zimmermann, Michalopoulos, Bancila, Prada, Dayer, & Aubry, 2014). Bipolar disorder may occur due to genetics, stress or trauma, chemical imbalances in the brain, or even hormonal imbalances. Heredity is the main cause. About 60 to 80% of cases are hereditary related. To obtain an accurate diagnosis, a mental health nurse practitioner must consider the client’s family history of mental illness as well as a family history of suicide (Otto, 2011). The fact that this patient manifested some of these symptoms makes the #3 list on the differential diagnosis.Two Pharmacologic AgentsRitalin(Methylphenidate) (MPH) alleviates symptoms of ADHD and, as such, is currently considered as a first-choice medication. It works by blocking dopamine and norepinephrine transporters leading to an increase in extracellular dopamine. It should be noted that its subjective effects are highly dependent on the pharmacokinetic and especially on the rate of input, which highlights the importance of choosing a sustained release formulation (Castells, Antoni Ramos-Quiroga, Rigau, Bosch, Nogueira, Vidal, & Casas, 2011). Two separate studies done on 474 individuals suffering from ADHD showed that improvement in core clinical ADHD symptoms of hyperactivity, impulsivity, and inattentiveness, and overall other psychiatric symptoms like anxiety and depression were alleviated with methylphenidate when compared to those of the placebo group. Also, trial data suggest that adverse effects of immediate-release methylphenidate for adults with ADHD are not of serious clinical significance (Epstein, Patsopoulos, & Weiser, 2014). The usual dose for an adult patient with ADHD is 20 to 30 mg PO daily and 10 to 30 mg transdermally per 9 hours and it be can be titrated upward to a maximum of 40 to 60 mg PO daily. For this 26-year-old patient with a new diagnosis of ADHD, I would start her treatment with 10 mg PO twice a day that is (10 mg in am and 10 mg PO at lunchtime) and then titrate it weekly as tolerated (Stahl, 2008).Adderall(Amphetamine) is a dopamine norepinephrine reuptake inhibitor and releaser (DN-RIRe). A stimulant approved by the FDA for the treatment of ADHD, Narcolepsy, and obesity. The XR version of it used in the treatment of the adult with ADHD. The Adderall XR capsule contains two types of drug-containing beads designed to give a double-pulsed delivery of amphetamines, which prolongs the release of amphetamine from Adderall XR compared to the immediate-release tablet formulation. The most common side effects in patients using these medications are loss of appetite, insomnia, nausea, dizziness, heart palpitations, headache, changes in blood pressure or pulse, and rash. Amphetamines have a high potential for abuse. Abuse of Adderall/Adderall XR may lead to tolerance and dependence. If the drug is withdrawn suddenly after prolonged high-dosage administration, extreme fatigue or depression may occur. The usual dosage treatment for adult initial 10 mg per day in the morning; can increase by 5–10 mg per day at weekly intervals to maximum dose generally 30 mg per day (Stahl, 2008). A multicenter double-blind trial of 248 adult patients with ADHD demonstrated significant control of ADHD symptoms as early as week 1 after the initiation of treatment and maintained this significant improvement throughout the four-week study. At the end of the trial, the average ADHD-RS Total Scores for patients taking Adderall XR were 49% lower compared with the average scores at the beginning of the trial before receiving the medication. Another data demonstrated significant symptom improvement was maintained over 18 months (FDA, 2004). For this patient who is new to this medication, I would start her therapy with 5 mg PO BID (5 mg in am and 5 mg in the evening) and then gradually increase the dose every week as tolerated.The RationaleBoth Ritalin and Adderall share similarities in their treatment, action, side effects, and cost prize but according to Edmunds & Mayhew 2014, Adderall is an intermediate-acting amphetamine/dextroamphetamine compound with Adderall XR being long-acting Ritalin is short-acting methylphenidate with Ritalin SR being intermediate-acting and Ritalin LA being long-acting (Moore, 2014). Meaning Ritalin works sooner and reaches peak performance more quickly than Adderall does. However, Adderall stays active in the body longer than Ritalin does. Adderall works for four to six hours. Ritalin is only active for two to three hours. This is a hard selection to make on these two drugs, but I would choose Adderall for this patient at this time over Ritalin because, this patient is very occupied with so many things; a full-time job, single mother of 2, with 1 of them diagnosed with ADHD, and her issue with ADHD, I believe that prescribing her with medication such as Adderall that stays active in the body for a long period would help her in managing the activities and be able to engage in social life.Lessons LearnedAdderall is a stimulant so do Ritalin. They are the most widely prescribed drug for ADHD and is classified as a Schedule II substance by the United States Drug Enforcement Administration because of its potential for psychological and physical dependency and abuse. They both work Like how cocaine works and some other illicit drugs. Prescribing them to someone who has not been determined to need this drug due to a true neurobiological disorder can be considered the Nonmedical use of prescription drugs (NMUPD). Their most common side effects are anorexia, weight loss, nausea, abdominal pain, diarrhea or constipation, and xerostomia. Side effects are typically worse during initial days of treatment. They are considered as “Black Box” warnings for high abuse potential, drug dependence, and increased risk of serious cardiovascular adverse events and sudden death. The medical indications for both Adderall and Ritalin, in-addition, to ADD and ADHD, include narcolepsy and short-term weight loss. Management of these conditions with pharmacological treatment should be under the supervision of a healthcare provider (Moore, 2014).ReferencesCastells, X., Antoni Ramos-Quiroga, J., Rigau, D., Bosch, R., Nogueira, M., Vidal, X., & Casas, M. (2011). Efficacy of Methylphenidate for Adults with Attention-Deficit Hyperactivity Disorder A Meta-Regression Analysis. CNS DRUGS, 25(2),157–169.Epstein, T., Patsopoulos, N. A., & Weiser, M. (2014). Immediate-release methylphenidate for attention deficit hyperactivity disorder (ADHD) in adults. The Cochrane Database of Systematic Reviews, 9, CD005041. https://doi org.ezp.waldenulibrary.org/10.1002/14651858.CD005041.pub2FDA approves ADDERALL XR to treat ADHD in adults. (2004). Medical Letter on the CDC & FDA.Gentile, J. P., Atiq, R., & Gillig, P. M. (2006). Adult ADHD: Diagnosis, Differential Diagnosis, and Medication Management. Psychiatry (Edgmont (Pa. : Township)), 3(8), 25–30.Kulacaoglu, F., & Kose, S. (n.d.). Borderline Personality Disorder (BPD): In the Midst of Vulnerability, Chaos, and Awe. BRAIN SCIENCES, 8(11). https://doi-org.ezp.waldenulibrary.org/10.3390/brainsci8110201Matheson, C., & Weightman, E. (2019). Research and recovery: Can patient participation in research promote recovery for people with complex post-traumatic stress disorder, CPTSD? Health Expectations : An International Journal ofPublic Participation in Health Care and Health Policy. https://doi-org.ezp.waldenulibrary.org/10.1111/hex.13014Moore, S. C. (2014). Adderall and Ritalin: potential influence on perinatal health. International Journal of Childbirth Education, 4, 72.Otto, M. W. (2011). Living with bipolar disorder. [electronic resource]: a guide for individuals and families (Updated ed.). Oxford University Press.Perroud, N., Cordera, P., Zimmermann, J., Michalopoulos, G., Bancila, V., Prada, P., Dayer, A., & Aubry, J.-M. (2014). Comorbidity between attention deficit hyperactivity disorder (ADHD) and bipolar disorder in a specialized mood disorders outpatient clinic. Journal of Affective Disorders, 168, 161–166.https://doi-org.ezp.waldenulibrary.org/10.1016/j.jad.2014.06.053

 
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Nursing  2 coments each one 150 words (CITATION AND REFERENCE)

reply1In clinical research and in implementation of EBP projects, results that are statistically significant are many a times often interpreted, and wrongly so, as being clinically significant or important. Clinical significance, unlike statistical significance which indicates the reliability of the study results, reflects the impact of such results into clinical practice (Leung, 2017). The results may be reliable but impactful in terms of practice. This means that most times, clinical data is often analysed with traditional statistical probability with the result that the study results may be difficult to interpret clinically. The results do not give clinicians enough information to make clinical decisions. Clinical significance of data ensures that it provides information on the magnitude or direction of the results. Inclusion of more clinically relevant information such as confidence intervals and effect sizes is essential (Page, 2014). This way, clinical significance is important as it helps support the intended project outcomes by making them ore clinically relevant. Evidence based practice is meant to affect clinical decision making. However, if interpreting the research results is either difficult or impeded by the presentation of such results, this intention can hardly be achieved (Page, 2014). Clinical interpretation of research on treatment outcomes in important because of its influence in decision making. It imparts or confers confidence that the results are a true and reliable presentation of findings.Source: Leung, W. (2017). Balancing statistical and clinical significance in evaluating treatment effects. BMJ Quality and Safety, 77(905), 73-81. doi:10.1136/pmj.77.905.201Page, P. (2014). Beyond statistical significance: Clinical intepretation of rehabilitation research literature. International Journal of Sports Physical Therapy, 9(5), 726-736. Retrieved March 31, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4197528/#__ffn_sectitlereply2One of the barriers that I foresee preventing my EBP change proposal from continuing would be staff participation. I would need ER nurses to assess the patient and implement the checklist on admission. The ER nurses are very busy and often have 10 patients at the same time. Initiating a new project during a pandemic, and adding more work to the nurses already heavy workload is probably not the best way to ensure that the project is continued. Another barrier would be the patient’s health acuity at that time may not permit for the nurse to talk to the patient at length about their health literacy, support system and financial status. To overcome these barriers, I would ask that the checklist be completed at some point during the admission process, perhaps when the patient is in their room and stable. Having management and administrative support from the beginning will be a key factor in the success of the project. They will be able to inform me on similar projects that were implemented and techniques that were used to ensure continuation. Frequent audits of charts by nurse leaders would also ensure that the checklist has been started and education is being documented. If the checklist becomes part of the patient’s permanent record, there would be proof of task completion. Having this information in the patient’s medical records will help with clinical auditing results and changes can be made to the checklist as needed to improve quality of care.Esposito, P., & Dal Canton, A. (2014). Clinical audit, a valuable tool to improve quality of care: General methodology and applications in nephrology. World journal of nephrology, 3(4), 249–255. https://doi.org/10.5527/wjn.v3.i4.249Ginex, P. (2018) Overcome Barriers to Applying Evidence Based Process for Practice Change. Retrieved from https://voice.ons.org/news-and-views/overcome-barriers-to-applying-an-evidence-based-process-for-practice-change

 
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Nursing  HEAD TO TOE ASSESSMEN

HEAD TO TOE ASSESSMEN

 
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Nursing  united

Describe the organizational characteristics of a facility in which you currently work. Include the following: the type of organization, its organizational culture, its structure, and its formal and informal goals and processes.Define three different kinds of power, and describe how power affects the relationships between people of different disciplines (e.g., between staff in nursing, medicine, physical therapy, housekeeping, administration, finance, social work) in a health-care organization.at least 400 words in length and utilize at least one scholarly source other than the textbook.

 
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Nursing  Critical history

The Mayans were an amazing civilization that we credit with many discoveries and inventions we use today.  For this assignment, research something amazing the Mayans did and tell me about it.  I’m looking for information BESIDES what you’ve already read in the slides!

 
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Nursing  5 pages Pre-malignant lesions and 5 pages Pre-malignant conditions

write 5 pages for Pre-malignant lesionsA) LeukoplakiaB)palatal reverse smokersC)Erythroplakiawrite 5 pages for pre-malignant conditionsA) Oral submucous fibrosisB) Lichen planusC) Lupus erythematousExplain the following in detail based on its etiology , clinical features, classifications , histopathological features.

 
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