Case Study of Harris

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APA formatCase study of HarrisHarris: Spinal Cord Injury at T3, CompleteHarris is a 20-year-old African American male with a diagnosis of complete spinal cord injury at T3 and resultant paraplegia. Harris also has a diagnosis of a fractured right tibia and fibula and right proximal radial and ulna fractures. Harris was admitted to the rehabilitation hospital from the acute-care hospital where he stayed for 2k weeks after his accident.Harris was in an automobile accident that resulted in his injuries. He was a passenger in the car and was struck from the right side by another car. Harris was pinned in the car for a short period of time and reports having no feeling in his legs immediately after the two cars collided. His friend, who was driving the car, was not seriously injured.Harris lives with his fiancée, Marsha, on the 15th floor of a new apartment complex in the city, It is a small one-bedroom apartment, They intend to be married next spring. Harris is also planning on completing his baccalaureate degrec in computer science and has one semester left to finish,   Harris works full-time for his brother’s plumbing business as a bookkeeper. During the little free time he has, he likes to travel with Marsha and golf with his friends. Harris had no funcional deficits before the accident.Harris’ family is extremely supportive and visits daily. His brother Jeff calls frequent|y and his mother makes all his favorite meals, which she brings in for the nurses as well as Harris. Harris’ father is not well and cannot visit as often due to respiratory distress, but teleshones his son regularly. Marsha, who is a dental hygienist, has taken time off work to be with Harris every day at the hospital.Harris is admitted to the rehabilitation hospital with the goal of returning home. He is eager to get started and tells the admission nurse “he more therapy, the better.” Harris will be evaluated by PT, OT, nursing, social work, and the physiatrist.Occupational Therapy EvaluationUpon evaluation, Harris is talkative and motivated. He is in a wheelchair with lateral supports. His right LE is in a full-arm cast and his right LE is in a cast from the toes distal to the knee. Harris says he is right-handed. When asked how he has been feeling since the accident, his reply is “fine.” When the question is rephrased as to his emotional state, his response is the same.Harris has no cognitive, perceptual, visual, or hearing deficits. He has no sensation in either LE and reports no sensation in his buttocks as well., His LE sensation is intact, as is the sensation in his superior trunk region. His sensation is impaired in his inferior trunk region. Harris’ low back area cannot be assessed during the evaluation due to his position in the chair.Harris has no AROM in the LEs. His motion is intact in the left UE and cervical area. His right LE cannot be fully assessed due to the cast. Motion in his right digits is normal given the limitations of the cast. His left UE has normal strength, right UE is not fully assessed, but Harris can lift the cast up over his head.Harris has no complaints of pain except for stiffness in his neck. He has some light edema in the right digits at the MCP to DIP joints but no cyanosis. He has multiple bruises and abrasions over his body that nursing is monitoring.Harris’ sitting balance is poor to fair, and he is unable to sit up independently without minimal assistance. He does attempt to correct himself when leaning but lacks the strength to maintain upright posture without external assistance. He is independent in sitting with the lateral supports in the wheelchair.Harris uses a sliding board with moderate assistance to transfer from surface to surface. He is non-ambulatory and is non-weight-bearing on the right leg. Harris requires ocasional assistance to propel himself in a wheelchair because of his inability to use his right arm. He performs bathing tasks ably and can wash his face, hands, chest, and peri-area independently. He requires total assistance for back, buttocks, and legs. He requires maximum assistance for dressing himself.  Harris reports feeding himself without help although “it’s messy sometimes.” Harris has a catheter for urination and had been incontinent of bowel since the accident. His admission Functional Independence Measure (FIM) scores were in the 3 to 4 range for UE tables and 1l range for LE tables.Assignment Objectives:· The student will identify and demonstrate (as applicable) role and participation in the Occupational Therapy process (referral, screening, evaluation, treatment planning, intervention, reevaluation and discharge planning)· The student will determine and select the model of practice/frame of reference that would best guide the treatment of the identified impairments.· The student will demonstrate proficiency in applying OT treatment techniques and practices to a case study that will be assigned to them.· The student will create a problem list, list of strengths, long-term goals, and short-term goals.· The student will demonstrate treatment session which will be described in an intervention note.· After the treatment session, the student will identify opportunities to recommend to the occupational therapist the need for referring client for reevaluation, discharge planning and additional evaluation for other services and/or professional(s).Procedure:· The student will be assigned a case study with an array of physical dysfunctions.· Student will complete an analysis based on a structure and guideline that requires information in regards to: Problems, strengths of the client, long-term and short-term goals for treatment.· Student will develop two treatment sessions applying techniques, strategies and practices· Student will demonstrate by role play, one treatment session.· Student will write an intervention/treatment note accordingly.

 
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therapeutic communication

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Using Boundaries as an aspect of therapeutic communication. Answer the following questions in totality.Topic:BoundariesDiscuss the problems/barriers that can arise for the topic you have chosen.Identify how these problems/barriers can interfere with therapeutic communication.Discuss how this aspect of therapeutic communication might change to enhance alliance building with individuals who are another culture (choose one).

 
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pcm powerpoints

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15 slides including title and reference page with speaker notesPLAG freeIntext citation

 
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Discussion: reply with two references

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reply to this discussion with two referencesProfessional Nursing and State-Level RegulationsBoards of nursing are equipped to regulate nursing in each state in the United States. It is however important to note that the regulations vary from one state to another. Over the years, there have been reforms in different states with the view of lifting restrictions to practice. It should be noted that expanded state NP practice regulations have come to be associated with greater NP supply and improved access to care among rural and underserved populations without decreasing care quality (Yang et al., 2021). Indeed, there is enough evidence supporting the lifting of restrictive practice. Thus, it is important that APRNs should be aware and understand existing regulations for the specific states where they practice in order to not only practice within their scope but to also identify opportunities for advocating for independent practice. This discussion will compare regulations as they apply to APRNs in the state of Maryland and Georgia.Maryland Versus GeorgiaIn the state of Maryland, it is important to note that the board of nursing licenses qualified APRNs to full scope of practice. The regulations therefore allow a licensed and certified APRN to practice without supervision from a physician by carrying out duties such as evaluating the patient, diagnosing and treating the patient (American Association of Nurse Practitioners, 2021). On the other hand, the board of nursing of Georgia State allows restricted scope of practice for APRNs who are licensed and certified to practice within the state. This means that the licensure laws and regulations provided by the board of nursing restrict the APRN’s ability to be involved in at least one nursing practice’s element. The law requires supervision, delegation or management of team by another healthcare provider for the nurse practitioner to provide care for the patient (American Association of Nurse Practitioners, 2021). In both states, the APRN is required to register with the prescription drug monitoring program (PDMP) in order to prescribe opiates. However, in the state of Georgia, the regulations allow the APRN to only practice under a physician’s prescriptive authority (Georgia Department of Public Health, 2018). This regulation also applies for prescription of controlled substances. In the State of Maryland, the APRN has to get a DEA number and after that, they can independently prescribe schedule II to V of controlled substances. In the State of Georgia, the APRN can only be involved in prescribing schedule III to V control substance under the prescriptive authority of a physician (American Medical Association, 2017).APRNs with Full Practice AuthorityThese regulations apply to advanced practice registered nurses with legal authority to practice within the full scope of their experience and education. For example, the prescriptive authority of APRNs in Maryland allows them to prescribe medications, including schedule II to V controlled substances independently or without supervision of physicians. This is however not the case for the APRNs in Georgia. In cases where there is need for supervision, the required agreements should be signed and NPs in Georgia will have to practice only within the scope that is allowed by the law. Notably, full scope of practice for NPs has come to be associated with improved access to care (Kandrack et al., 2021). It is unfortunate that nurses that are able to provide safe and quality care just like physicians do are restricted from doing so by state laws. Access to quality care has always been negatively impacted when NPs that are willing to deliver cost-effective, safe and quality care become restricted and this calls for an update in health policies in such states (Peterson, 2017).Adherence to the RegulationsThe APRNs have the responsibility and role to make sure that they are conversant with the regulations as per the specific state they work in. In order to adhere to the set regulations, it is very important for the APRN to be familiar with the state’s regulating board and ensure that the Nurse Practice Act for that particular state is read and understood. Notably, the APRN should be aware of the process and regulations put in place concerning licensing and authorizing them to practice. In conclusion, it is very important for every nurse practitioner to be well equipped and knowledgeable about the regulations of the state’s board of nursing and the scope of practice of that particular state and what it means. It is clear that each state is unique and different.ReferencesAmerican Association of Nurse Practitioners. (2021). State practice environment.https://www.aanp.org/advocacy/state/state-practice-environmentAmerican Medical Association. (2017). State law chart: Nurse practitioner prescriptive authority. AMA.https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/specialty%20group/arc/ama-chart-np-prescriptive-authority.pdfGeorgia Department of Public Health. (2018). Prescription Drug Monitoring Program. DPH.https://dph.georgia.gov/pdmpKandrack, R., Barnes, H., & Martsolf, G. R. (2021). Nurse practitioner scope of practice regulations and nurse practitioner supply. Medical Care Research and Review, 78(3), 208-217.Peterson, M. E. (2017). Barriers to practice and the impact on health care: A nurse practitioner focus. Journal of the Advanced Practitioner in Oncology, 8(1), 74.Yang, B. K., Johantgen, M. E., Trinkoff, A. M., Idzik, S. R., Wince, J., & Tomlinson, C. (2021). State nurse practitioner practice regulations and US health care delivery outcomes: A systematic review. Medical Care Research and Review, 78(3), 183-196.

 
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Clinical case scenario

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A 39-year-old homeless man presents to the emergency department for cough and fever. He says that his illness has been worsening over the past 2 weeks. He originally had dyspnea on exertion and now is short of breath at rest. On questioning, he tells you that he lives in a homeless shelter when he can, but he frequently sleeps on the streets. He has used IV drugs (primarily heroin) “on and off” for many years. He denies medical history but the only time he gets medical attention is when he comes to the emergency department for an illness or injury. On review of systems, he complains of fatigue, weight loss, and diarrhea. On examination, he is a thin, disheveled man appearing much older than his stated age. His temperature is 100.5°F (38.0°C), his blood pressure is 100/50 mm Hg, his pulse is 105 beats/min, and his respiratory rate is 24 breaths/min. His initial oxygen saturation is 89% on room air, which comes up to 94% on 4 L of oxygen by nasal cannula. Significant findings on examination include dry mucous membranes, a tachycardic but regular cardiac rhythm, a benign abdomen, and generally waste dappearing extremities. His pulmonary examination is significant for tachypnea and fine crackles bilaterally, but no visible signs of cyanosis. His chest x-ray is read by the radiologist as having diffuse, bilateral, interstitial infiltrates that look like “ground glass.”Answer the following questionsWhat is the most likely cause of this patient’s current pulmonarycomplaints?➤ What underlying illness does this patient most likely have?➤ What testing and treatment should be started now?

 
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Topic4 Q1

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Describe the spectrum of death and dying rituals and practices across cultures. Why are death and dying rituals so significant?

 
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gun violence

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Make a Plan for Priority Diagnosis  which Includes a minimum of 1 short-term1 long-term goal for identified priority.Goals relate to the identified priority diagnosis.Goals should have SMART specific, measurable, attainable,realistic, and timed.Explains how the plan allows for client involvement.Explains how the plan advances the knowledge of members of the community.cite in APA Format

 
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Week 9: Assignment: Controversy Associated with Dissociative Disorders

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Please review the complete assignment instructions.

 
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Nursing Theory scenario/Responding to classmate

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Then, comment on one (1) classmate’s posting . Be sure to say something substantial.Did you learn something new?Do you agree? Why or why not?How would you modify this information?200 wordsBelow scenario and classmate answer to commentScenario #2 Question:You are assessing a 33-old female of Hispanic descent admitted on the Medical-Surgical Unit. She has been diagnosed as having hypertension, obesity, and depression.  She is divorced and has four children ages 15, 12,  8 and 4, and she is currently unemployed and receiving governmental assistance. She does not speak English very well and has no health insurance. She describes her religion as Catholic.What family and nursing theory or theories would be best utilized to properly assess this patient. Why?(be sure to include at least one nursing theory and one family theory. Keep in mind that theories should complement each other.)What approaches would you use to provide culturally sensitive care to this patient?Classmate answerA. To assess this 33-year-old Hispanic woman, I would employ Bowen’s family systems theory and Leininger’s transcultural theory. The Bowen family systems theory represents the best approach. Her obesity, hypertension, and depression can significantly impact how other family members feel, think, and conduct themselves. Bowen’s family systems theory considers the family as an emotional unit, and the numerous interconnections within the family are described by systems thinking (Couto et al., 2018). By their very nature, families are deeply emotionally linked, and one member’s sorrow can severely impact these connections and relationships. The patient and their family members may be influenced by their treatment, so the entire family system should be considered.Different cultures have distinct ways of understanding, providing healthcare, knowing, and anticipating receiving care (Marilyn et al., 2019). To foster compliance, well-being, and healing, patient care should provide culturally tailored therapy and manage the patient and family as a system. The transcultural theory holds that empathy, compassion, and culture are strongly linked.B. One should start by obtaining an experienced interpreter. Because the patient is Hispanic, a competent translator will be of the highest help to ensure that the client knows and understands the care offered. I could approach this patient courteously, attentively, and curiously, and I would query about the patient’s social identity, culture, and intentions for their care.As the assessment advances, I would ask them about their history of mental illnesses while making careful and accurate notes of their disease symptoms and maintaining an eye out for mood changes. I would start with open-ended inquiries before moving on to more focused investigations. In learning from the patient and assisting the patient in receiving better care, I must approach the client neutrally and clarify why I want to know detailed information, such as any ideas of self-harm.

 
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Case study 5 pages apa seven references less than five years

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Case study about picot questionsimilarity less than 15 %

 
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