I want to start by saying I love the word cadre in this week’s discussion post! If we consider its definition as a group of people specially trained for a particular purpose or profession it works, OR if we assume it to be a group of activists or other revolutionary organization it works!  Both fit in the role of the DNP as we consider their role in health care.

Melnyk et. al (2012), states that EBP gives nurses a voice, supports nurses as individuals and as a collective, and encourages patient advocacy with the intent to assure quality care.  The research, EBP, and QI processes that give nurses this voice is driven by terminal degree Registered nurses such as the DNP.  The DNP can lead not only by example but by shared advocacy. Whether it be a grassroots campaign to speak with local and state representatives to advocate for nursing or patient initiatives, or by being involved in a task force, activity, or key committees in health systems, our collective accomplishments speak much louder than individual ones.

The DNP cohort can lead the charge to translate evidence into practice by applying quality improvement strategies, heading interprofessional teams, mastering health information technologies, and championing patient-centered care through existing EBP principles (Melnyk, et.al, 2012)

The DNP cohort can lead clinical innovation by using the theories we reviewed in Scientific Underpinnings to inform and change EBP assuring quality patient-centered care. The DNP cadre can also advocate for legislative changes, curriculum changes, and lead research teams looking to address a knowledge gap.  It will be important for the DNP army to be mindful of the interworking of the microsystems, mesosystems, and macrosystems in the organization they are trying to innovate.

Successful change is difficult, and many change initiatives ultimately fail.  Patient care is too important to not overcome those barriers to effective change. As a DNP, my first step prior to implementing the change would be to review my organization’s structure and culture to identify challenges I will be facing regarding staff motivation for change.  It will important that I recognize my own hesitations or transferences, and deal with those prior to addressing the team.  I believe educated employees are empowered employees, so assuring they understand the evidence behind the change movement, and how it will impact the team’s daily tasks will be crucial.  Elisabeth Kubler-Ross taught us many years ago that change is not a linear process, but a curved one where the team goes through shock, fear, acceptance, and commitment. Throughout the informed process, I will need to be consistent and transparent as I lead and coach the change to completion. I will need to ensure adequate communication that is clear, concise, and not overwhelming to staff.  Once the change is implemented, it will be important I give and take feedback on the process and debrief the team.  If the team can witness my dedication and passion to EBP and patient-centered care, they will be more trusting with future initiatives I bring forth.

REFERENCE

Melnyk, B. M., Fineout-Overholt, E., Gallagher-Ford, L., & Kaplan, L. (2012). The state of evidence-based practice in US nurses: Critical implications for nurse leaders and educators. Journal of Nursing Administration, 42(9), 410–417. https://doi.org/10.1097/NNA.0b013e3182664e0

I NEED A COMMENT FOR THIS POST WITH AT LEAST TWO-THREE  PARAGRAPH AND TWO SOURCES NO LATER THAN FIVE YEARS

Define and explain in writing in your own words the vocabulary assigned to the Workshop.  It should include definition of the concept, associated organ, associated and/or referred pain and at least two differential diagnoses for each.

Pancreatitis

Appendicitis

Gastritis

Diverticulitis

Cholecystitis

Work must be in APA format including references.  

Review and store a diagram of the abdominal quadrants and organs in each of them. 

Using the client family from your Week 3 Practicum Assignment, address in a progress note (without violating HIPAA regulations) the following:

• Treatment modality used and efficacy of approach
• Progress and/or lack of progress toward the mutually agreed-upon client goals (reference the treatment plan for progress toward goals)
• Modification(s) of the treatment plan that were made based on progress/lack of progress
• Clinical impressions regarding diagnosis and or symptoms
• Relevant psychosocial information or changes from original assessment (e.g., marriage, separation/divorce, new relationships, move to a new house/apartment, change of job)
• Safety issues
• Clinical emergencies/actions taken
• Medications used by the patient, even if the nurse psychotherapist was not the one prescribing them
• Treatment compliance/lack of compliance
• Clinical consultations
• Collaboration with other professionals (e.g., phone consultations with physicians, psychiatrists, marriage/family therapists)
• The therapist’s recommendations, including whether the client agreed to the recommendations
• Referrals made/reasons for making referrals
• Termination/issues that are relevant to the termination process (e.g., client informed of loss of insurance or refusal of insurance company to pay for continued sessions)
• Issues related to consent and/or informed consent for treatment
• Information concerning child abuse and/or elder or dependent adult abuse, including documentation as to where the abuse was reported
• Information reflecting the therapist’s exercise of clinical judgment

Based on this week’s readings, prepare a privileged psychotherapy note that you would use to document your impressions of therapeutic progress/therapy sessions for your client family from the Week 3 Practicum Assignment.

In your progress note, address the following:

• Include items that you would not typically include in a note as part of the clinical record.
• Explain why the items you included in the privileged note would not be included in the client family’s progress note.
• Explain whether your preceptor uses privileged notes. If so, describe the type of information he or she might include. If not, explain why.

Respond to  your  colleagues who argued the opposite side as you by countering their  argument with evidence. Identify at least two consequences to support  your position. 

NOTE( my position is against the issue of diagnosing pediatric bipolar depression disorder)

                                                    Main post

Pediatric Bipolar Depression Disorder

Bipolar  disorder is a mood disorder distinguished by profound fluctuations in  emotions, moods, energy, and activity levels in which the individual  experiences episodes of mania, depression, or hypomania (National Institute of Mental Health,  2020). Moreover, bipolar depression disorder is a subdivision of  bipolar disorder characterized by depression extreme enough to impair  day-to-day activities involving school, work, social, and family  interactions (Mayo Clinic, 2018). Symptoms of bipolar depression  include but are not limited to the presence or history of 1 or more  major depressive episodes, presence or history of 1 or more hypomanic  episodes, absence of manic/mixed episodes, significant impairments in  all aspects of life, feeling sad, hopeless, worthless, irritability,  loss of interest in previously enjoyed activities, weight loss/gain,  increased/decreased appetite, sleep disturbance, fatigue, decreased  concentration, decreased ability to make decisions, and suicidal  ideations (American Psychiatric Association, 2013). 

Additionally,  diagnosing bipolar depression disorder in the pediatric population can  be debated both for and against the diagnosis. However, it is a real  mental health condition effecting the pediatric population. Hence, the  diagnosis should be made if criteria is met. Therefore, the remainder of  this discussion will aim to justify the diagnosing of pediatric bipolar  depression disorder. 

To begin, the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-V) is a clinical guideline that uses a common language and standard criteria to diagnosis mental disorders (American Psychiatric Association,  2013). It does not dictate an age requirement when diagnosing bipolar  disorder. Hence, it is suggested that any age group can be diagnosed  with bipolar disorder if criteria is met. Next, a familial history of  bipolar disorder increases the likelihood of the pediatric client having  the disorder with a five-time greater chance if a 1st degree family member has the disorder (Cleveland Clinic,  2019). Also, a research roundtable identified and concluded that  pediatric children can be diagnosed with bipolar disorder using  psychiatric assessment tools (Lynn, 2001). Too, the  Oregon Adolescent Depression Project identified a peak onset of bipolar  disorder at 14 years old with significant progression throughout  developmental stages including adulthood (Lewinsohn et al., 2002). Therefore, there is sufficient support for the diagnosing of pediatric bipolar depression disorder.

Conclusion

While  controversy exist regarding diagnosing pediatric clients with bipolar  depression disorder, the diagnosis should be made if the client meets  criteria. Accurate diagnosing is vital as bipolar depression disorder is  a lifelong mood disorder that will require treatment for effective  management. With accurate diagnosing and treatment management, the  pediatric client can live a productive life. 

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: Author.

Cleveland Clinic. (2019). Bipolar Disorder in Children. https://my.clevelandclinic.org/health/diseases/14669-bipolar-disorder-in-children 

Lewinsohn, P. M., Seeley, J. R., Buckley, M. E., & Klein, D. N. (2002). Bipolar disorder in adolescence and young adulthood. Child and Adolescent Psychiatric Clinics of North America, 11(3):461-75. DOI: 10.1016/s1056-4993(02)00005-6

Lynn, G. T. (2001). National Institute of Mental Health research roundtable on prepubertal bipolar disorder. Journal of American Academy of Child Adolescent Psychiatry, 40(8):871-8. DOI: 10.1097/00004583-200108000-00007 

Mayo Clinic. (2018). Bipolar disorder. https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955

National Institute of Mental Health. (2020). Bipolar Disorder. https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml 

An understanding of the neurological and musculoskeletal systems is a critically important component of disease and disorder diagnosis and treatment. This importance is magnified by the impact that that these two systems can have on each other. A variety of factors and circumstances affecting the emergence and severity of issues in one system can also have a role in the performance of the other.

Effective analysis often requires an understanding that goes beyond these systems and their mutual impact. For example, patient characteristics such as racial and ethnic variables can play a role.

An understanding of the symptoms of alterations in neurological and musculoskeletal systems is a critical step in diagnosis and treatment. For APRNs this understanding can also help educate patients and guide them through their treatment plans.

In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.

To prepare:

You will be assigned to a specific case study scenario for this Case Study Assignment.

Assignment (2-page case study analysis)

In your Case Study Analysis related to the scenario provided, explain the following:

· Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.

· Any racial/ethnic variables that may impact physiological functioning.

· How these processes interact to affect the patient?

Case Study:

A 58-year-old obese white male presents to ED with a chief complaint of fever, chills, pain, and swelling in the right great toe. He states the symptoms came on very suddenly and he cannot put any weight on his foot. Physical exam reveals exquisite pain on any attempt to assess the right first metatarsophalangeal (MTP) joint. Past medical history positive for hypertension and Type II diabetes mellitus. Current medications include hydrochlorothiazide 50 mg PO q am, and metformin 500 mg po bid. CBC normal except for elevated sedimentation rate (ESR) of 33 mm/hr and C-reactive protein (CRP) 24 mg/L. Metabolic panel normal. Uric acid level 6.7 mg/dl.