Some debate in the literature exists specific to whether or not bipolar disorder can be diagnosed in childhood. While some have anecdotally argued that it is not possible for children to develop bipolar disorder (as normal features of childhood confound the diagnosis), other sources argue that pediatric bipolar disorder is a fact.

In this Discussion, you engage in a debate as to whether pediatric bipolar disorder is possible to diagnose.

 Assignment

 You will engage in a debate as to whether pediatric bipolar disorder is possible to diagnose. 

    *  YOU WILL ARGUE FOR THE DIAGNOSIS

• Based on the position you were assigned, justify that pediatric bipolar depression disorder should be diagnosed.

Support your position with evidence and examples.

At least 3 creditable references

The Omnibus Budget Reconciliation Act (OBRA), also known as the Nursing Home Reform Act of 1987, has dramatically improved the quality of care in the nursing home over the last twenty years by setting forth federal standards of how care should be provided to residents. 

This Act is interpreted with the U.S. Code of Federal Regulations (42 CFR Part 483). Such improvements include less use of antipsychotic drugs, a reduction in chemical and physical restraint use, and a reduction in inappropriate use of indwelling urinary catheters.

Mandates

The quality of care mandates contained within OBRA, and the regulations, require that a nursing home must provide services and activities to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident in accordance with a written plan of care. 

In order to participate in Medicare and Medicaid programs, nursing homes must be in compliance with the federal requirements for nursing homes.

The mandates of OBRA are regarded in the nursing home setting to represent minimum accepted standards of care. The failure of a nursing home to comply with the OBRA quality of care mandates in caring for a resident represents a failure to exercise the degree of reasonable care and skill that should be expected.

Penalties

The Indiana State Department of Health is responsible for ensuring that nursing homes follow these mandates through the state survey process. The Department of Health and Human Services (DHHS) and the states may apply penalties against nursing homes for failure to meet the minimum standard of care as defined in the OBRA regulations. 

Such penalties may include fines, appointment of administrative consultants to run the nursing home while deficiencies are remedied, and even closure of a nursing home.

• Residents must be assessed to identify their medical problems and their abilities to perform basic self-care activities. The DHHS established a uniform data set, referred to as the minimum data set (MDS), to document this assessment.
• The nursing home is responsible for the safety of each resident. This includes being responsible for orders written by the resident’s primary physician or other medical provider. If the physician writes an order that does not comply with the federal regulations, the nursing home is responsible for making sure the physician changes such order. The mere presence of a physician’s inappropriately written order does not absolve the nursing home of responsibility in providing safe care.
• Provide services that will enhance each resident’s quality of life to its fullest (42 CFR §483.15).
• Maintain the dignity and respect of each resident (42 CFR §483.15).
• Develop a comprehensive care plan for each resident (42 CFR §483.20).
• Conduct a comprehensive and accurate assessment of each resident’s overall health upon admission and at each required interval (42 CFR §483.20).
• Prevent a decline in activity of daily living (ADL) activities, including the ability to eat, toilet, bathe and walk. Staff must provide for ADL care when necessary (42 CFR §483.25).
• Prevent the development of pressure sores, and if a resident has pressure sores, provide the necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing (42 CFR §483.25).
• Provide appropriate care to those who have urinary incontinence and restore bladder function if possible. This also includes only using urinary catheters when appropriate as outlined in the regulations to prevent adverse consequences related to such use (42 CFR §483.25).
• Prevent accidents, including falls, accidental poisonings and other incidents that could cause injuries (42 CFR §483.25).
• Maintain adequate nutrition to prevent unnecessary weight loss (42 CFR §483.25).
• Provide each resident with sufficient fluid intake to prevent dehydration (42 CFR §483.25).
• Ensure that residents are free from significant medication errors (42 CFR §483.25).
• Have sufficient nursing staff (42 CFR §483.30).
• Ensure that each resident’s rights to choose activities, schedules, and health care are maintained (42 CFR §483.40).
• Provide pharmaceutical (medication) services to appropriately meet the physical and psychological needs of each resident (42 CFR §483.60).
• Maintain accurate, complete, and easily accessible clinical records for each resident (42 CFR §483.75).

Mrs. J is repeatedly asking for a nurse; other patients are complaining, and you simply cannot be available to Mrs. J for long periods.  Considering the setting and the OBRA guidelines, what would you do to manage the situation?

1. Analyze the challenges anatomical and physiological changes in the aging individual have on providing safe and effective care
2. Conclude the health outcomes of the health promotion, disease prevention, and early detection and treatment of diseases
3. Organize an interdisciplinary plan of care for the aging client
4. Advocate for the protection of the aging population in the conduct of research

Please answer the following questions for a community nursing class

-describe the critical attributes that define a community

-define community health and goals of community health practice

-describe primary, secondary, and tertiary levels of prevention

-what is the role of the professional nurse in the community setting

Please answer those questions using proper apa 7th edition format

please utilize at least 3 references

Psoriasis is a chronic autoimmune disease that triggers the rapid build-up of skin cells. Deep in the skin, the skin cells expand and eventually rise to the surface and therefore fall off. The build-up of the cells gradually creates the whitish-silver colored scaling on the surface of the skin that grows in red patches, dense and often they may crack and bleed. Typically, on joints such as knees and elbows and other parts of the body, the scales grow. The disease transforms skin cells from individuals into overachievers that grow faster than normal skin cells, creating itchy patches.

Psoriasis is activated by risk factors and causes, according to studies. The genes and immune system of a person cause psoriasis because the tiny bits of DNA genes instruct the cells that help control the body. Therefore, since they are mixed up, a person with psoriasis interferes with the genes, so instead of the genes that protect the body from invaders as they are meant to do, they appear to stimulate the inflammation, thereby turning the skin cells on the overdrive. Another consideration is smoking, as lighting doubles the chance of developing psoriasis, making it impossible to get rid of the symptoms. Psoriasis is caused by hormonal changes during puberty, pregnancy and menopause. In addition, the chronic disease may be triggered by some medications such as lithium, certain antimalarial drugs (Koran, 2020).

The common signs and symptoms of psoriasis differ depending on the type of psoriasis one suffers from. They include: red, inflamed skin rashes or patches that are covered with loose silver-colored scales that expand and blend into each other, thus covering wide areas, scaly plaques on the scalp itching, burning or soreness, swollen and rigid joints, rough, broken skin that itches or bleeds, discoloration and pitting of the finger nails and toe nails as the nails begin to crumble or crumble.

 According to Weldment al, fibrocystic breast disease is a fluid-filled condition with circular or oval cysts and fibrous tissue grows on the breasts, rendering them tender and lumpy in women. In certain women, the breasts become sore and usually encountered on the upper, outer region of the breast, thereby caused by the estrogen hormone. Fibro adenomas are solid, non-cancerous lumps of the breast that occur in women. With a well-developed shape, the breasts become solid, smooth, rubbery or rough. They are usually painless, so when examined, a person feels like a marble in the breasts that passes effortlessly under the skin. As they differ in size, they can expand or shrink on their own. As they enter and destroy the underlying tissue, which is most common in women, malignant tumors are cancerous and violent. If a tumor is found to be malignant, then the person suffers from breast cancer or another type of cancer. It is advisable, however, for a biopsy to be performed on a suspicious lump to determine whether it is a tumor or malignant (Waldman et. al 2019).

References

Koran, N. J. (2020). Management of psoriasis as a systemic disease: what is the evidence? British Journal of Dermatology, 182(4), 840-848.

Waldman, R. A., Finch, J., Grant-Keels, J. M., Stevenson, C., & Whitaker-Worth, D. (2019). Skin diseases of the breast and nipple: benign and malignant tumors. Journal of the American Academy of Dermatology, 80(6), 1467-1481.

Edited by Beltran, Lioydis on Jan 19 at 12:17pm

REPLY 2

Psoriasis is “a hereditary chronic inflammatory skin disease with environmental triggers.  Plaque psoriasis is a raised, scaly, erythematous patch with silvery scales, often pruritic and painful.  Occurs on scalp, extensor surfaces of knees and elbows, lower back.  Accompanied by nail pitting, onycholysis.” (Jarvis, 236, 2020).  There are different types of psoriasis, but the most common type is plaque psoriasis.  Things that put people as risk for developing psoriasis are family history, some types of infections, certain medicines, smoking, and obesity (NIH, 2020).  Signs and symptoms include patches of thick, red skin with silvery-white scales that itch or burn, dry cracked skin that itches or bleeds, and thick ridged, pitting nails.  The symptoms could come and go.  According to the National Institute of Health (NIH) because psoriasis is an inflammatory disease it can increase one’s risk of developing psoriatic arthritis, heart attack, or stroke.  (NIH, 2020).

            Fibrocystic Breast Disease (Benign Breast Disease) is when there are multiple tender masses that occur usually between the ages of 30-55 years of age and decrease after menopause.  This comes with multiple symptoms and physical findings such as swelling and tenderness, nodularity, dominant lumps (including cysts and fibroadenomas), nipple discharge (including intraductal papilloma and duct ectasia), infections and inflammations (including subareolar abscess, lactational mastitis, breast abscess, and Mondor disease) (Jarvis & Eckhardt, 18 (399), 2020). 

            Fibroadenoma’s are benign masses that are most commonly self-detected in late adolescence and early adulthood.  From 15-30 years of age but an occur up to 55 years of age.  It is a solid nontender mass that is firm, rubbery, and elastic.  They are round lobulated and about 1 to 5 cm (Jarvis & Eckhardt, 18 (399), 2020).  They are freely moveable, slippery, and can easily slide through tissue.  According to Jarvis there usually isn’t any axillary lymphadenopathy.  It’s diagnosed by breast exam, ultrasound, and needle biopsy.  Surgery is usually reserved for masses >5cm that are continuously enlarging, well defined, multiple masses, or if they are suspicious.  They are usually non tender and usually non tender (Jarvis & Eckhardt, 18 (399), 2020). 

            Breast Cancer is a “solitary, unilateral, 3-dimensional, usually non tender mass.  Solid, hard, dense, and fixed to underlying tissues or skin as a cancer becomes invasive.  Borders are irregular and poorly delineated.  Grows constantly.” (Jarvis & Eckhardt, 18 (399), 2020).  This requires diagnostic mammogram for those over age 30.  It is found mostly in the upper outer quadrant and found in women between the ages 30-80 years of age.  As cancer advances, signs include firm hard irregular axillary nodes; skin dimpling; nipple retraction, elevation, and discharge.  These are serious and needs early treatment.  It is important to educate patients on how to perform self-breast exams and regular mammograms as recommended by there healthcare provider.  Women need to inspect breasts, supraclavicular and infraclavicular areas, palpate the axillae and regional lymph nodes, and an actual physical exam including nipples areolae including tail of Spence.  As healthcare providers it is very important to not only educate your patients but also to educate them on how to perform the self-exam.   

Resource:

Jarvis, C. & Eckhardt, A., (2020).  Physical Examination & Assessment 8th Edition. Elsevier

copyright.  Skin, Hair, and Nails. 13(236). Breasts, Axillae, and Regional Lymphatics. 18 (399).

National Institute of Health (NIH) National Institute of Arthritis and Musculoskeletal and Skin

Disease. (2020). Psoriasis. Retrieved January 18, 2021 from Psoriasis Types, Symptoms & Causes | NIAMS (nih.gov) (Links to an external site.).

Health Assessment Discussion #2.docx

200 WORDS EACH

A 67-year-old man presents to the HCP with chief complaint of tremors in his arms. He also has noticed some tremors in his leg as well. The patient is accompanied by his son, who says that his father has become “stiff” and it takes him much longer to perform simple tasks. The son also relates that his father needs help rising from his chair. Physical exam demonstrates tremors in the hands at rest and fingers exhibit “pill rolling” movement. The patient’s face is not mobile and exhibits a mask-like appearance. His gait is uneven, and he shuffles when he walks and his head/neck, hips, and knees are flexed forward. He exhibits jerky or cogwheeling movement. The patient states that he has episodes of extreme sweating and flushing not associated with activity. Laboratory data unremarkable and the HCP has diagnosed the patient with Parkinson’s Disease.

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.