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NR 601 Week 3 Case Study Discussions Physical Examination  (Part-1) NEW

Discussion Part One (graded)

Katie Smith, a 65 year-old female of Irish descent, is being seen in your office for an annual physical exam. You are concerned since she has rescheduled her appointment three times after forgetting about it. She and her husband John are currently living with their daughter Mary, son-in-law Patrick, and their four children. She confesses that while she loves her family and appreciates her daughter’s hospitality, she misses having her own home.  As she is telling you this, you notice that she develops tears in her eyes and does not make eye contact with you. 

Background:

Although Mrs. Smith is scheduled for an annual physical exam and reports no particular chief complaint, you will need to complete a detailed geriatric assessment. Katie reports a lack of appetite. She tells you that she nibbles most of the time rather than eating full meals. She also reports having insomnia on a regular basis.

PMH:

Katie reports a recent bout of pneumonia approximately 3 months ago, but did not require hospitalization.  She also has a history of HTN and high cholesterol.

Current medications: 

HCTZ 25mg daily

Evista 60mg daily

Multivitamin daily

Surgeries:      

Appendectomy as a child in Ireland (date unknown)

1968- Cesarean section

Allergies: Denies food, drug, or environmental allergies Vaccination History:

Cannot remember when she had her last influenza vaccine

Does not recall having received a Pneumovax

Her last TD was greater than 10 years ago

Has not had the herpes zoster vaccine

 Screening History:

Last Colonoscopy was 12 years ago

Last mammogram was 4 years ago

Has never had a DEXA/Bone Density Test

 Social history:

Emigrated with her husband from Ireland in her 20s and has always lived in the same house until recently. She retired a year and a half ago from 30 years of teaching elementary school; has never smoked but drinks alcohol socially. She states that she does not have an advanced directive, but her daughter Mary keeps asking her about setting one up.   Family history:

Both parents are deceased but lived disease-free up into their late 90s.  She has one daughter who is 44 years old with no chronic illness and two sons, ages 42 and 40, both in good health.  

Discussion Day 1:

Differential Diagnoses 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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NR 601 Week 5 Case Study Discussions Physical Examination  (Part-1) NEW

Discussion Part One (graded)

 C.W. is a tall, thin 78-year-old African American male brought into the office by his son who states that the patient is restless, angry, and has been unable to sleep for the last week. The son indicates that he is very concerned about his father because he lives alone. Also, he is concerned about the “strange” symptoms that his father has presented with recently.

 Background: 

C.W. presents as restless, hyperverbal, obnoxious and angry. He expresses himself by periodic yelling. He is unkempt and smells strongly of urine, alcohol and body odor. ………… has an unsteady gait and sways while standing. As you converse with the son, you determine that C.W. was medically separated from military service due to mental health issues after 2 years of active duty that ended in 1947. He has been married and divorced three times over the years. He typically seeks no acute or preventative medical care. ___ was treated by a psychiatrist previously, but he did not like taking the prescribed medications so he stopped taking them and did not keep any further psychiatric appointments.  

 PMH:

Patient denies any previous diagnoses. However, when asked why he saw a psychiatrist in the past, he tells you that the psychiatrist diagnosed paranoid schizophrenia, but that he does not have any psychiatric diagnoses or problems. He states: “It was just a way for him to make money off me coming in and seeing him and paying the drug companies for me to take all those meds!” 

Current medications: 

Denies prescription medications, over the counter medication, herbal therapies or vitamins.  

Surgeries:

Denies surgeries 

Allergies: NKA

Vaccination History:

Flu vaccine: never given

Pneumovax: never given

Tetanus: never given

Herpes zoster: never given 

Screening History:

 Last Colonoscopy was 2012-normal

Last dilated retinal and glaucoma exam was 2013 

 Social history and Risk Factors:

 Patient admits to smoking cigarettes and cigars. …… estimates that he smokes about 1 pack of cigarettes daily for the last 40 years, and 2 cigars each week for the last 30 years.

He states that he drinks a 24 ounce bottle of beer 4-6 times a week. … denies drinking wine or hard liquor. …….. does admit to smoking marijuana on occasion but does not use other recreational drugs. Patient denies falling. You notice some scrapes on his forearms, and when asked, he tells you that he fell yesterday: “I got pretty drunk out fishin’ with friends and fell off my bike trying to ride home”. He does not use any assistive devices for ambulation or balance.

Significant ROS:

Productive cough with white sputum. Denies hemoptysis.

He answers “No” to the PHQ-2 screening questions. 

Family history:

Reports no significant family history

  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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NR 601 Week 6 Case Study Discussions Health Promotion, Health Protection, Disease Prevention, and Treatment Considerations in Long-Term Care (Part-1) NEW

Discussion Part One (graded)

 Ms. S. is a 62-year-old black female who has returned to the clinic to discuss her concerns that her lifestyle modifications to lose weight have not worked. At the last visit 3 months ago, she was advised to change her eating habits and increase activity to promote weight loss. She reports walking at least 30 minutes a day but has lost very little weight. ……….. indicates that the walking only made her extremely thirsty and hungry and attributes her increased thirst and hunger to increased exercise and her increased urination due to drinking more water since “it’s been hot lately” and exercise makes me thirsty”…… has returned to the clinic to discuss if there is anything else that can be done to lose weight and to determine why she is so tired, thirsty and hungry all the time. She also thinks she may have an overactive bladder since she has to urinate frequently during the day, which has influenced her not to go on outings with her friends.

  Discussion Questions Part One

 Conduct a ROS on this patient.

Indicate which symptoms are most concerning to you.

List your differential diagnoses.

What types of screenings would be appropriate to use based on the chief complaint?

What primary diagnosis are you choosing at this point?

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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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