Use the following Case Scenario, Subjective Data, and Objective Data to answer the Critical Thinking Questions. Case Scenario Mrs. J. is a 63-year-old woman who has a history of hypertension, chronic heart failure, and sleep apnea. She has been smoking two packs of cigarettes a day for 40 years and has refused to quit. Three days ago, she had an onset of flu with fever, pharyngitis, and malaise. She has not taken her antihypertensive medications or her medications to control her heart failure for 4 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure. Subjective Data 1.Is very anxious and asks whether she is going to die. 2.Denies pain but says she feels like she cannot get enough air. 3.Says her heart feels like it is “running away.” 4.Reports that she is so exhausted she cannot eat or drink by herself. Objective Data 1.Height 175 cm; Weight 95.5 kg 2.Vital signs: T 37.6 C, HR 118 and irregular, RR 34, BP 90/58 3.Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint; all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation 4.Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82% 5.Gastrointestinal: BS present: hepatomegaly 4 cm below costal margin Critical Thinking Questions What nursing interventions are appropriate for Mrs. J. at the time of her admission? Drug therapy is started for Mrs. J. to control her symptoms. What is the rationale for the administration of each of the following medications? 1.IV furosemide (Lasix) 2.Enalapril (Vasotec) 3.Metoprolol (Lopressor) 4.IV morphine sulphate (Morphine) Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition. Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide rationale for each of the interventions you recommend.

Ethics
Read the following scenarios and answer the reflection questions that follow.
Jennifer: I dont see why we have to learn statistics and research methods! I am never going to use them anyway. I want to be a counselor and I am just going to deal with each person as an individual. Science treats everyone as if they are interchangeable and totally predictable. In fact I think people would be better counselors and teachers and social workers if they didnt take research classes at all because then they would treat everyone as individuals not clones.
Bethany: People are a lot more predictable than you think. Psychologists have learned so much about human behavior in the last hundred years or so using the scientific method. I really believe that if you can figure out all the factors that are affecting someones behavior you can be pretty accurate in figuring out what they are going to do. Ive decided that I want to be a researcher because I think I can help more people in the long run than you will as a therapist. As a researcher I can develop programs that will help a lot of people who suffer from the same problem. A therapist can only help one person at a time and sometimes it takes years for a person to get better.
Reflection Questions:
a. How do Jennifer and Bethany differ in their understanding of what people are like? With whom do you agree more and why?
b. What is ethically troubling about taking Jennifers position to the extreme? What would happen if therapists received no training in the scientific study of human behavior?
c. What is ethically troubling about taking Bethanys position to the extreme? What is the problem with assuming that if you can figure out all the variables (genes environment etc.) you can perfectly predict peoples behavior?
Reflection Questions:
c. Keeping in mind that she never gave any false information to anyone who purchased her treatment program do you think Dr. Franklin should give the therapists who purchased her program a refund of their money? Why or why not?
Reflection Questions:
c. What are some possible negative consequences that might result if Karen tells Dr. Tarner but they agree not to report the mistake to the journal editor?
a. Why is it risky for Beverly to make up the data?
b. What would you choose to do if you were in Beverlys place? Explain.
5. As part of their class requirements the students in Dr. Taylors Research Design and Analysis class are sent over to Trumbull Mall to observe interactions between mothers and their toddler-aged children. They are told not to interact with the moms at all but just record certain behaviors like the number of times they speak harshly to their children and the number of times the children whine or cry.
One of the mothers notices that the students are watching people and complains to mall security. The manager of the mall asks the students where they are from then writes a letter of complaint to Dr. Taylor. Here is an excerpt:
I am requesting that you do not engage in any more observational research at Trumbull Mall. I dont think it is right to allow students to observe peoples behavior without getting their permission first. It is a violation of privacy and is wrong even if they dont realize they are being watched. People come to the mall to shop not to be watched.
Reflection Questions:

Research Paper References
Topic – What happens to children whose parents get divorced?
List of references in APA format; include a short summary (one to two paragraphs) of the article
References cannot be more than 4 years old.
Also include what you found most interesting or intriguing about this topic and why and what you think it contributes to the existing developmental psychology knowledge base
Paper should have at least 80% of your own original thought not borrowed paraphrased [or] quoted from material pulled from the Internet articles journals books etc.
Must strictly adhere to deadline

Assignment: “Captain of the Ship”Project – Obsessive-Compulsive Disorders

Although actual statistics vary, obsessive-compulsive disorder impacts approximately 1.2% of the population in the United States (APA, 2013, p. 239). It is characterized by the presence of obsessive thoughts, which are manifested as persistent thoughts, images, or even “urges.” The only way that the individual can disperse the anxiety of these persistent thoughts/images or urges is to perform a behavior (the compulsion). The compulsion could be checking things, counting, reciting a silent prayer, or repeating a number of phrases. The disorder becomes so pervasive that the person can spend a significant amount of time each day attending to the compulsion in order to relieve the anxiety caused by the obsession.

Assignment

In this assignment, you will become “captain of the ship” as you take full responsibility for a client with an obsessive-compulsive disorder by recommending psychopharmacologic treatment and psychotherapy, identifying medical management needs and community support, and recommending follow-up plans.

Remember that there is an excellent example for ‘Captain of the Ship’ project attached with this ASSIGNMENT.

Instructions:

To prepare for this Assignment

Select an adult or older adult client with a bipolar disorder that you have seen in your practicum/clinical rotation site.

In 3-4 pages, write a treatment plan for your client. In which you do the following:

· Describe the history of the present illness (HPI) and clinical impression for the client.

· Recommend psychopharmacologic treatments based on evidence-based practice and describe specific and therapeutic end points for your psychopharmacologic agent. (This should relate to HPI and clinical impression.).

· Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.

· Identify medical management needs, including primary care needs, specific to this client.

· Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.

Recommend a plan for follow-up intensity and frequency and collaboration with other providers.

N: B. (1)The Captain of the Ship project needs to show that you are evaluating the patient, making a diagnosis, providing treatment plans and outcomes as well as collaborating with other providers. The project MUST meet all these requirements. (2) The choice of medications should be clear, and the medical management should be clear. (3) Consider using the bipolar disorder algorithm from http://www.psychiatrictimes.com/bipolar-disorder/new-psychopharmacology-algorithms

Learning Resources

Required Readings

-Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

Chapter 10, “Obsessive-Compulsive and Related Disorders” (pp. 418–436)

-Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.

Chapter 21, “Obsessive-Compulsive Disorder”

-American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

“Obsessive-Compulsive and Related Disorders”

-Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

To access information on specific medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication.

Obsessive-compulsive disorder Medication

citalopram

clomipramine

escitalopram

fluoxetine

fluvoxamine

paroxetine

sertraline

venlafaxine

vilazodone

-Thompson-Hollands, J., Edson, A., Tompson, M. C., & Comer, J. S. (2014). Family involvement in the psychological treatment of obsessive-compulsive disorder: A meta-analysis. Journal of Family Psychology, 28(3), 287–298. doi:10.1037/a0036709

Required Media

-Bruce, T. & Jongsma, A. (Producers). (n.d.) Evidence-based treatment planning for obsessive compulsive disorder [Video file]. Mill Valley, CA: Psychotherapy.net.

Optional Resources

-Himle, J. A., Chatters, L. M., Taylor, R. J., & Nguyen, A. (2013). The relationship between obsessive-compulsive disorder and religious faith: Clinical characteristics and implications for treatment. Spirituality in Clinical Practice, 1(S), 53–70. doi:10.1037/2326-4500.1.S.53

-Wheaton, M. G., Rosenfield, D., Foa, E. B., & Simpson, H. B. (2015). Augmenting serotonin reuptake inhibitors in obsessive–compulsive disorder: What moderates improvement? Journal of Consulting and Clinical Psychology, 83(5), 926–937. doi:10.1037/ccp0000025

Submit your approved proposal using the attached “Change Investigation Proposal Form” that includes the following information:

• a brief description of the organizational change you plan to investigate

• a process for conducting the investigation (e.g., data collection, key stakeholders to talk to), including how you will obtain the information on the “QIA Form”

• approval signature and credentials of the change leader, giving you permission to investigate the change

B. Summarize (suggested length ½ to 1 page) the identified organizational change and the patient population that it affects.

Note: Use the attached “QIA Form” and gather data from the organization that is necessary to populate sections I–V of the form. The form should serve as a guide to complete your assessment and conduct your investigation. Refer to the attached “QIA Instructions Form” for information on how to complete the QIA Form.

C. Submit a completed copy of the attached “QIA Form” in which you record data from your investigation in sections I–IV.

1. Summarize what data you collected for each section (I–IV) of the “QIA Form.”

a. Discuss what data collection measure(s) were used by the organization.

b. Analyze the appropriateness of the data collection measures, including whether the data supported the need for change.

2. Discuss how the data collection measure(s) could have been improved, using master-level nursing and interprofessional standards.

D. Analyze the effectiveness of the change project in the organizational setting by doing the following:

1. Discuss how the change was evaluated for success after implementation.

a. Discuss the effects the implementation has had on the organization and quality care outcomes.

2. Evaluate whether stakeholders involved with implementation were successful in their roles.

3. Discuss how the change project could have been improved to increase quality care outcomes.

E. Summarize your involvement with the organization and/or stakeholders as you conducted your investigation.

F. When you use sources, include all in-text citations and references in APA format.