Psychotherapy with Individuals

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PSYCHOTHERAPY WITH INDIVIDUALS 6

 

 

 

 

 

 

 

 

 

 

 

 

 

Psychotherapy with Individuals

Name

Institutional Affiliation

Date

 

Comprehensive Client Family Assessment

Demographic information: a 28-year-old male Hispanic and working-class (from home due to COVID-19). Works in a warehouse as a call center representative

Presenting Problem: the patient is experiencing reduced ADLs and hygiene and has not been sleeping nor eating for the past few days before the admission to the facility. The patient is also lacking a motive to live, and having suicidal ideation with no plan. These problems have been linked to the recent anxiety and depression which has occurred as a result of working from home due to COVID.

Medical History: the patient states that she is having anxiety and depression that has been caused by working from home due to the emergence of COVID-19. The patient is distracted and showing signs of depression. He has been hospitalized for a mental problem even though he was anxious.

Substance use History: the patient admits to being using alcohol and has been taking marijuana six months ago.

Developmental history:

Family psychiatric history: Father is deceased, diagnosed with Attention deficit hyperactivity disorder. The mother having a personality disorder.

Psychosocial History: He has been hospitalized for a mental problem even though he stated that he was anxious. He has a history of depression, PTSD, paranoia, anxiety, and pseudo-seizures.

History of the abuse or trauma: the patient stated that he has been sexually abused at the age of 5 years old by their maid. Nevertheless, she never shared the story with another person. She also has a history of post-traumatic stress disorder (PTSD).

Review of the system

Psychiatric: Depression, unspecified bipolar disorder and other related behavior, trauma

Constitutional: No fever nor chills.

Respiratory: No breathing difficulty. No orthopnea.

Cardiovascular: absence of edema.

Gastrointestinal: denies vomiting, nausea, abdominal pain, and constipation

Physical Assessment

Height: 5’8”; weight: 125 pounds; BMI: 18.2 kg/m2; B/P: 110/70; Temperature: 97.8; p 80 R 22

Abdomen: No distension of the abdomen with no axillary and the inguinal lymphadenopathy; non-tender; bowel sounds + × 4 quadrants. No organomegaly. No palpable masses.

Neurological: Cranial nerve is intact i.e. A & O × 3

Cardiovascular: the S1 and S2 rhythm are regular and stable.

Musculoskeletal: the patient is having stable gait

Respiratory: there is a normal chest when percussion is performed. There is bilateral expiratory wheezing.

Mental status examination: the patient is cooperative and is redirectable even though he is having some thoughts. He easily loses attention when he is distracted. He is depressed and having anxiety as a result of working from home. The situation is made worse since he is having some marital issues which increase his level of stress. He admits to being having some suicidal ideation even though he has no plan to implement it. This patient seems to be having some psychosis and this is evident by the fact that he is having auditory and visual hallucinations.

Differential Diagnosis

Anxiety Disorder: this is a condition that is characterized by anxiety or fear that interferes with daily activities. An example of an anxiety disorder is a post-traumatic stress disorder. In this case study, the patient has neglected his ADLs and hygiene. He is also not eating and he is having no motivation in life. The patient is also having a history of the post-traumatic disorder (Karlson et al., 2016).

Suicidal Ideation: this is a mental disorder that has the characteristic of persistent depressed mood and the loss of interest in activities. In this case, the patient is depressed and he has neglected the ADLs and hygiene, not eating, and not sleeping.

Post-traumatic stress disorder: this is a condition that is related to the triggers that can bring memories of the trauma that is characterized by the intense emotional and physical reactions. In this case, the patient has been abused while at the age of five years. She is currently having marital stress which might be the trigger to his current condition. The patient is also not sleeping and having some depressed moods or anxiety as some of the chiefs complain while reporting to the facility.

Schizophrenia: This is a severe mental disorder whereby the victim abnormally interprets the events. It leads to hallucination, delusions, and severely disordered thinking and behaviors that impair functioning and disabling. In the case study, the patient is having both auditory and visual hallucinations. He is neglecting his ADLs, not observing his hygienic condition at the moment, and getting easily distracted. (Chakhssi et al., 2017)

Case formulation

Based on the symptoms presented in the case study, it is clear that the patient might be suffering from the anxiety disorder which is also characterized by the post-traumatic disorder that is being triggered by the marital stress. The anxiety disorder is caused by the fact that he is unable to attend to his jobs in the organization as a result of the COVID-19. He is forced to work from home, something he finds not comfortable with. The problem has forced him not to be further attentive to his ADLs and hygiene. He is losing a focus in his life and he is no longer feeling motivated to live.

The Treatment Plan

The patient is having some issues to be addressed to help him deal with his situation. The patient is currently dealing with issues related to suicidal ideation with no plan of fulfilling it and anxiety. The patient is also having sleeping and eating problem, therefore, the goal of therapeutic approaches, in this case, is to help in the reduction of anxiety, help in addressing the sleeping problem, and to deal with suicidal ideation. Therefore, the therapeutic approach will involve the use of medication and therapy.

Therefore, the treatment will involve the initiation of Seroquel 50 mg at HS for the mania and Prazosin 1 mg at HS for the trauma. The patient is also put under activity therapy by engaging him in a group focus therapy. Activity therapy is also aimed at improving coping skills and managing the moods of the patient.

Part 2: Family Genogram

According to the familial history of the patient, his father is still alive while the mother is deceased. His father died three years ago after being found in a borehole, something that was linked to suicide. Before his death, his father was diagnosed with attention deficit hyperactivity disorder (ADHD). His mother is having a personality disorder and she is always and she is showing some strange behaviors which makes the family to be much worried. The family has always found a hard time while explaining to her about some events in the family. She always faces the challenge of perceiving and relating to the circumstance and people.

 

References

Chakhssi, F., Schaap, G., Bohlmeijer, E., & Westerholf, J. G. (2017). Well-being in psychotherapy for individuals with personality disorders. Society for the Advancement of Psychotherapy. Karlson, B., Johnell, K., Sigstrom, R., & Sjoberg, L. (2016). Depression and depression treatment in a population-based study of individuals over 60 years old without dementia. The American Journal of Geriatric Psychiatry, 24(8), 615-623.

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Describe three political actions nurses could take to strengthen their role in policymaking as it relates to advocacy for improving LGBTQ health

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Describe three political actions nurses could take to strengthen their role in policymaking as it relates to advocacy for improving LGBTQ health. Correlate your discussion to the AACN MSN Essentials, identify one that most pertains to this topic and elaborate on your selection.

Attached below is additional information regarding providing adequate care for the LGBTQ community as outlined by Joint Commission and the CDC:

Joint Commission Model for Improving LGBTQ Health

Hide DetailsJoint Commission Model for Improving LGBTQ Health item options

Survey Report cover

Lesbian, Gay, Bisexual and Transgender Health: https://www.cdc.gov/lgbthealth/

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Write a paper (2,000-2,500 words) in which you apply the concepts of epidemiology and nursing research to a communicable disease. Refer to “Communicable Disease Chain,” “Chain of Infection,” and the CDC website for assistance when completing this assignment.

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Epidemiology Paper

Write a paper (2,000-2,500 words) in which you apply the concepts of epidemiology and nursing research to a communicable disease. Refer to “Communicable Disease Chain,” “Chain of Infection,” and the CDC website for assistance when completing this assignment.

Communicable Disease Selection is HIV

Epidemiology Paper on HIV Requirements:

Describe HIV the disease, including causes, symptoms, mode of transmission, complications, treatment, and the demographic of interest (mortality, morbidity, incidence, and prevalence). Is this a reportable disease? If so, provide details about reporting time, whom to report to, etc.

Describe the social determinants of health and explain how those factors contribute to the development of this disease.

Discuss the epidemiologic triangle as it relates to the communicable disease you have selected. Include the host factors, agent factors (presence or absence), and environmental factors. Are there any special considerations or notifications for the community, schools, or general population?

Explain the role of the community health nurse (case finding, reporting, data collection, data analysis, and follow-up) and why demographic data are necessary to the health of the community.

Identify at least one national agency or organization that addresses the communicable disease chosen and describe how the organizations contribute to resolving or reducing the impact of disease.

Discuss a global implication of the disease. How is this addressed in other countries or cultures? Is this disease endemic to a particular area? Provide an example.

A minimum of 4 peer-reviewed or professional references is required.

The post Write a paper (2,000-2,500 words) in which you apply the concepts of epidemiology and nursing research to a communicable disease. Refer to “Communicable Disease Chain,” “Chain of Infection,” and the CDC website for assistance when completing this assignment. appeared first on Infinite Essays.

   Health care industry is the biggest industry in U.S.  It saddens me to know that there are people that receive better care because of their financial state and that some people can’t receive benefits from SNFs, clinics and pharmacy companies and hospitals

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1- Kaori

Health care industry is the biggest industry in U.S.  It saddens me to know that there are people that receive better care because of their financial state and that some people can’t receive benefits from SNFs, clinics and pharmacy companies and hospitals. If you have been nursing for a long time in your community, you already know which hospitals and clinics can provide excellent care to their patient as well as excellent compensation to their employee. The business will succeed if it can provide a product that the market (customers) wants (Austin & Wetle, 2016, p. 23). This is true.

There’s a very simple way for the business to grow. Increase income, decrease expense, and always looking for tax wisely. For example, home health company under huge hospital system would take Medicare patients only capped to the hospital system. The home health division does not need authorization from insurance company and patient does not need to pay co-pay, which would be a win-win situation. It would be easy to discuss winning model for huge hospitals, which already won.

On the other had we have people living in lower income communities. In these communities there is a well-known community clinic taking care of the majority of GMC patient. GMC means Medi-Cal and paying limited. MD in these systems are harder to reach because they do not have money to improve their office settings eg. receptionists. These clinics cannot improve because the patients they take in only have Medi-Cal which does not provide enough money to give their patents adequate care. So how do we help these clinics in the lower income communities?

 

2- Ivana

 

To improve overall patient experience, satisfaction and outcomes in the medical field, healthcare workers must have great communication with staff and patients, take care of the clinicians, promote well-informed diagnosis, ensure continuity of care and support for patients following discharge (Montag; 2020). Patients want to be listened and have their needs met, they do not want to be ignored or feel as if their concerns do not matter. Other strategies that could possibly help is giving patients the power to make decisions over their health, have them engage in their plan of care, this can help them better comply to treatment and become more educated about their health, and provide a safety and clean environment. If patients receive great patient care or overall patient experience, they would recommend others to attend the hospital they were admitted and received treatment. By doing so, this will bring more patients to the hospital or facility and they will benefit financially from it and have a good reputation.

Hospitals have expenses on medical supplies, equipment, personnel, etc. “Supply chain is becoming an increasingly important area for health system cost reduction. The supply chain represents close to a third of the average hospital’s overall operating expenses. Health system leaders are making supply chain optimization a priority, they are also focusing on improving the consumer experience and reducing clinician burnout (RevCycleIntelligence; 2019). A cost reduction that hospitals or facilities can do is lower the number of medical tests for patients, if specific tests are not necessary, then it should not be performed. If health care workers improve their clinical outcomes and reduce the chances of their patients from acquiring an infection during their stay at the hospital, then labs or other medical tests will not bed necessary to perform. Reducing clinician burnout is important, if caregivers are overworking, they cannot provide the same patient care or quality of care due to being tired and stressed. “Staff scheduling software can help to monitor and prevent overtime work, which will decrease payroll costs and keep nurses from being chronically overworked. Optimization of care must occur to reduce costs and maintain quality care” (Nersi; 2018).

 

Discussion 2

 

1-Leticia

 

COLLAPSE

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Policies affect us as nurses in our daily practice.  Sadly, when policies are being made these determine what type of health care a person gets it determines the “when, how, from whom, and at what cost” (Mason et al., 2016, p. 10).  In the policy development model, our role as nurses are that of advocacy and activism.  As nurses we advocate for our patients and many times, we don’t have any issues doing so but when it comes to getting involve with policy making and politics many times we choose to stay away.  Its important to be active and be involved.  Our role as nurses not only involves providing excellent clinical care but also to speak up for those that we care for daily.  We are the front-line health care workers and we know what our patients needs are as well as our needs to be able to care for those patients.

I’ve attended a fall risk policy meeting at my previous job at a nursing home.  Where I used to work fall rates where increasing especially doing the day and we had to come up with solutions on how to decrease the amount of falls we where having.  Each unit had to look back at their fall incidents and some key points that where brought in was the time of the falls.  We determined that most of the falls where happening after lunch.  Patients where trying to either get back to bed unassisted or where trying to use the restroom.  We implemented ideas how to decrease the falls during this time for toileting the patient before going to eat lunch to having more staff available on the floor to assist those patients wanting to go back to bed after lunch.  The new ideas worked we seen a decrease in falls.  We also updated the fall policy by determining who needed to have a safety alarm in place based on fall risk scores and patient condition along with fall history.

Bottom of Form

 

 

3- Kimberly

 

Nurses play a huge role in the modification and development of health care policies since nurses have to make sure it protects patient’s quality of care and quality of life. According to the article Nurses’ policy influence: A concept analysis, “Nurses’ policy influence is nurses’ ability in influencing decisions and affairs related to health through political knowledge, effective communication, and collaboration with other members of the health team, which results in the improvement of nurses’ job environment and increases patient outcomes” (Arabi, et al., 2014). The policy meeting that I will be attending is about Coronavirus Vaccine Development. Its goal is to make a vaccine that is effective and safe and produce mass quantities as soon it has been tried and trested. Key points that a nurse could bring or questions to ask to this meeting is how did they make sure that it is safe and effective, who did they try it on and what could be the possible side effects. Would it offer lifetime protection? These questions are critical and need to be addressed since this is the first vaccine being created.

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