Discussion: Does Psychotherapy Have a Biological Basis?

Many studies have found that psychotherapy is as effective as  psychopharmacology in terms of influencing changes in behaviors,  symptoms of anxiety, and changes in mental state. Changes influenced by  psychopharmacology can be explained by the biological basis of  treatments. But how does psychotherapy achieve these changes? Does  psychotherapy share common neuronal pathways with psychopharmacology?  For this Discussion, consider whether psychotherapy also has a  biological basis.  Discussion: Does Psychotherapy Have a Biological Basis?

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Post an explanation of whether psychotherapy has a  biological basis.

Explain how culture, religion, and socioeconomics  might influence one’s perspective of the value of psychotherapy  treatments.

Support your rationale with evidence-based literature.

Required Readings

American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.

• Standard 1 “Assessment” (pages 44 & 45)

Note: Throughout the program you will be reading excerpts from the ANA’s Scope & Standards of Practice for Psychiatric-Mental Health Nursing. It is essential to your success on the ANCC board certification exam for Psychiatric/Mental Health Nurse Practitioners that you know the scope of practice of the advanced practice psychiatric/mental health nurse. You should also be able to differentiate between the generalist RN role in psychiatric/mental health nursing and the advanced practice nurse role.

Wheeler, K. (Eds.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

• Chapter 1, “The Nurse Psychotherapist and a Framework for Practice” (pp. 3–52) Discussion: Does Psychotherapy Have a Biological Basis?

Fournier, J. C., & Price, R. B. (2014). Psychotherapy and neuroimaging. Psychotherapy: New Evidence and New Approaches, 12(3), 290–298. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207360/

 

Holttum, S. (2014). When bad things happen our brains change but psychotherapy and support can help the recovery of our brains and our lives. Mental Health and Social Inclusion, 18(2), 52–58. doi:10.1108/MHSI-02-2014-0006 

 

Petiprin, A. (2016). Psychiatric and mental health nursing. Nursing Theory. Retrieved from http://www.nursing-theory.org/theories-and-models/psychiatric-and-mental-health-nursing.php

Fisher, M. A. (2016). Introduction. In Confidentiality limits in psychotherapy: Ethics checklists for mental health professionals (pp. 3–12). Washington, DC: American Psychological Association. doi:10.1037/14860-001

Document: Practicum Journal Template (Word document)

 

Note: This template is provided by the School of Nursing and is designated to document practicum activity. You are required to use this template for all journal entry submissions.

Document: Midterm Exam Study Guide (Word document)

Document: Final Exam Study Guide (Word document)

Document: NP Student Clinical Orientation (PowerPoint file)

Document: Practicum Manual (PDF). Retrieved from http://academicguides.waldenu.edu/ld.php?content_id=7356923

 

Required Media

Laureate Education (Producer). (2016). Introduction to psychotherapy with individuals [Video file]. Baltimore, MD: Author. Discussion: Does Psychotherapy Have a Biological Basis?

Note: The approximate length of this media piece is 2 minutes.

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Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Content

Name: NURS_6640_Week1_Discussion_Rubric

• Grid View
• List View

	Outstanding Performance		Excellent Performance	Competent Performance	Proficient Performance	Room for Improvement
Main Posting: Response to the discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.	Points Range: 44 (44%) – 44 (44%) Thoroughly responds to the discussion question(s) is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. Discussion: Does Psychotherapy Have a Biological Basis? supported by at least 3 current, credible sources		Points Range: 40 (40%) – 43 (43%) Responds to the discussion question(s) is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module. 75% of post has exceptional depth and breadth supported by at least 3 credible references	Points Range: 35 (35%) – 39 (39%) Responds to most of the discussion question(s) is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module. 50% of post has exceptional depth and breadth supported by at least 3 credible references	Points Range: 31 (31%) – 34 (34%) Responds to some of the discussion question(s) one to two criteria are not addressed or are superficially addressed is somewhat lacking reflection and critical analysis and synthesis somewhat represents knowledge gained from the course readings for the module. post is cited with fewer than 2 credible references	Points Range: 0 (0%) – 30 (30%) Does not respond to the discussion question(s) lacks depth or superficially addresses criteria lacks reflection and critical analysis and synthesis does not represent knowledge gained from the course readings for the module. contains only 1 or no credible references
Main Posting: Writing	Points Range: 6 (6%) – 6 (6%) Written clearly and concisely Contains no grammatical or spelling errors Fully adheres to current APA manual writing rules and style		Points Range: 5.5 (5.5%) – 5.5 (5.5%) Written clearly and concisely May contain one or no grammatical or spelling error Adheres to current APA manual writing rules and style	Points Range: 5 (5%) – 5 (5%) Written concisely May contain one to two grammatical or spelling error Adheres to current APA manual writing rules and style	Points Range: 4.5 (4.5%) – 4.5 (4.5%) Written somewhat concisely May contain more than two spelling or grammatical errors Contains some APA formatting errors	Points Range: 0 (0%) – 4 (4%) Not written clearly or concisely Contains more than two spelling or grammatical errors Does not adhere to current APA manual writing rules and style
Main Posting: Timely and full participation	Points Range: 10 (10%) – 10 (10%) Meets requirements for timely and full participation posts main discussion by due date		Points Range: 0 (0%) – 0 (0%) NA	Points Range: 0 (0%) – 0 (0%) NA	Points Range: 0 (0%) – 0 (0%) NA	Points Range: 0 (0%) – 0 (0%) Does not meet requirement for full participation
First Response: Post to colleague’s main post that is reflective and justified with credible sources.	Points Range: 9 (9%) – 9 (9%) Response exhibits critical thinking and application to practice settings responds to questions posed by faculty the use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives		Points Range: 8.5 (8.5%) – 8.5 (8.5%) Response exhibits critical thinking and application to practice settings	Points Range: 7.5 (7.5%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting	Points Range: 6.5 (6.5%) – 7 (7%) Response is on topic, may have some depth	Points Range: 0 (0%) – 6 (6%) Response may not be on topic, lacks depth
First Response: Writing	Points Range: 6 (6%) – 6 (6%) Communication is professional and respectful to colleagues Response to faculty questions are fully answered if posed Provides clear, concise opinions and ideas that are supported by two or more credible sources Response is effectively written in Standard Edited English		Points Range: 5.5 (5.5%) – 5.5 (5.5%) Communication is professional and respectful to colleagues Response to faculty questions are answered if posed Provides clear, concise opinions and ideas that are supported by two or more credible sources Response is effectively written in Standard Edited English	Points Range: 5 (5%) – 5 (5%) Communication is mostly professional and respectful to colleagues Response to faculty questions are mostly answered if posed Provides opinions and ideas that are supported by few credible sources Response is written in Standard Edited English	Points Range: 4.5 (4.5%) – 4.5 (4.5%) Responses posted in the discussion may lack effective professional communication Response to faculty questions are somewhat answered if posed Few or no credible sources are cited	Points Range: 0 (0%) – 4 (4%) Responses posted in the discussion lack effective Response to faculty questions are missing No credible sources are cited
First Response: Timely and full participation	Points Range: 5 (5%) – 5 (5%) Meets requirements for timely and full participation posts by due date		Points Range: 0 (0%) – 0 (0%) NA	Points Range: 0 (0%) – 0 (0%) NA	Points Range: 0 (0%) – 0 (0%) NA	Points Range: 0 (0%) – 0 (0%) Does not meet requirement for full participation
Second Response: Post to colleague’s main post that is reflective and justified with credible sources.	Points Range: 9 (9%) – 9 (9%) Response exhibits critical thinking and application to practice settings * responds to questions posed by faculty the use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives		Points Range: 8.5 (8.5%) – 8.5 (8.5%) Response exhibits critical thinking and application to practice settings	Points Range: 7.5 (7.5%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting	Points Range: 6.5 (6.5%) – 7 (7%) Response is on topic, may have some depth	Points Range: 0 (0%) – 6 (6%) Response may not be on topic, lacks depth
Second Response: Writing	Points Range: 6 (6%) – 6 (6%) Communication is professional and respectful to colleagues Response to faculty questions are fully answered if posed Provides clear, concise opinions and ideas that are supported by two or more credible sources Response is effectively written in Standard Edited English		Points Range: 5.5 (5.5%) – 5.5 (5.5%) Communication is professional and respectful to colleagues Response to faculty questions are answered if posed Provides clear, concise opinions and ideas that are supported by two or more credible sources Response is effectively written in Standard Edited English	Points Range: 5 (5%) – 5 (5%) Communication is mostly professional and respectful to colleagues Response to faculty questions are mostly answered if posed Provides opinions and ideas that are supported by few credible sources Response is written in Standard Edited English	Points Range: 4.5 (4.5%) – 4.5 (4.5%) Responses posted in the discussion may lack effective professional communication Response to faculty questions are somewhat answered if posed Few or no credible sources are cited	Points Range: 0 (0%) – 4 (4%) Responses posted in the discussion lack effective Response to faculty questions are missing No credible sources are cited
Second Response: Timely and full participation	Points Range: 5 (5%) – 5 (5%) Meets requirements for timely and full participation Posts by due date. Discussion: Does Psychotherapy Have a Biological Basis?		Points Range: 0 (0%) – 0 (0%) NA	Points Range: 0 (0%) – 0 (0%) NA	Points Range: 0 (0%) – 0 (0%) NA	Points Range: 0 (0%) – 0 (0%) Does not meet requirement for full participation
Total Points: 100

 

Module 1 Assignment: Case Study Analysis, NURS 6501: Advanced Pathophysiology

An understanding of cells and cell behavior is a critically important component of disease diagnosis and treatment. But some diseases can be complex in nature, with a variety of factors and circumstances impacting their emergence and severity.

Effective disease analysis often requires an understanding that goes beyond isolated cell behavior. Genes, the environments in which cell processes operate, the impact of patient characteristics, and racial and ethnic variables all can have an important impact. Module 1 Assignment: Case Study Analysis, NURS 6501: Advanced Pathophysiology

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Photo Credit: Getty Images/Hero Images

An understanding of the signals and symptoms of alterations in cellular processes is a critical step in the diagnosis and treatment of many diseases. 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 cell, gene, and/or process elements that may be factors in the diagnosis, and you explain the implications to patient health.

To prepare:

By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

The Assignment (1- to 2-page case study analysis)

Develop a 1- to 2-page case study analysis in which you:

• Explain why you think the patient presented the symptoms described.
• Identify the genes that may be associated with the development of the disease.
• Explain the process of immunosuppression and the effect it has on body systems. Module 1 Assignment: Case Study Analysis, NURS 6501: Advanced Pathophysiology

By Day 7 of Week 2

Submit your Case Study Analysis Assignment by Day 7 of Week 2.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates). All papers submitted must use this formatting. Module 1 Assignment: Case Study Analysis, NURS 6501: Advanced Pathophysiology

 

PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS ASSIGNMENT

..heart disease remains the No. 1 killer in America; nearly half of all Americans have high blood pressure, high cholesterol, or smoke—some of the leading risk factors for heart disease…

—Murphy et al., 2018

Despite the high mortality rates associated with cardiovascular disorders, improved treatment options do exist that can help address those risk factors that afflict the majority of the population today.

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As an advanced practice nurse, it is your responsibility to recommend appropriate treatment options for patients with cardiovascular disorders. To ensure the safety and effectiveness of drug therapy, advanced practice nurses must consider aspects that might influence pharmacokinetic and pharmacodynamic processes such as medical history, other drugs currently prescribed, and individual patient factors.

Reference: Murphy, S. L., Xu, J., Kochanek, K. D., & Arias, E. (2018). Mortality in the United States, 2017. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db328.htm

PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS

BN is a 74-year-old African American male who is seeing his PCP because he noticed when he woke up that his “heart was not beating right; it feels like it is going to slow.” He denies chest pain, SOB, N/V. He notes feeling dizzy earlier in the day. 6 weeks earlier his PCP started him on Diltiazem CD to further lower his BP to goal. His Metoprolol was lowered at that time as well from 75 mg to 50 mg BID. His PCP recommends he be admitted to the hospital. PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS ASSIGNMENT

Upon presentation to the hospital:

PMH:

• HTN x 7 years
• Type II DM
• CAD s/p angioplasty 2 years ago
• MI 3 years ago
• EF = 60%
• PVD s/p left femoral to posterior bypass
• Hx of A Fib x 4 years

Medications:

• Digoxin 0.25 mg QD KCl 40 mEq QD Vitamin C 500 mg QD
• Diltiazem CD 180 mg QD ASA EC 325 mg QD Vitamin E 400 IU QD
• Metoprolol 5- mg BID Warfarin 5 mg QD Ibuprofen 200 mg 2 tabs prn headache
• Lisinopril 20 mg QD Famotidine 20 mg QHS Multivitamin QD
• Imdur 30 mg QD Lantus 26u QHS Ca++/Vit D 500mg/200 IU BID
• HCTZ 12.5 mg QD Humalog 8u with meals. PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS ASSIGNMENT

PE:

• BP 110/50 Pulse 38 bpm Resp 14/min
• Rest of physical exam unremarkable

Labs:

• K+ 6.9 WBC 5,800/mm3
• Na+ 135 Hct 35%
• Cr 1.9 Dig 2.78
• BUN 35 INR 2.3
• Gluc 10

Write a 2- to 3-page paper that addresses the following:

• Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
• Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
• Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements . PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS ASSIGNMENT

To Prepare

• Review the Resources for this module and consider the impact of potential pharmacotherapeutics for cardiovascular disorders introduced in the media piece.
• Review the case study assigned by your Instructor for this Assignment.
• Select one the following factors: genetics, gender, ethnicity, age, or behavior factors.
• Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.
• Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.
• Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient. PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS ASSIGNMENT

 

Concept Map And Case Analysis Nursing Care Of Patients With Cardiovascular Disorders

Read the following case and construct a concept map, and complete a case analysis.   Please see criteria for concept Maps and case analysis. Posting as attachment.

Concept Maps

As you learned in Unit 1, a concept map is a visual tool that assists you with organizing and prioritizing care and interventions. The concept maps you create for Assignments 1 should demonstrate an understanding of the acute or chronic condition(s) experienced by the person featured in each case by illustrating links and cross links between different relevant concepts described in the case study.  It is preferable that you create the concept map in a word document to ensure clarity and legibility. To avoid formatting issues, you may choose to save your concept map as a .pdf file and submit as a separate file from your case analysis discussion. If creation of the concept map on the computer is an exceptional challenge, then connect with your course tutor about other ways you may submit the concept map diagram. Some students have created the concept map on paper and then simply submitted a photo. The main guiding principle is that your concept map is legible for the tutor to review and mark. Concept Map And Case Analysis Nursing Care Of Patients With Cardiovascular Disorders

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Below is the marking guide with clear indications of the criteria for the concept map. As you create your concept maps, reflect back on the criteria to ensure they are addressed and that your map presents a holistic picture of the patient. Concept Map And Case Analysis Nursing Care Of Patients With Cardiovascular Disorders

Case Analysis Discussion

For the case analysis, you will have the opportunity to choose three questions for your discussion.

 

Marking Criteria for Concept Maps/Case Analysis

Concept Mapping – 10 Marks	Approaching Expectation	Meeting Expectation	Exceeding Expectation	Marks
Concepts (Knowledge)	Insufficient concepts selected relating to topic Arrangement of concepts demonstrates a little understanding of relationship between them Relationships between concepts are weak	Acceptable number of concepts selected, with some relationships to topic Arrangement of concepts demonstrates some understanding of relationship between them Relationships make some logical sense	Most concepts and all significant concepts selected and they clearly relate to the topic Arrangement of concepts demonstrates complete and insightful understanding of relationship between them Relationships make logical sense	/2.5
Nursing Care Plan	Poor priority chosen weak relationship to case study Lacking in evidence-based interventions Not in SMART format No evaluation strategy discussed. Concept Map And Case Analysis Nursing Care Of Patients With Cardiovascular Disorders	Acceptable priority chosen Is missing some elements of required plan Some appropriate evidenced-based interventions are listed	Based on correct top priority Contains all required elements: nursing diagnosis, goal/outcome, interventions, and evaluation statement Interventions are appropriate Written in SMART format	/2.5
Hierarchical Structure (Nursing Priorities)	Only a few concepts connected in a hierarchical structure	Some concepts connected in a hierarchical listed in priority	Most or all concepts listed in priority	/3
Linkages (Thinking)	A few relationships indicated by connecting lines Only a few lines labeled with linking words Many errors in the linking words. Concept Map And Case Analysis Nursing Care Of Patients With Cardiovascular Disorders	Some relationships indicated by connecting lines Some lines labeled with linking words Some errors in the linking words	Most or all relationships indicated by connecting lines All lines labeled with linking words Most or all linking words are accurate and varied	/2
Case Analysis – 5 Marks	No or minimal professional scholarly evidence is seen Use of layman sources i.e. WebMD etc. Is not within word count (250 – 400words per question) Too much adjunct information Minimal demonstration of current APA  formatting	Good response to questions with limited scholarly support Is within word count 250 – 400 words per question Too much adjunct information that is not needed Mostly accurate demonstration of current APA formatting	Excellent response to questions with professional and scholarly supporting sources Is within word count 250 – 400 words per question Information is pithy (succinct) Excellent demonstration of current APA formatting	/5

 

 

Case Study #1

James

History of Presenting Illness (HPI)

James is a 66-year-old First Nations man who came to the emergency department with 5 days of progressing shortness of breath. He is now short of breath at rest, has orthopnea, and a decreased appetite. He is feeling increasingly fatigued and has swollen legs bilaterally. Today he started to feel lightheaded with palpitations which brough him to seek medical help. He states he used to weight 86kg but in the past few weeks has an increased weight gain of 92kg.

Health History

Hypertension

Coronary artery disease

NIDDM (non insulin dependent diabetes mellitus)

Infrequent social ETOH

No illicit drug misuses

Half pack per day smoker

BMI at baseline 27 (overweight)

Home Medications

ASA 81mg Daily

Rosuvastatin 10mg Daily

Perindopril 4mg Daily

Amlodipine 5mg Daily

Metformin 500mg BID

Gliclazide 80mg Daily

 

Physical Assessment and Diagnostics on Admission

General Appearance: Appears fatigued and anxious. Is walking in a steady but slow gait.

Neurological: Alert and orientated x3. GCS 15.

Respiratory: Speaking in short, clipped sentenced. Accessory muscle use. Short of breath at rest. Scattered coarse crackles throughout lung fields bilaterally. No cyanosis

Cardiovascular: S1 S2 and S3 auscultated, heartrate is rapid and irregular. Pulses palpable and weak. Skin pink, moist, and cool to extremities, with +3 edema from knees to feet bilaterally. Cap refill 3 seconds.

Gastrointestinal: Abdomen soft, non-tender. Regular BM today, passing flatus, bowel sounds present x4 Decreased appetite. Moist mucus membranes. Concept Map And Case Analysis Nursing Care Of Patients With Cardiovascular Disorders.

Genitourinary: Voiding without difficulty, urine clear yellow. No bladder distention noted

Integumentary/ Musculoskeletal: Motor power strong x4. Skin is intact, no visible lesions, rashes, or wounds

Psychosocial: Lives with wife and 3 grandchildren. States he often forgets to take medications or pick up refills at the pharmacy. He is concerned over expenses of caring for his young grandchildren. He states he is also worried about who will care for the children when he is in hospital or going to follow-up appointments. He states his wife cannot handle the 3 children on her own. He is covered under the non-insured health benefits (NIHB) program of Indigenous services Canada.

Vital Signs: Temp. 36.5, HR 138, RR 26, BP 158/72, 02 saturation 86% RA. Denies pain

Diagnostics

12 lead ECG demonstrated Atrial fibrillation

(Chiorescu et al, 2017).

ECHO demonstrated Ejection fraction of <40%

 

Blood Work

CBC: Hemoglobin 142g/L (120-160), Platelets 160 (130-380), WBC 5.2 (3.5-10.5)

Electrolytes: Sodium 136 mEq/L (135-145), Potassium 4.2 mEq/L (3.5-5.0), Chloride 100 mEq/L (98-107), fasting glucose 8.2 mmol/L (<5.6 =normal, 5.6- 6.9 = impaired glucose, >7 = diabetes)

A1C 7.6% (<5.7= normal, 5.7-6.4% = Pre diabetes or at risk, >6.5% = diabetes)

Renal panel: Creatine 178 (53-106mcmol/L) , eGFR 36 ml/min (>60 ml/min)

Cardiac markers: Troponin T high sensitivity 38 (3-14 ng/L) , NT proBNP >1800 pm/ml (<100pg/ml)

 

Working Diagnosis

New onset Congestive Heart Failure (systolic heart failure with ejection fraction <40%)

New diagnosis uncontrolled Atrial fibrillation

In-hospital Treatment and Course

Oxygen applied to maintain 02 saturations >92% (successfully weaned off day 3 of admission)

IV diuretics, furosemide 40mg IVPB BID x3 days (successfully decreased fluid volume)

Cardiac Ablation was performed once stable on day 5 due to persistent Atrial fibrillation not managed with pharmacologic interventions (successfully resulting in restored Normal Sinus rhythm)

Low sodium diet and fluid restriction 1.5L/day

Daily weights (discharge weight 88kg)

Medication adjustments (see new discharge medication list)

Vital signs at discharge: Temp. 36.7, HR 86, RR 18, O2 95% RA, BP 135/68.

Cardiac and Respiratory assessment as discharge: No SOB or accessory muscle use. Lungs clear throughout with adequate air entry. S1 S2, no S3/S4, Skin pink, warm, dry. Cap refill 2-3 seconds. +1 edema to ankles bilaterally. Heart rate regular, and strong. Concept Map And Case Analysis Nursing Care Of Patients With Cardiovascular Disorders

New Discharge Medications

ASA 81mg Daily

Amlodipine 5mg Daily (discontinued)

Carvedilol 3.125mg PO BID (*new)

Gliclazide MR 80mg PO daily (*new dose/formulation)

Metformin 500mg PO TID (*new dose)

Perindopril 8mg PO daily (*new dose)

Rosuvastatin 10mg PO daily

Spironolactone 25mg PO BID (*new)

Discharge Orders

 

Follow-up with Cardiologist in 3 months for repeat ECHO, 12 lead ECG, stress test, blood work, and physical assessment. Return to emergency department if symptoms of SOB, palpitations, weight gain, edema or fatigue return. Monitor and record daily weights and blood glucose. Strict medication compliance, fluid restriction 1.5/day, and low sodium diet.

 

 

Concept Map and Nursing Care Plan

For assignment 1 concept map and case analysis you are the RN in charge of James’ care and you want to develop a nursing care plan to provide direction for James’ discharge . Use the assessment data and information in the case scenario to guide your development of the one-page only concept map visual diagram. Identify and outline 6-10 nursing care priorities related to this case scenario and number the care priorities in level of importance. Include lines and arrows to visually display relationships and connections among concepts. Include linking words with the lines to indicate the nature of the connection or relationship (for example: leads to, influences, contributes to, results in, etc.)

Include a full nursing care plan (nursing diagnosis, SMART goals, nursing interventions supported with credible and current sources of evidence, and evaluation statements) with the first nursing care priority you have identified. This can be completed as an appendix attached to the paper portion of the assignment. Refer to the Assignment 1 and 2 marking guide in the Assessment Overview for further direction of the requirements of the concept map as well as case analysis. You may also find it useful to go back to Unit 1 and review the content related to Concept Mapping. Keep in mind the concept map in Unit 1 is not as fully detailed as we expect your concept map to be. The concept map is worth 65% of your entire mark for this assignment, so spend your time constructing this.

Choose three questions from the case analysis list below that correlate to your learning needs. Ensure that you are adequately integrating the case of James into your discussion. Answers for each question are limited to 250 – 400 words (per question) and you are expected to use credible and current sources of evidence to support your discussion. Please refer to the Using Evidence in Scholarly Writing document in the References & Help section of the course homepage. The case analysis discussion must also be written in APA formatting and citation style, you do not need to include and intro or conclusion.

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Case Analysis Questions

1. What dietary changes are recommended for heart failure and why?

2. Explain pre-load, afterload, and Frank Starling principle.

3. What are James’ risk factors for heart failure? Which ones are modifiable vs non-modifiable?

4. What is the difference between a dihydropyridine and non-dihydropyridine calcium channel blocker? Why was James prescribed Amlodipine prior to hospital admission?

5. What electrolyte abnormalities are anticipated in Heart failure patients and why?

6. Why are James’ troponin T High sensitivity levels elevated if he is not having an MI? List reasons why troponins may be elevated. At what range are troponin T High sensitivity levels indicative of an MI?

7. Why does James have a high creatinine and low eGFR? Explain the relationship Acute Kidney Injury (AKI) and heart failure.

8. What are 3 discharge priority teachings for James?

9. What allied health professional would you collaborate with to prepare James for discharge and why?

10. What is a cardiac ablation and what are 3 discharge teaching points for James after this procedure?

11. James is not interested in smoking cessation. You overhear a healthcare professional at the front desk say “I don’t know why we provide free healthcare to those who refuse to quit substance use. It’s just a waste of our hard-earned taxpayer money”. Discuss how these comments do not meet CARNA competency #2.5 “Identifies the influence of personal values, beliefs, and positional power on clients and the health-care team and acts to reduce bias and influences”. What 2 alternative competencies could be integrated in James’ care? Provide rationale. Concept Map And Case Analysis Nursing Care Of Patients With Cardiovascular Disorders

Resources Used

Canadian Cardiovascular Society. (2021). CCS/CHFS heart failure guidelines: defining a new pharmacologic standard of care for heart failure wit reduced ejection fraction. Retrieved from https://www.onlinecjc.ca/article/S0828-282X(21)00055-6/fulltext#secsectitle0010 doi: https://doi.org/10.1016/j.cjca.2021.01.017

Chiorescu, I.M., Dabija, E., Statescu, C., Grecu, M., & Georgescu, C.A. (2017). Diagnosis and management of wide QRS regular tachycardia. Research Gate DOI: 10.22551/2017.15.0402.10101

Darby, A. (2014). Management of atrial fibrillation in patients with heart failure. Journal of Atrial Fibrillation 7(2):1105. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5135259/#:~:text=Pharmacologic%20options%20for%20controlling%20the,tone%20on%20the%20atrioventricular%20node.

Fine, N.M. (2020). Heart failure (HF). Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary. Merck Manuals Retrieved from https://www.merckmanuals.com/professional/cardiovascular-disorders/heart-failure/heart-failure-hf#v935899

Fine, N.M. (2020). Drugs for heart failure. Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary. Merck Manuals. Retrieved from https://www.merckmanuals.com/professional/cardiovascular-disorders/heart-failure/drugs-for-heart-failure

Pagana, K. D., Pagana, T.J, Pike-MacDonald, S.A. (2013). Mosby’s manual of diagnostic and laboratory tests. 1st Canadian Ed. Elsevier

 

Hypertension Canada. (2015). XIII. Treatment of hypertension in association with heart failure. Retrieved from https://guidelines.hypertension.ca/prevention-treatment/hypertension-with-heart-failure/. Concept Map And Case Analysis Nursing Care Of Patients With Cardiovascular Disorders

 

HR Challenge: Choosing a Performance Appraisal System

Assignment Introduction
Scenario
You are a newly hired HR professional in a small private-sector company that provides a broad spectrum of products for the cruise ship industry. The company repackages standard personal grooming products, perfumes, and lotions into smaller gift packages appropriate for customer appreciation gifts. There are 300 employees in the firm, and the organization has a history of a stable workforce with very limited turnover. Recently, the company gained over 200 employees and there are several supervisory and managerial positions that need to be filled. The CEO has asked you to work with him to fill positions based on an organizational structure he has just created. It is rumored that the CEO has spoken discreetly to two internal candidates about the position and feels no need to take any action to announce the position internally. It should be noted that the employee manual specifies that all vacant positions be announced both internally and externally. New supervisors and managers are needed in sales (one), marketing (one), operations (two), and security (one). Each of these areas has seasoned employees eager to compete for jobs, though some may not be as qualified as external candidates. HR Challenge: Choosing a Performance Appraisal System

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Your Challenge
You are now in a situation with a tough call to make. As the responsible HR professional, you must consider and decide which course of action will provide the greatest benefit for the company and its employees, and how to make a persuasive argument for your recommendation. Your options are to support the CEO’s guidance, or to take a hiring position that protects the organization’s legal posture and maintains an ethical work environment.
Assignment Instructions
Prepare a 3–4 page plan that states your recommended course of action. Along with your recommendation, include the following:
Analyze how your proposed HR solution to an HR challenge contributes to organizational goals and strategies.Should you just follow the guidance of the CEO, or discuss the consequences of placing unqualified people in managerial roles?
If you remain silent without any further discussion, what might the implications be to you and the organization?
What is the potential opportunity cost of ignoring outstanding external candidates?
Describe key legal factors you considered in the formulation of a proposed HR solution. HR Challenge: Choosing a Performance Appraisal System
Explain the role of the HR practitioner in advancing a proposed HR solution.Briefly explain the role you will take to influence the eventual outcome. Consider aspects of leadership, negotiation, and consultation.
What pros and cons are there for promoting internally versus externally? Consider the implications to the organization and its operations when selecting from both of these populations.
Discuss the application of any SHRM behavioral competency(ies) to the process of solving an HR challenge.Which SHRM behavioral competencies are most directly applicable to a successful resolution of this challenge, and why?
Review the HR Challenge: Hire From Within or Outside? rubric to see the criteria by which your assignment will be evaluated.
Submission Requirements
The deliverable for this assessment applies professional skills in Human Resources Management (HRM) to workplace situations that you will likely encounter in your day-to-day work in HRM. As part of your learning, we focus on the development of effective professional communication skills for the workplace. Your assessment should meet the following additional requirements:
Length: Your plan should be 3–4 typed, double-spaced pages, not including the cover and resources pages.The first page should be a cover sheet with your name, the course number, assessment title, and date. No other information is required on this page. HR Challenge: Choosing a Performance Appraisal System

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The last page should be the reference list.
Organization: Make sure that your assessment writing is well organized, using headings and subheadings to organize content for the reader.
Font and font size: Times New Roman, 12-point font.
Resources: Use 2–4 references from trade publications.
Evidence: Support your assertions with data and/or in-text citations.
APA formatting: Resources and in-text citations are formatted according to current APA style and formatting.
Written communication:Support main points and recommendations with relevant and credible evidence.
Address the appropriate audience, using familiar, discipline-specific language and terminology.
Use spell-check and other tools to ensure correct spelling and grammar.
Competencies Measured
By successfully completing this assignment, you will demonstrate your proficiency in the following course competencies:
Competency 1: Analyze the ways in which the human resource function contributes to individual and organizational performance.Discuss the application of any SHRM behavioral competency(ies) to the process of solving an HR challenge.
Competency 2: Analyze the impact of the legal environment of human resource management policies and practices.Describe key legal factors considered in the formulation of a proposed HR solution.
Competency 3: Explain the strategic role of human resources in the support of organizational goals in a multicultural and global environment.Analyze how a proposed HR solution to a HR challenge contributes to organizational goals and strategies.
Competency 5: Analyze the strategic and operational roles that a human resource practitioner plays within an organization.Explain the role of the HR practitioner in advancing a proposed HR solution.
Competency 6: Communicate clearly, accurately, and professionally in the Human Resource Management field.Support main points and recommendations with relevant and credible evidence.
Address the appropriate audience, using familiar, discipline-specific language and terminology. HR Challenge: Choosing a Performance Appraisal System