Minimum of 300 words with at least 2 peer review reference

 

What is the difference between epigenetics and genetics? In nurse practitioner clinical practice, how would one apply the principles of epigenetics when prescribing treatment for a patient? What is the difference between hyperplasia, dysplasia, and metaplasia in relation to epigenetic disorders?

To prepare:

• Read the Diaz (2017) article and take note of their experience using the CFI and the advantages they found in the process. Also note the minority stress concerns that arise in those working with anxiety issues in different cultures.
• Review the CFI questions and readings in the DSM-5 on cultural variations, syndromes, and idioms.
• Meet your collaboration partner and take turns administering the CFI questions (and any needed subsections) to each other. Your partner will role-play an anxiety issue but otherwise be as true to their own situation as possible.
• Observe how the CFI administration process goes and take any notes needed. Based on what you learn about your partner’s needs and culture, you may need to do further research in the suggested readings and library before submitting your Assignment.

 

Submit a paper, using the Diaz article as well as additional resources about culture, in which you do the following:

• Describe the skills or techniques you used to engage your partner during the CFI.
• Explain which aspects of the CFI were the most helpful in learning about your partner’s personal view of the problem and situation from a cultural perspective.
• Describe the cultural components (e.g., race/ethnicity, religion, geographic region, socio-economic status, etc.) that may influence your partner, and analyze how those cultural components influence their mental health experience.
• Identify which relevant subsections of the CFI you used. Explain why you did (or did not) use a subsection as part of your assessment.
• Analyze how you, as a social work treatment provider, might adjust interventions for the client (your partner), their individualized circumstances, and culture of origin. Be specific and demonstrate critical thought through application of concepts in resources.
• Recommend a specific evidence-based measurement instrument to validate the diagnosis and assess outcomes of treatment. Explain any cultural considerations you made when determining an appropriate instrument, including whether or not the instrument was validated with diverse populations.

 In this assignment, you will create a PowerPoint to address the “Acid-Base Case Study.  The PowerPoint should be 10-15 slides and contain speaker notes.  Each of the following should be addressed:

1. Research and fill in the normal values for the table in the “Acid-Base Case Study” resource. Include the table in your PowerPoint.
2. What type of acid-base disturbance is Mr. Davis suffering from? Why?
3. What role does excessive alcohol consumption play in the acid-base disturbance seen?
4. What type of fluid or electrolyte imbalances does Mr. Davis have and why?
5. Calculate the anion gap. Is it high or normal? Why is it high or normal? What information does the anion gap give the provider?
6. Are Mr. Davis’ respiratory and renal systems attempting to compensate for his acid-base disturbance? If so, how are they compensating and what evidence do you have that they are compensating?
7. Explain the rationale for the low glucose level and high urine ketones.
8. Is the protein level seen in the UA abnormal? Provide a rationale. How do the findings relate to Mr. Davis?

For your Assignment, your Instructor will assign you one of the decision tree interactive media pieces provided in the Resources. As you examine the patient case studies in this module’s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders.

Photo Credit: Getty Images/Science Photo Library RF

To Prepare

• Review the interactive media piece assigned by your Instructor. 
• Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.
• Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.
• You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.

By Day 7 of Week 8

Write a 1- to 2-page summary paper that addresses the following:

• Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
• Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
• What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
• Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.

 

 

Complex Regional Pain Disorder
White Male With Hip Pain

BACKGROUND

This week, a 43-year-old white male presents at the office with a chief complaint of pain. He is assisted in his ambulation with a set of crutches. At the beginning of the clinical interview, the client reports that his family doctor sent him for psychiatric assessment because the doctor felt that the pain was “all in his head.” He further reports that his physician believes he is just making stuff up to get “narcotics to get high.”

SUBJECTIVE

The client reports that his pain began about 7 years ago when he sustained a fall at work. He states that he landed on his right hip. Over the years, he has had numerous diagnostic tests done (x-rays, CT scans, and MRIs). He reports that about 4 years ago, it was discovered that the cartilage surrounding his right hip joint was 75% torn (from the 3 o’clock to 12 o’clock position). He reports that none of the surgeons he saw would operate because they felt him too young for a total hip replacement and believed that the tissue would repair with the passage of time. Since then, he reported development of a strange constellation of symptoms including cooling of the extremity (measured by electromyogram). He also reports that he experiences severe cramping of the extremity. He reports that one of the neurologists diagnosed him with complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy (RSD). However, the neurologist referred him back to his family doctor for treatment of this condition. He reports that his family doctor said “there is no such thing as RSD, it comes from depression” and this was what prompted the referral to psychiatry. He reports that one specialist he saw a few years ago suggested that he use a wheelchair, to which the client states “I said ‘no,’ there is no need for a wheelchair, I can beat this!”

The client reports that he used to be a machinist where he made “pretty good money.” He was engaged to be married, but his fiancé got “sick and tired of putting up with me and my pain, she thought I was just turning into a junkie.”

He reports that he does get “down in the dumps” from time to time when he sees how his life has turned out, but emphatically denies depression. He states “you can’t let yourself get depressed… you can drive yourself crazy if you do. I’m not really sure what’s wrong with me, but I know I can beat it.”

During the client interview, the client states “oh! It’s happening, let me show you!” this prompts him to stand with the assistance of the corner of your desk, he pulls off his shoe and shows you his right leg. His leg is turning purple from the knee down, and his foot is clearly in a visible cramp as the toes are curled inward and his foot looks like it is folding in on itself. “It will last about a minute or two, then it will let up” he reports. Sure enough, after about two minutes, the color begins to return and the cramping in the foot/toes appears to be releasing. The client states “if there is anything you can do to help me with this pain, I would really appreciate it.” He does report that his family doctor has been giving him hydrocodone, but he states that he uses is “sparingly” because he does not like the side effects of feeling “sleepy” and constipation. He also reports that the medication makes him “loopy” and doesn’t really do anything for the pain.

MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. He is dressed appropriately for the weather and time of year. He makes good eye contact. Speech is clear, coherent, goal directed, and spontaneous. His self-reported mood is euthymic. Affect consistent to self-reported mood and content of conversation. He denies visual/auditory hallucinations. No overt delusional or paranoid thought processes appreciated. Judgment, insight, and reality contact are all intact. He denies suicidal/homicidal ideation, and is future oriented.

Diagnosis: Complex regional pain disorder (reflex sympathetic dystrophy)

Decision Point One

Select what you should do:

Savella 12.5 mg orally once daily on day 1; followed by 12.5 mg BID on day 2 and 3; followed by 25 mg BID on days 4-7; followed by 50 mg BID thereafterAmitriptyline 25 mg po QHS and titrate upward weekly by 25 mg to a max dose of 200 mg per dayNeurontin 300 mg po BEDTIME with weekly increases of 300 mg per day to a max of 2400 mg  

 

PLEASE PAY ATTENTION TO MY CASE STUDY

five references not more than 5 years

Zero plagiarism