Day: September 6, 2020

A 29-year old woman who is three months postpartum with her fifth child comes to the clinic to talk about her worsening depression.  You have cared for this woman over the years, most recently for her prenatal care and delivery. During that time she took herself off all psych/mental health drugs which included Zoloft 100mg and buspar 15mg TID for anxiety.  She is a long term pot smoker at least 2 x a day and smoked pot during her pregnancy for nausea. You counseled her several time to stop. She had a stable pregnancy and did not have any symptoms of depression during the pregnancy.  She is married to the father of all of her children and has a good relationship with him. Lately she has been more withdrawn at home and wants to just stay in her room with the baby all day. In a bipolar assessment of her symptoms (MDQ) screening questionnaire, she scored very high on the bipolar scale.  You know that her previous meds have not helped her symptoms and she goes though time when she cannot sleep for weeks at a time.

CC: I get sad and angry a lot during the day even at the children and I love my kids and always strive to be a good mom. I just want to feel better!

Questions:

1. What are the important elements to the description of her depression and why?

2. Does this meet the DMV 5 definition of major depression?  Why or why not?

3. What else might you want to know from this patient?

4. What is her differential diagnosis and what is the most like diagnosis?

5. Describe the plan of care for this patient.

6. Discuss the difference of major depression and bipolar disease in women.

PLEASE ANSWER ALL THE QUESTIONS AND PROVIDE REFERENCES

The final step is to develop the plan discussing the steps clearly and succinctly. The plan must be evidence based .
Post an explanation of how you could apply key interventions supported by the scholarly research evidence to potentially help resolve the issue in measurable ways. Continue to collaborate with the selected individuals in your practice environment as needed in the development of the Practice Experience Project, and share this information with your group.

RUBRIC:
Explains the key interventions supported by the scholarly evidence to potentially help resolve the issue in measurable ways. Continues to collaborate with the selected individuals in the practice environment as needed in the development of this project and shares this information with the group.
Writing and Format

Uses evidence to support a claim and give credit to the source. Uses course learning resources and seeks additional scholarly resources to support ideas. Displays sentence, paragraph, and essay skills. Writes in a scholarly, well-organized manner using own words by synthesizing evidence/resources. Paraphrases to avoid plagiarism of the source. APA: No more than one short, unique quote with correct APA format. Appropriate use and format of in-text citations and reference list.

As a nurse, you serve an important role in identifying strategies to effectively manage health care resources and in leading health care quality improvement. You must be able to decide what leadership style or strategy to apply in a given situation to achieve an effective resolution of the issue. Read the following two scenarios and select one to focus on in this Discussion. Consider the leadership style or strategy that might be most effective in the scenario you selected.

Scenario 1
You work in a for-profit nursing home, with about 100 beds, on a 20-bed unit that is largely patients with Alzheimers disease. Your patient mix is predominantly Medicare and Medicaid patients. Your nursing home is part of a larger system that includes a major medical center, as well as VNA, outpatient dialysis, and a fully integrated network. Your nurse manager is getting feedback from the hospital that your nursing home is sending too many patients to the ED who really dont need to go. How would you go about figuring out what could be done at the nursing home to prevent avoidable ED visits?

Scenario 2
Youve been associated with an outpatient cardiology clinic that is part of a large academic medical center. Your patients are mostly charity care and managed Medicaid. Most have a prescription plan, but none have a family doctor and use the clinic (and the ED) regularly. Most are unfamiliar with their medications and do not have the resources for care coordination in their family/social network. About 25 CHF patients have been lovingly, but inappropriately, called frequent fliers because of their inability to manage their own care, their frequent visits to the ED, and their one night stays paid at the observation rate. As a staff nurse in this clinic, describe the strategies you could devise for you and your fellow staff nurses targeting these 25 patients. Find at least one article from the professional literature to corroborate your recommendations

Select one of the scenarios, and post the following:

Describe the most appropriate leadership style and/or strategy to apply in the scenario you chose in order to implement the recommendations successfully. Justify your selection.

Support your response with references from the professional nursing literature. Your posts need to be written at the capstone level (see checklist)

Notes Initial Post: This should be a 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually 5 years old). (Refer to AWE Checklist, Capstone