Behavioral Health in the Community

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Behavioral Health in the Community

Case Study

Chapter 27

Behavioral Health in the Community The principal escorted Audrey, aged 13, an overweight girl with long blonde braids into the rural middle school nurse’s office. “Ms. Schmitz will help you, Audrey.” The principal signaled for the girl to sit down and then handed Ms. Schmitz, RN, a note and left. The note bulleted three lines:“Disruptive, fighting, teacher requests a home visit.”Ms. Schmitz extended a wet facecloth while assessing Audrey’s appearance. Audrey wiggled on the wooden chair wearing torn and too small clothing, tennis shoes with holes, and a full backpack. “Place this on your eyes, and see if it helps.” The crying child’s tongue poked out the right side of her mouth and she swallowed several times as she reached for the cloth. “Are you hurt?” asked the nurse.Audrey shook her head. “I have a sore throat though.” She shrugged her shoulders. “I wish I were dead. I could jab a pencil in my eye and bleed to death. That would fix them.”“You sound pretty upset. Tell me what happened.”“Brian made fun of my tics. I can’t help it. I am so tired of people laughing at me, my clothes and my mother. I hit him with a book because he wouldn’t stop. I bet he never thought I would hit him. I am not a bully, Brian is.” A fresh bout of sobbing doubled the girl in half.The nurse read Audrey’s health record. Learning disabilities, ADHD, Tourette’s disorder,prenatal drug exposure, R. 20/80 and L. 20/100 vision, a normal scoliosis screening, and free lunch eligibility. The nurse searched for a telephone number. “I need to call your mother.”The school secretary said, “There is no phone. I can give you the case worker’s contact.”“Momma is sick,” said Audrey and swallowed. “She won’t answer the door”.

1. What will be included in the school nurse’s assessment plan?

2. What resources should be explored?

Working with the Homeless

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Working with the Homeless

Case Study

Chapter 28

Working with the Homeless Sally Anne, aged 19, brought two children into the emergency room. The 6-month-old boy’s complaints are a cold with mild fever, fatigue, vomiting with dry coughing spells, decreased intake of cola (2 ounces every 3 hours—her version of clear liquids), one scraped diaper per 12 hours—the diaper is not soaked so Mom recycles it after scrapping off the solids. The child’s cry is weak,red eyes, sneezing moves thick mucus, prolonged cough, high-pitched noise during intake. The child’s condition did not improve over the last 24 hours.The family of three lives in the family sedan parked behind a service station due to Mom’s fear of lack of shelter safety. Turk, the 3-year-old, sports bruises on arms and legs, and a knot on his forehead. He appears semiconscious (responds to light pain), coughs when disturbed, refuses fluids and food, and pulls away from touch. Mother states that he has been sick for more than a week, but she is concerned that he has not been as fussy the last 24 hours. His skin tents when pinched. Sally Anne believes he lost weight but has not used a scale. Turk does not look adults in the eye or follow a finger point. He moans but has not communicated with words. He appears to fantasize, and finger plays violently. His fingers seem to attack each other. He does not seem to listen nor does he respond to questions. Both children are wearing dirty clothing. Mom is exhausted and asks for help with formula and diapers.Treatment: Both children kept overnight for assessment in a room with a bathroom and couch. Mother permitted to bath and wash children’s clothing after their baths. Cooling mist tent ordered. Children placed next to each other for convenience and for precautions. Social worker involved for discharge planning. The boys are placed on IVs for hydration and given clear fluids for drinking. Antibiotics are placed in the IV.

1. What information is needed for a complete assessment?

2. Will this family be worse off when released from the hospital? What community resources

for homeless families could be activated in the small town? What prevents the family from

falling through economic cracks that will prevent developmental assessments and

treatments?

Issues with Rural, Migrant, and Urban Health care

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Issues with Rural, Migrant, and Urban Health care

Case Study

Chapter 29

Issues with Rural, Migrant, and Urban Health Care Marty, a 75-year-old male, with a history of myocardial infarction called home complaining of heartburn and running out of antacids. When his daughter-in-law reminded him to maintain his rest and diet times, Marty grew angry. “Knock it off. I am doing fine despite what the doctor said. I will care for the diabetes after the harvest and I will come home as soon as I can.” Driving his combine formation with other workers for a night harvest, Marty paused at 9:45 PM for a break while the rest of the combine formation continued moving forward. Marty’s 6-year-old grandson rode in the combine with him to experience his first night harvest. No further communication was received from Marty’s combine.The boy’s mother called again at 10:00 PM with no answer. Used to “farmtime” and dead space for the cell phones, she was not overly worried but was concerned about her son being out so late at night. The mother called her spouse who drove another combine in a different field to find out why the boy was not yet home. The father dispatched a truck to find Marty while the combines continued harvesting and gleaning.The truck driver found the missing combine on its side in a gully with the lights shining upward. A satellite phone was used to notify the Northern Air Ambulance and the local 911 of GPS coordinates. The volunteer flight and paramedic teams were dispatched. The Italian-made Agusta Power-109 helicopter used instruments to fly over two counties of hilly terrain. The single pilot employed night vision goggles to study the instrument panel and the radio to keep the pilot informed of ground rescue operations and hospital preparations. The flight nurses double checked the laryngoscopes, blood supplies, and jump kits while maintaining contact with the first scene arrivals.

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When the paramedic vehicle arrived, an employee truck was seen driving away from the combine. Marty was unconscious with a weak, irregular pulse of 100,BP of 65/48, and respirations of 26. A bruise over the right mastoid is noticed. The grandson is conscious and crying, splinted for a broken leg. His pulse is 120, BP138/118, and respirations of 24. Purple circles are seen around his eyes. The 6-year-old complains of a headache and calls for his mother.

1. How will the nurse gather needed information to effect a successful rescue?

2. What travel and emergency transport resources are available?

3. What rural barriers to diagnosis, treatment, and follow-up resources exist?

4. What roles do rural nursing theory principles play in Marty’s health behaviors?

5. The nearest critical access hospital does not have a trauma level due to the lack of a 24-hour staff with trauma training. What types of trauma support do patient needs indicate?

Health Promotion

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Achieving Change Through Education

Case Study

Chapter 11

Health Promotion: Achieving Change Through Education. The community health nurse is preparing a smoking cessation program to be presented at the local high school for individuals who are thinking about quitting smoking. The community health nurse is identifying appropriate education activities that include the three domains of learning and the three stages of change.

1. The community health nurse has to consider the three stages of change in considering individual reasons to stop smoking. What are the three stages of change?

2. Planned or managed change is a purposeful, designed effort to effect improvement such as smoking cessation with the help of a change agent who is the community health nurse. What are the eight steps of planned change that the community health nurse needs to consider?

3. The community health nurse understands that encompassing strategies are the critical change strategies to consider in planning the health education program. What are the three major change strategies that must be considered by the community health nurse?

4. The community health nurse understands that the nature of learning contributes to the effectiveness of teaching on smoking cessation. The nurse needs to include the three domains of learning in the presentation. What are the three learning domains that must be considered in planning the education program?

communicable disease outbreak

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communicable diseases

Case Study

Chapter 8

Knowledge of communicable diseases is fundamental to the practice of community/public health nursing because these diseases typically spread through communities of people. The community health nurse has to complete an investigation about a Salmonella outbreak in the local community that occurred from food served at a local fast-food chain .

1. Prior to contacting the individuals in the community who are affected with Salmonella for an interview, what key items must be completed by the community health nurse in the process of investigating a reportable communicable disease?

2. What key things should be considered by the community health nurse during the interviews of those individuals with Salmonella?

3. There are three modes of transmission for communicable diseases. Provide a brief description of the three modes of transmission. Which mode of transmission is involved for the Salmonella communicable disease outbreak?

4. There are several strategies used for the three levels of prevention in communicable disease control. What types of prevention methods and activities are considered to prevent communicable disease, such as Salmonella, from occurring in a community?

community health nurses

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    • Impact of Disaster, Terrorism, and War

Case Study

Chapter 17

Being Prepared: Impact of Disaster, Terrorism, and War Many opportunities are available for both student nurses and experienced community health nurses to become involved in emergency preparedness and response efforts. A disaster is any event that causes a level of destruction that exceeds the abilities of the affected community to respond without assistance.Disasters may be caused by natural or man-made/technologic events and may be classified as multiple-casualty incidents or mass-casualty incidents. Student nurses are developing a plan on how to approach the upcoming community-wide disaster drill.

1. What characteristics of disasters, including causation, number of casualties,

scope, and intensity, should the student nurses consider?

2. What factors contribute to a community’s potential for experiencing a

disaster?

3. What are the four phases of disaster management that must be included in

the student nurses planning for the drill?

4. Using the levels of prevention, what is the role of the community health

nurse in relations to acts of chemical, biologic, or nuclear terrorism

Note

Answers must:

Be 300 words or more

Use the stand English grammar and spelling

References are cited APA

Ethical approach in institution

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Ethical approach in institution

You are a nurse in a Third World country in a small village of 150 people (adults and children – roughly equal in numbers). There is an outbreak of a deadly infection which is easily treated with a specific antibiotic. Untreated, the mortality rate is close to 100%. However, you only have enough to treat 25 adults or 50 children. Additional dosages are on their way but are not expected to arrive before the disease will run its course. Note that anyone over 11 is considered an adult and you are in as much danger from the infection as everyone else.

What do you do? What is the ethical approach in this situation? How do you treat the community knowing that you may have to watch some die while you reserve treatment for specific individuals?

You MUST choose an action. If you waffle or refuse to state who gets treated and why

Training programs

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Training programs for the technology

Discuss what training programs are needed for the technology required for your final presentation topic.  Consider what training to provide to new employees and what on-going training may be necessary. Training program : Epic Software

Your initial posting should be at least 400 words in length and utilize at least one scholarly source other than the textbook. Please reply to at least two classmates.  Make up Replies to classmates should be at least 200 words in length.

diagnostic reasoning and therapeutic decision making

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Diagnostic reasoning and therapeutic decision making

Please provide an example of a case study with the provided presenting complaint specific to each of these systems. This case should present the clinical approach and decision-making process involved in diagnostic reasoning and therapeutic decision making.

 

Include the following in each case: 

Subjective data- questions to be asked

Objective data- Expected physical findings

Differential Diagnosis

Cannot miss diagnosis (Important diagnosis which CANNOT be missed)

Final Diagnosis

Clinical Guideline for specific diagnosis

Treatment

Follow-up

Prognosis

The preceptor

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Aspects of developing the proposal

What aspects of developing the proposal were most enjoyable? What aspects of developing the proposal were most challenging?

The aspects of developing the proposal that were the most enjoyable were the translation of the project’s vision. However, if the rigor of the proposal was challenging, it was pleasant to go to every step of the proposal and envision the finished product. The challenges were the quantity of information delivered one by one and the strict requirements. The most difficult part for me was the budget. Patients will be coming to the clinic and project or not, their fingerstick blood glucose will be taken and recorded. I felt it was difficult to separate the cost related to the project from the cost of day-to-day activities.

The preceptor

My preceptor is a role model in daily practice, and she kept her qualities during this session. She received the proposal’s different phases by email, especially in Week 4 and 6, for review.  ideas, questions and shared her suggestions which were all incorporated into the proposal. Working in the same organization, in similar clinics with the same population, I felt she was the best person to comprehend and “feel” the project.

Project dissemination

Following the AACN essentials, the DNP project should provide recommendations for dissemination and sustainability (AACN, 2006). The project should be meaningful and lead a change in practice to continue after the DNP project. The DSMES at the FQHC should become part of the routine and direct patient care. This education should be embedded in daily practice and offered to everyone presenting to the clinic. To ensure sustainability, the DNP project must be selected with the approval of the practicum site as a need for practice (Turkson‐Ocran et al., 2020). If the results are favorable, it is expected to be ruled out to three other FQHCs in the organization.

Recommendations for potential DNP students

Don’t do it! You will lose your sleep and mind! Or, if you decide that it is essential to you, try to work part-time to allow plenty of time to do and redo, and redo your work. Make sure your schedule is open and do not take other obligations. Before starting, review the expectations and your understanding of Evidence-Based Practice (Volkert & Johnston, 2018). If your program is rigorous, strict, and with high expectations, the quality of your work will only benefit from it. This will be challenging and character proving, but bring you personal satisfaction.

American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice. Https://www.aacnnursing.org/Portals/42/Publications/DNPEssential.pdf (Links to an external site.)

Turkson‐Ocran, R., Spaulding, E. M., Renda, S., Pandian, V., Rittler, H., Davidson, P. M., Nolan, M. T., & D’Aoust, R. (2020). A 10‐year evaluation of projects in a doctor of nursing practice programme. Journal of Clinical Nursing, 29(21-22), 4090–4103. https://doi.org/10.1111/jocn.15435 (Links to an external site.)

Volkert D, & Johnston H. (2018). Unique Issues of DNP Students: A Content Analysis. Nursing education perspectives. 2018;39(5):280-4. http://dx.doi.org.chamberlainuniversity.idm.oclc.org/10.1097/01.NEP.0000000000000379