NURS 6660 Entire Course Weekly Discussions And Assignments

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NURS 6660 Entire Course Weekly Discussions And Assignments

NURS 6660: Psychiatric Mental Health Nurse Practitioner Role I: Child and Adolescent 

NURS 6660 Week 1: Comprehensive Integrated Psychiatric Assessment

“We adopted Maria from an orphanage in Guatemala when she was 4 years old. We were hoping she would love us as much as we love her, but she is always so distant and will not let us get close. She continually bumps her head on the wall and screams when we try to make her stop. She is now 5, and we have tried everything to help her understand that we just want to love her and have her be part of our family.”

Jessica and Jason, Parents of 5-year-old Maria

The delicate dance—engagement and empathy.

Laureate Education (Producer). (2017d). Working with Children and Adolescents [Video file]. Baltimore, MD: Author.

The comprehensive integrated psychiatric assessment is one of the most important elements of the psychiatric-mental health nurse practitioner’s (PMHNP) skill set to understand, diagnose, and develop a treatment plan for Maria. The psychiatric interview is a craft by which one human being becomes acquainted with another’s deepest thoughts, fears, emotions, and behavior. “This task is not unlike exploring a darkened room in an old Victorian house” (Shea, p. 3) with only a candle for illumination. As the PMHNP sees more of the client’s life unfold, the picture becomes clearer.

This week, you explore in depth the elements of the comprehensive integrated psychiatric assessment and diagnostic process.

The comprehensive integrated psychiatric assessment of a child or adolescent consists of gathering information from not only the child but from several sources, most notably the family members, caregivers, and the child’s teacher or school counselor. Because of this, the diagnostic assessment becomes more complicated. Issues of confidentiality, privacy, and consent must be addressed. Also, the PMHNP must take into consideration the impact of culture on the child.

In this Discussion, you review and critique the techniques and methods of a mental health professional as he or she completes a comprehensive integrated psychiatric assessment of an adolescent.

Learning Objectives

Students will:

  • Evaluate comprehensive integrated psychiatric assessment techniques
  • Recommend assessment questions

To Prepare for the Discussion:

  • Review the Learning Resources concerning the comprehensive integrated psychiatric assessment.
  • Watch the Mental Status Examination video.
  • Watch the two YMH Bostonvideos.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts and cannot post anonymously. Please check your post carefully before clicking Submit!

By Day 3

Based on the YMH Boston Vignette 4 video, post answers to the following questions:

  • What did the practitioner do well?
  • In what areas can the practitioner improve?
  • At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
  • What would be your next question, and why?

By Day 6

Respond to at least two of your colleagues by offering additional insights or alternative perspectives on their diagnosis or provide alternate next questions and why you selected those.

NURS 6660 Entire Course Weekly Discussions And Assignments

Assignment: Practicum Journal Entry: Analyzing an Ethical Decision

In your role as a PMHNP, you will encounter several situations that will require your ability to make sound judgments and practice decisions for the safety and well-being of individuals, families, and communities. There may not be a clear-cut answer of how to address the issue, but your ethical decision making must be based on evidenced-based practice and what is good, right, and beneficial for patients. You will encounter patients who do not hold your values, but you must remain professional and unbiased in the care you provide to all patients regardless of their socio-demographic and ethnic/racial background. You must be prepared to critically analyze ethical situations and develop an appropriate plan of action. For this Assignment, you review the literature and discover the various ethical dilemmas PMHNPs encounter and how these issues are typically addressed in your state.

Learning Objectives

Students will:

  • Analyze salient ethical issues in psychiatric mental health practice
  • Compare ethical dilemmas with state health laws and regulations
  • Analyze ethical decision-making processes

To prepare:

  • Review literature for moral/ethical issues encountered by a PMHNP.
  • Select one of the articles you found that was published within the last 5 years to use as a focus for this assignment.

Write a 2-page paper in which you do the following:

  • Summarize the moral/ethical issue in the article (no more than 1 paragraph).
  • Describe the moral and ethical dilemmas surrounding the issue.
  • Analyze the ethical issue and compare them to the state health laws and regulations in your state.
  • Outline the process of ethical decision making you would use to address this ethical dilemma.

Note: Be sure to use the Practicum Journal Template, located in this week’s Learning Resources.

By Day 7 of Week 4

Submit your Assignment.

NURS 6660 Entire Course Weekly Discussions And Assignments

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NURS 6660 Week 2: Assessment in Child and Adolescent Psychiatry

Kathryn Barnard was a nurse first and second an early developmental specialist with a PhD in early ecological development. Dr. Barnard, with her nursing background, was instrumental in developing assessment tools and interventions to promote infant mental health. A center is named after her at the University of Washington, aptly named the Kathryn Barnard Center for Infant Mental Health and Development. Dr. Barnard reminds us that mental health is lifelong. Proper treatment of children from their earliest moments is instrumental to their development. One of her sayings was “infants can’t wait” (Weber, 2015).

All diagnosis, from infancy to adulthood, begins with an examination. While an organic basis for most medical disorders can be determined through the use of diagnostic testing, the field of psychiatry is different in that patients cannot be sent to the lab for blood tests to determine the degree of depression. Similarly, patients cannot be sent to the radiology department for a “scan” to determine how severe their bipolar disorder is. Instead, the field of psychiatry must use psychiatric assessments such as the comprehensive integrated physical exam, diagnostic interviews, and questionnaires to make diagnoses. These tools must be specialized to address the needs of children and adolescents.

Diagnostic assessment of the child and adolescent is a specialized area of expertise. Some of the diagnostic and clinical features will be like your assessment of the adult. However, the PMHNP will be seeing children who have been to the PCP. Many PCPs are comfortable handling ADHD and other straightforward childhood disorders. That means that the PMHNP and those in his or her office will be seeing the more complicated patients.

This week, you explore the many different psychiatric assessment tools and begin to explore treatment options. You also begin developing your resume and portfolio.

Infant, childhood, and adolescent development are a continual interplay between nature (genetic or biologic predisposition) and nurture (environmental experiences). The nature/nurture continuum and debate will always be a part of your career as a PMHNP.  Knowing common developmental milestone is important in the role as a child provider. Not only is it essential to the diagnostic process, but it is also important to the interdisciplinary interactions with other mental health professionals. The study of normal developmental processes, however, is only one tool that allows the mental health professional to understand the child being evaluated. There are many different assessment instruments and interviewing techniques that PMHNPs can have in their toolkit when working with children and adolescents.

In this Discussion, you examine the differences in assessing and treating children and adolescents versus adults. You take into consideration your own clinical experiences, as well as your experiences in your clinical rotation, and the information from the readings thus far.

Learning Objectives

Students will:

  • Analyze the importance of developmental assessments
  • Analyze assessment instruments used for evaluating children and adolescents
  • Analyze treatment options used for children and adolescents
  • Analyze roles parents play in assessment and treatment

To Prepare for the Discussion

  • Review the Learning Resources concerning psychiatric assessments and assessment tools.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts and cannot post anonymously. Please check your post carefully before clicking Submit!

By Day 3

Post your answers to the following:

  • Explain why a developmental assessment of children and adolescents is important.
  • Describe two assessment instruments and explain why they are used for children and adolescents but not adults.
  • Describe two treatment options for children and adolescents that may not be used when treating adults.
  • Explain the role parents play in assessment and treatment.

By Day 6

Respond to at least two of your colleagues by offering additional insights or alternative perspectives on their diagnosis or provide alternate next questions and why you selected those.

NURS 6660 Entire Course Weekly Discussions And Assignments

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Nurs 6660 Week 3 Assignment Practicum: Decision Tree- A young girl with difficulties in school

Case #1 :A young girl with difficulties in school

BACKGROUND

In psychopharmacology you met Katie, an 8-year-old Caucasian female, who was brought to your office by her mother (age 47) and father (age 49). You worked through the case by recommending possible ADHD medications. As you progress in your PMHNP program, the cases will involve more information for you to sort through.

For this case, you see Katie and her parents again. The parents have reported that the medication given to Katie does not seem to be helping. This has prompted you to reconsider the diagnosis of ADHD. You will consider other differential diagnoses and determine what information you need to accurately assess the DSM-5 criteria to make the diagnosis of ADHD or another disorder with similar diagnostic features.

When parents bring their child to your office, they may have read symptoms on the internet or they may have been told by the school “your child has ADHD”. Your diagnosis will either confirm or refute that diagnosis.

Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine a differential diagnosis and to begin medication, if indicated. The PMHNP makes this diagnostic decision based on interviews and observations of the child, her parents, and the assessment of the parents and teacher.

To start, consider what assessment tools you might need to evaluate Katie.

Child Behavior Check List

Conners’ Teacher Rating Scale – Practicum: Decision Tree A young girl with difficulties in school

The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised” (Available at: https://www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/GetPdf.cgi?id=phd000099.1 ). This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, makes careless mistakes in her schoolwork, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. She has difficulty interacting with peers in the classroom and likes to play by herself at recess.

When interviewing Katie’s parents, you ask about pre- and post-natal history and you note that Katie is the first born with parents who were close to 40 years old when she was born. She had a low 5 minute Apgar score. The parents say that she met normal developmental milestones and possibly had some difficulty with sleep during the pre-school years. They notice that Katie has difficulty socializing with peers, she is quiet at home and spends a lot of time watching TV.

SUBJECTIVE

You observe Katie in the office and she is not able to sit still during the interview. She is constantly interrupting both you and her parents. Katie reports that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds some subjects boring or too difficult, and sometimes hard because she feels “lost”. She admits that her mind does wander during class. “Sometimes” Katie reports “I will just be thinking about something else and not looking at the teacher or other students in the class.”

Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. She offers no other concerns at this time.

Katie’s parents appear somewhat anxious about their daughter’s problems. You notice the mother is fidgeting with her rings and watch while you are talking. The father is tapping his foot. Other than that, they seem attentive and straight forward in the interview process.

MENTAL STATUS EXAM

The client is an 8-year-old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. Affect is neutral. Katie says that she doesn’t hear any ‘voices’ in her head but does admit to having an imaginary friend, ‘Audrey’. No reports of delusional or paranoid thought processes. Attention and concentration are somewhat limited based on Katie’s short answers to your questions.

Evaluate clients for treatment of mental health disorders

Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders

Examine Case 1. You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.

At each Decision Point, stop to complete the following:

Decision #1: Differential Diagnosis

  • Which Decision did you select?
  • Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?

Decision #2: Treatment Plan for Psychotherapy

  • Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?

Decision #3: Treatment Plan for Psychopharmacology

  • Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
  • What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
  • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
  • Also include how ethical considerations might impact your treatment plan and communication with clients and their families.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

Decision Point One

BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHAT IS YOUR DIAGNOSIS FOR KATIE?

In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.

Decision Point One

314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation

RESULTS OF DECISION POINT ONE

Client returns to clinic in four weeks

You selected Attention deficit hyperactivity disorder, predominantly inattentive presentation. Based on this choice, outline the remainder of the diagnostic evaluation that you will conduct on this child and their parents. Be sure to include standardized assessment instruments that you would administer

Decision Point Two

Begin Adderall XR 10 mg orally daily

RESULTS OF DECISION POINT TWO

Client returns to clinic in four weeks

Katie’s parents seem absolutely delighted upon their return stating that Katie is paying more attention in school, but note that there is still room for improvement, particularly in the afternoon

They report that Katie’s teacher has reported that Katie is able to maintain her attention throughout the morning classes but come afternoon, she “daydreams.”

Katie’s parents are also concerned about her decrease in appetite since starting the medication

Decision Point Three

Add a small dose of immediate release Adderall in the early afternoon

Guidance to Student

Whereas weight loss is common with stimulant medication, this option does not address Katie’s parents’ concerns about the return of symptoms in the afternoon.

Augmentation with family therapy is also a good idea as it can help Katie with her symptoms and further help her parents to understand the unique challenges that Katie experiences, as well as ways that they can help her with symptoms, however, this option does not address the return of inattentive symptoms in the afternoon.

Adding a small dose of immediate relate Adderall in the afternoon can help Katie to maintain attention throughout the afternoon and into the early evening when she must do homework. This would be the best option.

WHY ARE THE FOLLOWING BELOW CHOICES NOT CHOOSEN FOR DECISION POINT ONE

299.00 Autism Spectrum; Disorder ASD mild and co – Occuring; 300.23 Social Anxiety Disorder

WHY ARE THE FOLLOWING BELOW CHOICES NOT CHOOSEN FOR DECISION POINT TWO

Why are these below medications choices not selected based on the diagnosis and the parent’s concerns, to begin Risperal 0.5mg po bid, to beginCelexa 20mg po daily,  to begin Olanzapine 5mg po daily

READING REQUIREMENT

Required Readings

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

Standard 5E “Pharmacological, Biological and Integrative Therapies” (page 59)

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

Chapter 3, “Contributions of the Sociocultural Sciences” (pp. 131–150)

Chapter 31, “Child Psychiatry” (pp. 1152–1181, 1244–1253)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

“Neurodevelopmental Disorders”

“Intellectual Disabilities”

“Communication Disorders”

“Disruptive, Impulse-Control, and Conduct Disorders”

Note: You will access this book from the Walden Library databases.

Volkmar, F., Siegel, M., Woodbury-Smith, M., King, B., McCracken, J., & State, M. (2014). Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 53(2), 237–257. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00819-8/pdf

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NURS 6660 Entire Course Weekly Discussions And Assignments

NURS 6660 Week 4: Trauma and Stressor-Related Disorders in Childhood

“He was drunk again, so I should have known better. I should have stayed away from the house, but that would have made him madder. He has done this before, but not nearly this bad. He broke my wrist as I was protecting my mom. The neighbor heard the screaming and called the cops. They hauled him away, but I know he will be back. She always lets him come back.”

Avery, age 14

In August of 2005, thousands of children lost their homes in Hurricane Katrina. On December 14, 2012, the students at Sandy Hook Elementary School experienced the death of 20 of their classmates and six of their teachers. Every day, children experience physical and sexual abuse and neglect by their parents or caregivers. These types of trauma have a lifelong impact on the children involved and those witnessing the events. As much as we try to prevent unwanted childhood trauma and stressors, the phenomena are present in our culture. Childhood trauma is a significant contributor to both physical and mental health problems in children and adults.

This week, you examine several cases of child abuse and neglect, and you recommend strategies for assessing for abuse. You analyze influences of media and social media on mental health and evaluate the need for mandatory reporting of abuse. You also submit your Practicum Journal and Assignments.

In 2012, statistics in the United States indicated that state CPS agencies received 3.4 million referrals for child abuse and neglect. Of these, nearly 700,000 children were found to be victims of maltreatment: 18% were victims of physical abuse and 78% were victims of neglect (CDC, 2014). Child sexual abuse makes up roughly 10% of child maltreatment cases in the United States (CDC, 2014). The CDC considers sexual abuse at any age a form of violence. Child abuse of any kind can lead to an increased state of inflammatory markers in adulthood, as well as multiple physical illnesses and high-risk behavior such as alcoholism and drug abuse. If a PMHNP identifies child abuse, there may be a need to report the abuse to authorities. Once able to provide treatment, the PMHNP can be instrumental in reducing the long-term effects of child abuse.

In this Discussion, you recommend strategies for assessing for abuse and analyze influences of media and social media on mental health. You also evaluate the need for mandatory reporting of abuse.

Learning Objectives

Students will:

  • Recommend strategies for assessing for abuse
  • Analyze influences of media and social media on mental health
  • Evaluate the need for mandatory reporting of abuse

To Prepare for this Discussion:

  • Read the Learning Resources concerning treating childhood abuse.
  • Read the Child Abuse Case Study in the Learning Resources.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts and cannot post anonymously. Please check your post carefully before clicking Submit!

By Day 3

Post:

  • What strategies would you employ to assess the patient for abuse? Explain why you selected these strategies.
  • How might exposure to the media and/or social media affect the patient?
  • What type of mandatory reporting (if any) is required in this case? Why?

By Day 6

Respond to at least two of your colleagues by providing at least two ways that their strategies may be expanded or improved.

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NURS 6660 Week 5: Anxiety Disorders in Childhood and Adolescence

“I don’t know why everyone is worried that I don’t want to go out with my friends anymore. I just like to stay home. There is nothing wrong with that. I go to school and get good grades, but I don’t know what to say to those other girls in my class. They ask why I can’t go to the mall with them on the weekend and I get all embarrassed. They don’t understand that I don’t know what to say to them. When I do say something, it is always wrong, or they laugh. I can just stay home and read my books.”

Emma, age 15

Anxiety disorders that plague many individuals in adulthood often have their origins in childhood and adolescence. By identifying those children and adolescents with anxiety disorders, the PMHNP can intervene and teach skills that the client can use to control anxiety throughout his or her life.

This week, you analyze case studies to determine the diagnosis and treatment of anxiety disorders.

Clinical Supervision is an essential component of your development as a psychiatric mental health nurse practitioner. It provides an opportunity for professional collaboration as you share experiences with and gain insights from colleagues. For this Clinical Supervision, consider a client whom you do not think is adequately progressing according to expected clinical outcomes.

Learning Objectives

Students will:

  • Analyze clients presenting for treatment of anxiety disorders
  • Evaluate effectiveness of therapeutic approaches for clients diagnosed with an anxiety disorder

To Prepare:

  • Review this week’s Learning Resources concerning treating patients with anxiety disorders.
  • Reflect on a child or adolescent client you are currently counseling or have previously counseled at your practicum site who has been diagnosed with an anxiety disorder.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts and cannot post anonymously. Please check your post carefully before clicking Submit!

By Day 3

Post a 3- to 5-minute Kaltura video in which you do the following:

  • Describe the client. Note: Do not use the client’s actual name.
  • Explain your therapeutic approach with the client, including the perceived effectiveness of your approach.
  • Identify any additional information about this client that may potentially impact expected outcomes.

Note: Nurse practitioners must have strong oral communication skills. This Discussion is designed to help you hone these skills. When filming your Kaltura video, be sure to dress and speak in a professional manner.

View a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues by suggesting an alternate therapeutic approach. Support your feedback with evidence-based literature and/or your own experiences with clients.

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NURS 6660 Entire Course Weekly Discussions And Assignments

NURS 6660 Week 6: Emergency Psychiatric Care in Childhood and Adolescence

“I can’t believe I am not dead. I want to be dead, but those pills did not work as fast as I expected. Dad found me and called 911. I cannot go on living after what they said about me on the Internet. My life is ruined and I cannot go back to school or even show my face around here. They all think I am that way, but I am not. Dad thinks this was a mistake, but he is wrong. When I get out of here, I am going to try something different, and this time it will work.”

Jessica, age 13

When psychiatric emergencies arise, they can present many challenges to the PMHNP. While there are many approaches to emergencies that are similar, there are also significant differences when dealing with children and adolescents versus adults. This is particularly true with coordination of care, availability of resources, and legal implications of the psychiatric emergency.

This week, you examine psychiatric emergencies that arise during childhood and adolescence and compare how those emergencies are assessed and treated to those of adult clients.

The diagnosis of psychiatric emergencies can include a wide range of problems—from serious drug reactions to abuse and suicidal ideation/behaviors. Regardless of care setting, the PMHNP must know how to address emergencies, coordinate care with other members of the health care team and law enforcement officials (when indicated), and effectively communicate with family members who are often overwhelmed in emergency situations.

In this week’s Discussion, you compare treatment of adult psychiatric emergency clients to child or adolescent psychiatric emergency clients.

Learning Objectives

Students will:

  • Compare treatment of adult psychiatric emergency clients to child or adolescent psychiatric emergency clients
  • Analyze legal and ethical issues concerning treatment of child or adolescent psychiatric emergency clients

To Prepare:

  • Review the Learning Resources concerning emergency psychiatric medicine.
  • Consider a case where your adult client had a psychiatric emergency. (Note: If you have not had an adult client with a psychiatric emergency, ask your preceptor to describe one of their clients with a psychiatric emergency to use as an example for this Discussion.)

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts and cannot post anonymously. Please check your post carefully before clicking Submit!

By Day 3

Post:

  • Briefly describe the case you selected.
  • Explain how you would treat the client differently if he or she were a child or adolescent.
  • Explain any legal or ethical issues you would have to consider when working with a child or adolescent emergency case.

By Day 6

Respond to at least two of your colleagues by recommending at least one additional way you would treat a child or adolescent client differently than you would an adult and at least one additional way you would address the legal and ethical issues involved.

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NURS 6660 Week 7: Learning and Motor Disorders in Childhood

“I had a substitute teacher today, so it was not a good day. She thought I was goofing off, but I could not help myself. As much as I tried to hold back, knowing she would freak out, I felt like a volcano. I erupted with a sound, kinda like a bullfrog that lasted for almost 10 minutes. She kept telling me to quiet down, but I could not help myself. Then the physical stretching and flexing of my neck started. She was really mad. Finally, my friend told her about me. It was embarrassing.”

Samuel, age 9

Learning disorders represent a diagnostic challenge in that many of the features of learning disorders overlap with ADHD. Appropriate diagnosis is essential to proper treatment. Motor disorders can be a source of considerable distress for both the child and their parents. Appropriate diagnosis is required in order to initiate the most appropriate treatment to minimize the impact of these conditions on the child.

This week, you work with your group again to develop a Parent Guide for an assigned learning or motor disorder. For your practicum, you examine the practice of voluntary and involuntary commitment of children and adolescents with mental health disorders.

Learning disorders and motor disorders can be difficult for parents to understand. They often have many questions that go unanswered and can create considerable misunderstanding. This misunderstanding can damage the child/parent relationship. The PMHNP can answer questions and provide guidance for the family in order to help reduce the uncertainty of the disorders.

For the Discussion, you will work with your group again to develop a Parent Guide for your assigned disorder.

Learning Objectives

Students will:

  • Analyze signs and symptoms of learning and motor disorders in childhood
  • Analyze pathophysiology of learning and motor disorders in childhood
  • Analyze diagnosis and treatment methods for learning and motor disorders in childhood
  • Evaluate Parent Guides

To Prepare for this Discussion:

  • Your Instructor will assign you to a group and a disorder by Day 1 of Week 2.
  • Review the resources concerning your assigned disorder.
  • Use your group’s Discussion Board to design and develop the Parent Guide before posting to the group wiki. For further guidance, refer to the Accessing Group Discussions instructions below.

Using evidence-based research, design and develop a Parent Guide for your assigned disorder including:

  • Signs and symptoms
  • Pathophysiology
  • How the disorder is diagnosed
  • Treatment options

Provide a minimum of three academic references.

By Day 5

One designated group member should post the completed Parent Guide to the Discussion.

By Day 7

Respond to at least two other groups’ wikis by providing at least two contributions for improving or including in their Parent Guide and at least two things that you like about their guide.

Assignment 1: Practicum Journal: Voluntary and Involuntary Commitment

PMHNPs may find themselves working in a wide variety of settings—each having their own unique challenges and inherent legal issues. For instance, what do you do in your state of practice when you are providing a therapy/treatment session and a client reports active suicidal ideation? What do you do if you are covering inpatient psychiatric consults and are called to see a patient in the ICU who overdosed on prescription medication requiring intubation? What do you do if you are a PMHNP on an inpatient unit and a client who admitted themselves on a voluntary basis suddenly states that they have decided to sign themselves out of the hospital so that they can go home to kill themselves? These are just some of the legal questions that PMHNPs must know the answers to specific to their state of licensure/practice.

In this Assignment, you investigate your state’s laws concerning voluntary and involuntary commitment. You also analyze a case to determine if the client is eligible for involuntary commitment.

Scenario for Week 7 Case:

You are a PMHNP working in a large intercity hospital. You receive a call from the answering service informing you that a “stat” consult has been ordered by one of the hospitalists in the ICU. Upon arriving in the ICU, you learn that your consult is a 14 year old male who overdosed on approximately 50 Benadryl (diphenhydramine hydrochloride) tablets in an apparent suicide attempt. At the scene, a suicide note was found indicating that he wanted to die because his girlfriend’s parents felt that their daughter was too young to be “dating.” The client stated in the suicide note that he could not “live without her” and decided to take his own life. Although he has been medically stabilized and admitted to the ICU, he has been refusing to talk with the doctors or nurses. The hospital staff was finally able to get in touch with the clients parents (using contact information retrieved from the 14 year old’s cell phone). Unbeknown to the hospital staff, the parents are divorced, and both showed up at the hospital at approximately the same time, each offering their own perspectives on what ought to be done. The client’s father is demanding that the client be hospitalized because of the suicide, but his mother points out that he does not have “physical custody” of the child. The client’s mother demands that the client be discharged to home with her stating that her son’s actions were nothing more than a “stunt” and “an attempt at manipulating the situation that he didn’t like.” The client’s mother then becomes “nasty” and informs you that she works as a member of the clerical staff for the state board of nursing, and if you fail to discharge her child “right now” she will make you “sorry.” How would you proceed?

Learning Objectives

Students will:

  • Evaluate clients for voluntary commitment
  • Evaluate clients for involuntary commitment based on state laws
  • Recommend actions for supporting parents of clients not eligible for involuntary commitment
  • Recommend actions for treating clients not eligible for involuntary commitment

To Prepare for this Practicum:

  • Review the Learning Resources concerning voluntary and involuntary commitment.
  • Read the Week 7 Scenario in your Learning Resources.
  • Research your state’s laws concerning voluntary and involuntary commitment.

The Assignment (2–3 pages):

  • Based on the scenario, would you recommend that the client be voluntarily committed? Why or why not?
  • Based on the laws in your state, would the client be eligible for involuntary commitment? Explain why or why not.
  • Did understanding the state laws confirm or challenge your initial recommendation regarding involuntarily committing the client? Explain.
  • If the client were not eligible for involuntary commitment, explain what actions you may be able to take to support the parents for or against voluntary commitment.
  • If the client were not eligible for involuntary commitment, explain what initial actions you may be able to take to begin treating the client.

By Day 7

Submit your Assignment.

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NURS 6660 Week 8: Mood Disorders

“School and going out with my friends used to be fun, but not anymore. Mom keeps telling me just to go out and have fun, but I don’t see the point of trying. All my friends are better than I am. I keep having these headaches and just feel worthless. I used to get As and Bs in school, but not anymore. I can’t concentrate at school. I would rather be at home sleeping.”

Madison, age 16

Mood disorders can be particularly challenging to address in childhood and adolescence as many parents do not believe it is possible for their child to become depressed or even suicidal. The PMHNP needs to know how to diagnose these conditions and must understand the importance of integrating medication management strategies, with both individual and family therapy to optimize treatment outcomes.

This week, you debate the theory that bipolar depression can or cannot be diagnosed in children and adolescents.

Some debate in the literature exists specific to whether or not bipolar disorder can be diagnosed in childhood. While some have anecdotally argued that it is not possible for children to develop bipolar disorder (as normal features of childhood confound the diagnosis), other sources argue that pediatric bipolar disorder is a fact.

In this Discussion, you engage in a debate as to whether pediatric bipolar disorder is possible to diagnose.

Learning Objectives

Students will:

  • Evaluate diagnosis of pediatric bipolar depression disorder
  • Analyze consequences to diagnosing/failing to diagnose pediatric bipolar depression disorder

To Prepare for the Discussion:

  • The instructor will assign you a position for or against the issue of diagnosing pediatric bipolar depression disorder.
  • Review the Learning Resources concerning the controversy over the diagnosis of pediatric bipolar depression disorder.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts and cannot post anonymously. Please check your post carefully before clicking Submit!

By Day 3

Post:

  • Write “for” or “against” in the subject line of your Discussion post.
  • Based on the position you were assigned, justify whether or not pediatric bipolar depression disorder should be diagnosed.

Support your position with evidence and examples.

By Day 6

Respond to at least two of your colleagues who argued the opposite side as you by countering their argument with evidence. Identify at least two consequences to support your position.

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NURS 6660 Week 9: Early-Onset Schizophrenia

“I can’t believe he is speaking to me! I have always liked his music, but now here he is on TV speaking directly to me! When I started following him on social media, he must have seen my profile. I know he loves me. He cannot love that model I saw with him in the picture. She must be the person following me to school. I have not seen her, but I know she is there. She does not want me being with him, but I will be with him. He loves me as much as I love him.”

Kaitlyn, age 17

Early-onset schizophrenia is a rare and severe mental illness in which children interpret reality abnormally. There are a range of problems with cognitive functioning, behavior, and emotions. Perceptions may be distorted and children or their parents may report that they have difficulty distinguishing reality. This is a diagnosis that is difficult to confirm in the early stages.

This week, you compare evidence-based treatment plans for adults versus children diagnosed with schizophrenia. You analyze the legal and ethical issues involved with forcing patients with early-onset schizophrenia to take medications for the disorder. You also complete a Decision Tree concerning children with psychotic disorders.

Assignment 1: Early Onset Schizophrenia

Children and adolescents with schizophrenia have more difficulty functioning in academic or work settings, and significant impairment usually persists into adulthood. They may have speech or language disorders and in some cases borderline intellectual functioning. These individuals are more likely to complete suicide attempts or die from other accidental causes. Schizophrenia is characterized by positive and negative symptoms. Positive symptoms include hallucinations, delusions, and behavior disturbance. Negative symptoms include blunted affect and attention, apathy, and lack of motivation and social interest.

In this Assignment, you compare treatment plans for adults diagnosed with schizophrenia with treatment plans for children and adolescents diagnosed with schizophrenia. You also consider the legal and ethical issues involved in medicating children diagnosed with schizophrenia.

Learning Objectives

Students will:

  • Compare evidence-based treatment plans for adults versus children and adolescents diagnosed with schizophrenia
  • Analyze legal and ethical issues surrounding the forceful administration of medication to children diagnosed with schizophrenia
  • Analyze the role of the PMHNP in addressing issues related to the forceful administration of medication to children diagnosed with schizophrenia

To Prepare for this Assignment:

  • Review the Learning Resources concerning early-onset schizophrenia.

Assignment 2: Practicum: Decision Tree

Childhood psychosis is extremely rare; however, children that present with psychosis must be carefully assessed and evaluated with appropriate interviewing of parent, child, and use of assessment tools.

For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with early onset schizophrenia.

Learning Objectives

Students will:

  • Evaluate clients for treatment of mental health disorders
  • Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders

The Assignment:

Examine Case 3: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.

At each Decision Point, stop to complete the following:

  • Decision #1: Differential Diagnosis
    • Which Decision did you select?
    • Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?
  • Decision #2: Treatment Plan for Psychotherapy
    • Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?
  • Decision #3: Treatment Plan for Psychopharmacology
    • Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
  • Also include how ethical considerations might impact your treatment plan and communication with clients and their families.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

By Day 7 of Week 10

Submit your Assignment.

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NURS 6660 Week 10: Feeding, Eating, and Elimination Disorders in Childhood

“I am so tired and frustrated. Jackson refuses to breastfeed, and bottle feeding is not much easier. He was the perfect baby when he was born, but now, 6 months later, he is only a few pounds heavier. He won’t take any more than 4 ounces of formula at a time and wakes up several times during the night. We started him on baby food early, but even then he only eats one or two bites before he starts kicking and crying. The pediatrician says there is nothing wrong physically as he is meeting all his milestones, but he just won’t eat.”

Jessica, age 32, mother of Jackson, age 6 months

Children and adolescents with feeding, eating, and elimination disorders may come to the attention of providers in a variety of settings. These disorders are disturbing to parents and may have significant morbidity for youth. It is not uncommon to hear of youth with eating disorders including anorexia and bulimia. It is less common to hear of pica and rumination disorder. Elimination disorders of enuresis and encopresis are troubling to children and parents and cause significant difficulty in daily functioning.

This week, you work with your group again to develop a Parent Guide for a feeding, eating, or elimination disorder. You also submit your cover letter, resume, and portfolio.

Feeding, eating, and elimination disorders can be difficult to detect and treat. Parents need education and information to determine if their infant, child, or adolescent may have these types of disorders. A Parent Guide can be a useful tool to help both the clinician and the parent in understanding the child or adolescent and providing behavioral strategies for helping families work with these disorders. For this Discussion, you will be assigned a feeding, eating, or elimination disorder.

In this Discussion, you work with your group again to develop a Parent Guide for your assigned feeding, eating, or elimination disorder.

Learning Objectives

Students will:

  • Analyze signs and symptoms of feeding, eating, and elimination disorders
  • Analyze pathophysiology of feeding, eating, and elimination disorders
  • Analyze diagnosis and treatment methods for feeding, eating, and elimination disorders
  • Create professional cover letters, resumes, and portfolios

To Prepare for this Assignment:

  • Your Instructor will assign you to a group and a disorder by Day 1 of Week 2.
  • Review the resources concerning your assigned disorder.
  • Use your group’s Discussion Board to design and develop the Parent Guide before posting to the group wiki. For further guidance, refer to the Accessing Group Discussions instructions below.

Using evidence-based research, design and develop a Parent Guide for your assigned disorder including:

  • Signs and symptoms
  • Pathophysiology
  • How the disorder is diagnosed
  • Treatment options

Provide a minimum of three academic references.

By Day 5

One designated group member should post the completed Parent Guide to the Discussion.

By Day 7

Respond to at least two other groups’ wikis by providing at least two contributions for improving or including in their Parent Guide and at least two things that you like about their guide.

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NURS 6660 Week 11: Special Topics in Child and Adolescent Psychiatry

“Here we go again; another foster home. My father kicked me out when he saw me wearing Mom’s clothes. He did not understand that deep down, I know that I am a girl. My birth certificate may say male, but it is wrong. I feel so much better being myself… being a girl. Maybe this foster family will understand and accept me for who I am, or I am just going to run away again.”

Joseph/Josephine, age 16

In your practice as a PMHNP, you may see many children and adolescents who are faced with challenges that go beyond the standard DSM-5 diagnoses. Children in foster homes or who have been adopted may have emotional scars from previous abuse or neglect; adolescents experiencing issues with gender dysphoria may be faced with peer and family issues; and children involved in acts of terrorism may face reoccurring fear and mistrust.

This week, you explore psychological issues that may arise in children faced with special circumstances and the assessment and treatment options specific to these special populations. You also take your final exam for the course.

Many children face special issues that impact everyday life, whether it is within themselves, their families, or their environment. The PMHNP must be sensitive to these many issues that children and adolescents are faced with during important developmental years.

In this Discussion, you select a special population and analyze the psychological issues that the population faces. You also address the assessment and treatment needs of the population.

Learning Objectives

Students will:

  • Analyze psychological issues that may arise in children faced with special circumstances
  • Evaluate assessment measures used with children faced with special circumstances
  • Evaluate treatment options used with children faced with special circumstances
  • Analyze cultural influences on treatments (D)

By Day 3

Post:

  • Write your selected disorder in the subject line of your Discussion post.
  • Explain the psychological issues that may result from your topic.
  • Describe the most effective assessment measure that could be used, and explain why you selected this.
  • Explain the treatment options available for children and adolescents involved with your selected disorder.
  • Explain how culture may influence treatment.

By Day 6

Respond to at least two of your colleagues who selected a topic other than the topic you selected. Provide at least two additional treatment strategies that could be used with this client and at least one additional cultural influence that you think should be considered. Explain your responses.

NURS 6660 Entire Course Weekly Discussions And Assignments

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