Complex and Chronic Problems

Week 1 Roll Call Discussion Board

(50 Points)

The Roll Call Discussion Board is designed so students can introduce themselves to the

instructor and other students. But we have done this before so let’s be a little creative with this

school required activity. Please create a brief (~ 200 words) biographical sketch in which you

share:

 Your name

 Your location and time zone and cell number

 Answer the miracle question – if I gave you a pill tonight before bed and it could make

miracles happens what would be different when you wake up tomorrow morning? This

is a question that we ask our patients so let’s see how we do with it. Think long and

hard, this is a big responsibility. You only get one change so make it a good one.

Part Two

Along with your introduction please answer the following prompt and discuss with your peers:

Case Study

SM is a 32-year-old female that has come to see you for a diagnostic psychiatric evaluation due to a

long history of depression. She has begun to see the signs that she has seen in the past when her

depression is starting up again. She is sad for no apparent reason, cries easily, has little interest in

her hobbies, finds it difficult to get up and going, and sometimes isn’t even enjoying playing with her

son. This has never happened before. She wants to treat this before it gets any worse like it has in the

past. SM is not on any current medication and has not been for about 5 years. She is married and she

has stated that she and her husband are trying to add to the family.

After an extensive interview it was found that SM was a nurse working in a step down unit in the

local hospital. She works 3 – 12 hours shifts a week usually. She has a 33 year old husband of 9

years and 1 boy aged 2 1/2 years. SM stated that her husband is working part time while he is

finishing up his master’s degree. He will be done in August and they would like to have another child

once he is finished with school. She stated that she felt that she was tired of waiting to have another

child since she had some fertility problems with the first one and she is worried about how long it

will take her to get pregnant again. She reports that she breastfed her son and plans to breastfeed

the next child. She had a physical by her PCP and she currently has no medical problems. She has a

history of PCOS (Poly Cystic Ovarian Syndrome) and she is overweight. SM stated she has

experienced some bouts with depression in the past and has been put on a medication but she doesn’t

remember what the name of it was. She maintains a fairly healthy diet and she walks and runs. She

has done several 5k’s and recently did a 10K. She has a very supportive family. Money is tight since

she is really the only income but she states that they are doing “ok”. She would like to move to a

larger home but she does see the light now at the end of the tunnel as he will be done with school in a

few months and be able to decrease the burden of the finances from her. She hopes this will enable

them to move in the near future to a larger home. She stated she had episodes in nursing school

where she could not sleep for “thinking” but that doesn’t seem to be a problem this time. She stated

she has 1-2 beers occasionally on the weekends, is a non-smoker, and did not take “street

drugs”. She is not taking any other medications except vitamins.

There are many ways to handle this issue so let’s discuss it. How would you treat? For this

assignment, please locate at least ONE peer-reviewed article that provides rationale for your

approach and provide the APA citation. Attach the article in case your peers are interested in reading

it.

2;

Week 3 & 4 Discussion Board

(100 Points)

A 12 year old girl is referred by her mother. Since Bethany started middle

school, her weight has been steadily decreasing. Bethany attributes this to her

vegetarian diet. Her mother reports that six months ago her daughter decided

to become vegetarian. Eight weeks ago, she turned vegan and further

restricted what she was “allowed” to eat. Worried about her health, Bethany

was sent to her pediatrician who discovered she had lost 15 pounds in the last

four months.

Bethany says that she doesn’t want to be “one of those fat girls who wear tight

jeans.” She will only eat lettuce, brown rice and popcorn. She thinks her

doctor’s scale is inaccurate and that she is actually a bit chubbier than last

year.

Bethany’s grades are excellent and she is on the gymnastics and track teams at

school. Her mother reports that Bethany has always been a perfectionist.

Family History: Mother has struggled with being overweight since her own

adolescence.

Medical History: Negative. Bethany is 5 feet 2 inches tall and weighs 80 pounds.

Medications: none

You are tasked with putting together a treatment team – who would you include

and what their role be. How you and the team treat this patient? For this

assignment, please locate at least ONE peer-reviewed article that provides

rationale for your approach and provide the APA citation. Attach the article in

case your peers are interested in reading it.

3;

Week 5 & 6 Discussion Board

(100 Points)

The themes for weeks 5 & 6 are Major Chronic and Severe Mental Illnesses:

Schizophrenia, Dissociative Disorders, Somatic D/O’s, Chronic Pain or Pediatric

Collaborative Care and Legal and Ethnic Issues in Pediatrics.

Please post a case of an interesting patient that fits into one of these themes.

Provide their:

  • Chief Complaint
  • History of Present Illness (tell us also whether this is inpatient or
  • outpatient setting)

  • Diagnosis
  • Meds
  • You can provide more but not less than these sections.

    Then discuss your plan or the plan of the preceptor, did you agree with each

    other’s plan?

    Answer the following questions:

    1. How have you addressed Maslow’s Hierarchy of Needs in your plan?

    2. Do you think based on the Nichols book that this patient might benefit

    from family therapy, and if so, which theory would you use?

    3. What labs would you order and how often if you continue to follow the

    patient?

    4. What cultural considerations are necessary with this patient?

    5. What could other team members provide? (Example – social worker, RD,

    therapist, case manager)

    6. Everyone has different ways to handle patients and different

    opportunities and services available to them. Discuss how you would

    handle your peers’ patient differently, what could you offer that might be

    better than your peer did?

    4;

    (100 Points)

    Last discussion board – isn’t it great! You have made it to the end, goal is in site but this DB has

    two parts.

    Topics for week 7

    Are about aging and resilience, dying and late in life disorders. The Older Adult, End of Life Issues –

    Geriatrics and Pediatrics, Late life disorders, Disordered Cognition, Neurocognitive Disorders, Other

    Conditions, Physical and Sexual Abuse of Adults, Medication-Induced Movement Disorders

    Please share a case with us that you found challenging, one that you would like to seek advice on

    handling. The case must be associated with the theme of resilience in the geriatric or dying patient.

    Tell us how you handled it and what your concern is. You may use a case from clinical or a client

    from your current job, or a client or case that has always stuck with you.

    How did you feel working with this age group of patients? How did you see this resilience? Was

    their resilience good or bad for them? What concerns did you have about their family?

    Topics for week 8

    Tying it together – Evidenced Based Nursing, Psychiatric Emergencies, Violence, Public Psychiatry,

    Interfacing with the School System and The Future of the PMHNP

    What is your burning question as we tie this all up? Peers – please try to answer each other’s

    questions but I will also come in and answer your questions. If it is for one of our other instructors, I

    will get the answer for you or maybe I can get them to pop in and answer it themselves!

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