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I believe this patient to have Oppositional Defiant Disorder.  This patient is within the guidelines of the DSM-5 criteria.  According to Criteria A, the patent must display a pattern of an angry or irritable mood, a behavior that displays defiance or argumentativeness, as well as vindictiveness (American Psychiatric Association, 2013). Criterion B states this disturbance is in correlation with the individual’s distress or that it impacts the person negatively (American Psychiatric Association, 2013). Lastly, Criterion C states these behaviors cannot be contributed to a psychotic episode, or other disorder (American Psychiatric Association, 2013).  

            This patient displays anger and irritability and verbalizes being resentful of being there.  She is defiant and is argumentative with the provider who is typically viewed as an authoritative figure. She also refuses to comply with treatment and the rules.  She displays vindictiveness in the form of withholding information from the therapist.  Her symptoms are moderate in that they are present in at least two different settings.

Therapeutic Approaches

 Through combined approaches, this disorder can be addressed with parenting modifications, social-emotional skills training, and if needed, psychiatric medication (Treatments for Oppositional Defiant Disorder in Children, 2020). Parenting modifications include fostering a healthy and loving relationship between the parent and child; creating healthy boundaries and rules; being consistent in ignoring annoying behaviors while praising good behaviors (Treatments for Oppositional Defiant Disorder in Children, 2020). The Social-emotional skills training includes implementing skills for the identification and management of feelings, and strategies for decision making that are not based on emotions (Treatments for Oppositional Defiant Disorder in Children, 2020).

            Lastly, if necessary, I would trial a psychiatric medication for the patient.  There are not medications for ODD specifically, but the symptoms are treated (Treatments for Oppositional Defiant Disorder in Children, 2020). There are stimulants such as methylphenidate or dextroamphetamine for ADHD (Treatments for Oppositional Defiant Disorder in Children, 2020). There are also escitalopram or fluoxetine for depression and anxiety (Treatments for Oppositional Defiant Disorder in Children, 2020). Other medications that can aid with disruptive behaviors include guanfacine, clonidine, or aripiprazole (Treatments for Oppositional Defiant Disorder in Children, 2020). Medication should not be used as a standalone treatment (Treatments for Oppositional Defiant Disorder in Children, 2020).

            For this patient specifically, I would implement the first two interventions prior to adding in a psych medication.  I would like to gauge the family dynamic and the patient’s emotional skills prior to adding a medication.  But, if at the second appointment she still had such aggressive symptoms, I would begin the patient on escitalopram 5mg, PO daily for three days then titrate to 10mg PO daily.  I would then recheck the patient in two weeks to make sure she wasn’t having any significant side effects.  

Expected Outcomes

The expected outcomes for this patient would benefit the entire family.  The family may benefit from stronger stability and healthier boundaries, less chaos, or a more caring environment. This can be seen or reflected in children’s behaviors.  I would also expect that with proper tools, social factors such as disagreements with other children, would also be overcome for the benefit of the patient (ODD, 2020).  It was once believed that a child could “outgrown” ODD , however this has been unfounded and symptoms can occur up to an individual’s later years (ODD, 2020). If the patient needs to have medication on board to help, I would expect at least a partial remission if not a full remission of symptoms. 

Reference

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

ODD (2020). Retrieved 23 October 2020, from             https://www.aacap.org/App_Themes/AACAP/docs/resource_centers/odd/odd_resource_c            enter_odd_guide.pdf

Treatments for Oppositional Defiant Disorder in Children | Boston Children’s Hospital. (2020).    Retrieved 23 October 2020, from https://www.childrenshospital.org/conditions-and-            treatments/conditions/o/oppositional-defiant-disorder/treatments

Instructions:

Prepare the informative speech outline. To prepare the outline, use the full-sentence outline method. The outline should have enough content in order to deliver a 5-7 minute informative speech. The outline should include the following:

• Specific Purpose
• Central Idea (aka:  Thesis Statement or Preview Statement)
• Introduction – capture attention, establish YOUR speaker credibility, preview the speech
• Body – key points (minimum of 3), transitions between main points, supporting materials from at least 3 sources including in-text references to the sources.
• Conclusion – signal the end, summarize main points, bring finality
• Researched supporting material references (minimum 3) – include a work cited at the end of your outline, use APA format.
• Identification of a presentation aid (visual)

Please be sure to validate your opinions and ideas with in-text citations and full references in APA

This topic is valued at 20 points. Please review the post and response expectations. Please review the rubric to ensure that your response meets the criteria (Read Me First Section of the Course).

Informative Speech Outline Draft

Instructions:

Please post 1 peer response.

In the response post, critique the outline by providing strengths and areas of improvement based on the quality of the following:

• Introduction
• Body w/ transitions
• Conclusion
• Supporting materials – in-text references and APA citations
• Were you informed? How was it or was it not effective?
• Other suggestions for improvement
• Any suggestions you have for smoothing out the content.

See attached. Thanks

Instructions

Informatics in the Clinical Setting

Conduct an interview with someone in an informatics role in a clinical setting. Then, in a Microsoft Word document of 5-6 pages formatted in APA style, discuss each of the following criteria:

·  Role description and education level required for the role.

·  Describe their views on how their role affects patient safety and improves the quality of patient care.

·  Describe the human factors faced in the role and other challenges.

·  Express insights gained from the interview.

·  Research and discuss the impact of the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators and The Joint Commission Patient Safety Goals in your clinical setting. Describe how these governing agencies influence delivery of direct patient care.

·  Research, discuss, and identify the Technology Informatics Guiding Education Reform (TIGER) utilized in your clinical setting. Be sure to get the perspective of your selected informatics professional during your interview.

·   

Please note that the title and reference pages should not be included in the total page count of your paper.

On a separate references page, cite all sources using APA format. Helpful APA guides and resources are available in the  University Online Library. Below are guides that are located in the library and can be accessed and downloaded via the University Online Citation Resources: APA Style page. The American Psychological Association website also provides detailed guidance on formatting, citations, and references at APA Style. 

Statistical application and the interpretation of data is important in health care. Review the statistical concepts covered in this topic. In a 750-1,000 word paper, discuss the significance of statistical application in health care. Include the following:

1. Describe the application of statistics in health care. Specifically discuss its significance to quality, safety, health promotion, and leadership.
2. Consider your organization or specialty area and how you utilize statistical knowledge. Discuss how you obtain statistical data, how statistical knowledge is used in day-to-day operations and how you apply it or use it in decision making.

Three peer-reviewed, scholarly or professional references are required.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

 In a Microsoft Word document of 5-6 pages formatted in APA style, you will describe the advocacy process. Whether nurses are advocating for their patients, health care, and/or policies that improve people’s lives, the advocacy processes have commonalities that transcend the subject of their advocacy. There are also differences, although these differences may be more nuanced than obvious.

Review the following chapters from your course textbook:

• Taking Action: Nurse, Educator, and Legislator: My Journey to the Delaware Senate
• Taking Action: A Nurse in the Board Room

Respond to the following questions based on your readings:

• Describe what you believe to be the drivers for each of the individual advocates.
  • What factors led the individuals to become advocates?
• Discuss the challenges that each of the individuals identified in their writings.
• Analyze these drivers and challenges and compare them with your own experience to date as an advocate.
• In what ways do you believe you can expand your advocacy skills within the next five years?

On a separate reference page, cite all sources using APA format. Please note that the title and reference pages should not be included in the total page count of your paper.

• Within your community, there has been a large increase in teenage smoking, and community leaders are developing a plan to decrease the incidence of smoking. To help them, you will:

A) Develop a research question to address the problem.
B) Determine what kind of study should be undertaken.
C) Design a study to decrease the incidence of smoking in teenagers.

How do best practices contribute to quality and safety?

 Follow the 3 x 3 rule: minimum three paragraphs per DQ, with a minimum of three sentences each paragraph.

·      All answers or discussions comments submitted must be in APA format according to Publication Manual American Psychological Association (APA) (6th ed.) 2009 ISBN: 978-1-4338-0561-5

·      Minimum of two references, not older than 2015.

Case Study for Evaluation (This is all the in the SOAP note)

GENITALIA ASSESSMENT

Subjective:

• CC: “I have bumps on my bottom that I want to have checked      out.”
• HPI: AB, a 21-year-old WF college student reports to your      clinic with external bumps on her genital area. She states the bumps are      painless and feel rough. She states she is sexually active and has had      more than one partner during the past year. Her initial sexual contact      occurred at age 18. She reports no abnormal vaginal discharge. She is      unsure how long the bumps have been there but noticed them about a week      ago. Her last Pap smear exam was 3 years ago, and      no dysplasia was found; the exam results were normal. She      reports one sexually transmitted infection (chlamydia) about 2 years ago.      She completed the treatment for chlamydia as prescribed.
• PMH: Asthma
• Medications: Symbicort 160/4.5mcg
• Allergies: NKDA
• FH: No hx of breast or cervical cancer,      Father hx HTN, Mother hx HTN, GERD
• Social: Denies tobacco use; occasional etoh, married, 3      children (1 girl, 2 boys)

Objective:

• VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs
• Heart: RRR, no murmurs
• Lungs: CTA, chest wall symmetrical
• Genital: Normal female hair pattern distribution; no masses      or swelling. Urethral meatus intact      without erythema or discharge. Perineum intact. Vaginal mucosa      pink and moist with rugae present, pos for firm,      round, small, painless ulcer noted on external labia.
• Abd: soft, normoactive bowel sounds, neg rebound,      neg murphy’s, negMcBurney
• Diagnostics: HSV specimen obtained

Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature.

• Analyze the subjective portion of the note. List      additional information that should be included in the documentation.
• Analyze the objective portion of the note. List      additional information that should be included in the documentation.
• Is the assessment supported by the subjective and      objective information? Why or why not?
• Would diagnostics be appropriate for this case, and how      would the results be used to make a diagnosis?
• Would you reject/accept the current diagnosis? Why or      why not? Identify three possible conditions that may be considered as a      differential diagnosis for this patient. Explain your reasoning using at      least three different references from current evidence-based literature.

The importance of understanding the advantages and limitations of  breast screening