You have been hired as the manager of a community health center. This health center provides medical care to children.  One of your first tasks is to develop a static annual budget for the health center.  In fact, the Board of Directors wants to see your budget by Saturday at midnight. 

In order to develop an accurate static budget you know you need to get some facts.  You ask around to see what kind of information you can gather. This is what you find out:

• The center pays rent of $12,000 per month.
• The center has a number of full-time staff members:  4 physicians, 6 clinical staff members and 8 administrative staff members.
• The center has to occasionally use part-time workers or pay overtime when patient volume is high.
• The center sees about 3,000 patients per month.
• Medical supply costs seem to run about $2 per patient.

Unfortunately, that’s all that you can find out on such short notice.  Nobody seems to have any more information.  You know that this is not enough information to build a proper static budget, so you will need to make some assumptions to get the job done.  You are comfortable with making assumptions because you know that it is OK to incorporate assumptions into a budget as long as you clearly identify the assumptions when you present the budget.  You also know that it is important to make assumptions that are based on reliable information.  Luckily, you recall that you have an HFMA membership and access to a variety of online databases with credible information!

You go home to review your old Health Services Finance text to see if there is anything there that can help you.  You find Chapter 16 and begin to read.  Luckily, you come across Table 16-4 (page 185) which shows you what a typical static budget looks like. It’s all coming back to you now!….You need to show your Revenue, your Expenses, and your Net Income.  You open a new Excel file and begin.

Requirement:  Create an annual static budget for the health center described above using Excel.  Submit the budget using the link provided below.

Below is the case scenario that you will use for your 1-2 page paper.

 A 67-year-old man presents to the HCP with chief complaint of tremors in his arms. He also has noticed some tremors in his leg as well. The patient is accompanied by his son, who says that his father has become “stiff” and it takes him much longer to perform simple tasks. The son also relates that his father needs help rising from his chair. Physical exam demonstrates tremors in the hands at rest and fingers exhibit “pill rolling” movement. The patient’s face is not mobile and exhibits a mask-like appearance. His gait is uneven, and he shuffles when he walks and his head/neck, hips, and knees are flexed forward. He exhibits jerky or cogwheeling movement. The patient states that he has episodes of extreme sweating and flushing not associated with activity. Laboratory data unremarkable and the HCP has diagnosed the patient with Parkinson’s Disease. 

In your Case Study Analysis related to the scenario provided, explain the following:

• Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.
• Any racial/ethnic variables that may impact physiological functioning.
• How these processes interact to affect the patient.

MUST BE IN APA 7 FORMAT

AT LEAST 3 REFERENCES FROM WITHIN THE LAST 5 YEARS…….

In a 1- to 2-page paper, address the following:

• Briefly describe how cognitive behavioral therapy (CBT) and rational emotive behavioral therapy (REBT) are similar.
• Explain at least three differences between CBT and REBT. Include  how these differences might impact your practice as a mental health  counselor.
• Explain which version of cognitive behavioral therapy you might use  with clients and why. Support your approach with evidence-based  literature.

1. Case Study, Chapter 43, Drugs Affecting Blood Pressure 

50 points if all questions are answered correctly

A staff nurse has to administer medications for blood pressure to several patients in the coronary care unit. The medications include captopril, diltiazem, and nitroprusside. The medications have to be administered to three older adults. 

a. What are the indications for captopril?

b. What are the therapeutic actions for diltiazem?

c. What are the most common adverse reactions for nitroprusside?

d. What are the lifespan considerations in the older adult for the use of drugs that affect blood pressure?

e. What are the nursing implementation considerations for a patient receiving nitroprusside for blood pressure?

2. Case Study, Chapter 46, Antianginal Agents

50 points if all questions are answered correctly

A student nurse is preparing a paper on coronary artery disease, including the risk factors and the clinical presentation. The paper must include a review of common antianginal agents: nitrates, beta-blockers, and calcium channel blockers. 

a. What are the therapeutic actions, indications, and pharmacokinetics for nitroglycerin?

b. What are the indications and pharmacokinetics for metoprolol?

c. What are the therapeutic actions for diltiazem?

d. What are the considerations for the older adult for the use of antianginal agents?

e. What are the important teaching points for patients receiving antianginal nitrates?

Review the Institute of Medicine’s 2010 report “The Future of Nursing: Leading Change, Advancing Health.” Write a 750‐1,000 word paper discussing the influence of the IOM report on nursing practice. Include the following:

1. Summarize the four messages outlined in the IOM report and explain why these are significant to nursing practice.
2. Discuss the direct influence the IOM report has on nursing education and nursing leadership. Describe the benefits and opportunities for BSN‐prepared nurses.
3. Explain why it is important that a nurse’s role and education evolve to meet the needs of an aging and increasingly diverse population.
4. Discuss the significance of professional development, or lifelong learning, and its relevance in caring for diverse populations across the life span and within the health‐illness continuum.
5. Discuss how nurses can assist in effectively managing patient care within an evolving health care system.

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. 

RUBRIC

Due Date: 22-Nov-2020 at 11:59:59 PM

Maximum Points: 250.0

The Five Phases of the Aggression Cycle

Most patients with mental health disorders are not aggressive. However, it is important for nurses to be able to know the signs and symptoms associated with the five phases of aggression and to appropriately apply nursing interventions to assist in treating aggressive patients. Please read the case study below and answer the four questions related to it.

Aggression Case Study

Christopher, who is 14 years of age, was recently admitted to the hospital for schizophrenia. He has a history of aggressive behavior and states that the devil is telling him to kill all adults because they want to hurt him. Christopher has a history of recidivism and noncompliance with his medications. One day on the unit, the nurse observes Christopher displaying hypervigilant behaviors, pacing back and forth down the hallway, and speaking to himself under his breath. As the nurse runs over to Christopher to talk, he sees that his bedroom door is open and runs into his room and shuts the door. The nurse responds by attempting to open the door, but Christopher keeps pulling the door shut and tells the nurse that if the nurse comes in the room he will choke the nurse. The nurse responds by calling other staff to assist with the situation.

1. What phase of the aggression cycle is Christopher in at the beginning of this scenario? What phase is he in at the end the scenario? (State the evidence that supports your answers).

2. What interventions could have been implemented to prevent Christopher from escalating at the beginning of the scenario?

3. What interventions should the nurse take to deescalate the situation when Christopher is refusing to open his door?

4. If a restrictive intervention (restraint/seclusion) is used, what are some important steps for the nurse to remember?

Topic: Anticipatory Grief

What is anticipatory grief?

Stages of anticipatory grieving ?

sign and symptoms

Ways of coping?

3 paragraphs include include at least 2 references nothing older than 2015

Hello, please I need help answering these questions on palliative care. There are two topics and each has two questions to be answered and each questions should be about 100 words. The guideline is included in the attached file below, thanks.

This is a Collaborative Learning Community (CLC) assignment. 

The purpose of this assignment is to assess leadership styles, traits, and practices as a nursing professional, establish the importance of effective interprofessional communication as a leader in nursing, and to explore the role of servant leadership in nursing practice.

Read the study materials on leadership and complete the topic quiz activities to better understand your leadership qualities.

Upon completion, summarize and share with your group what you learned about your specific leadership qualities, so you can become familiar with how you are similar and different from your peers when it comes to being a leader.

As a group, review the study materials related to servant leadership. Using what you have learned about the tenets of servant leadership and traits and practices of successful leaders, create a 10-12 slide PowerPoint presentation with speaker notes. Add an additional slide for references at the end of your presentation.  

Include the following in your presentation:

1. Each group member: Create a slide that summarizes your leadership style, traits, and practices.
2. Compare the personal leadership styles of your group members, including commonalities between group members’ strengths and weaknesses.
3. Explain why it is important for nursing professionals to be aware of their personal leadership style, traits, and practices.
4. Discuss what leadership traits and styles are necessary to be an effective communicator. Explain the importance of leaders adapting communication approaches when working interprofessionally (across ancillary departments, vendors, community members).
5. Discuss how nursing professionals can benefit from integrating the tenets of servant leadership to empower and influence others as they lead.
6. Discuss how leaders who practice servant leadership and have a strong understanding of their personal leadership traits can successfully lead others and navigate the unique challenges that are part of nursing and health care. Provide two examples that illustrate your main ideas.

You are required to cite to a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice. 

Refer to the resource, “Creating Effective PowerPoint Presentations,” located in the Student Success Center, for additional guidance on completing this assignment in the appropriate style. 

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center. 

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. 

 Assignment: 

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.

Support your responses with evidence-based literature with at least two references in each colleague’s response with proper citation in APA Format. 

Response Post #1

Against Diagnosing Pediatric Patients with Bipolar Disorder

           Bipolar disorder is genetic, and 60 to 90 percent of studies on twins indicates that it is passed down from generation to generation. Studies indicate that changes in the prefrontal cortex and subcortical area of the brain are associated with bipolar disorder (Sadock & Ruiz 2014).   Bipolar Disorder is a persistent mental health disorder that occurs with severe and single mood swings, either high with a lot of energy or low with a feeling of depression, according to the National Institute of Mental Health (2018).   The genetic aspect of Bipolar Disorder causes signs to be seen in pediatric patients and in the DSM-5 manual without meeting the diagnostic criteria.

           According to the DSM-5 manual, hypomanic or manic episodes (talkative, a flight of thoughts, diminished need for sleep, distractibility, high-energy agitation, and outburst) are the diagnostic criteria for Bipolar Disorder (APA, 2013).  This diagnosis criterion is close to the Attention-Deficit / Hyperactive Disorder criteria. ADHD requirements include (flight of thoughts, concentration difficulty, non-stop conversation, higher energy, etc.) (APA, 2013).  Therefore, an ADHD child with Bipolar Disorder is extremely likely to be misdiagnosed.

           The American Association of Psychology recognized children’s irritability, rage, and mood swings and agreed to add another diagnosis; Destructive Mood Dysregulation Disorder  (APA, 2013). Chronic irritability in between periods of rage or temper tantrums seen in the Bipolar Disorder criteria is the main characteristic of DMDD.  Diagnosis of DMDD is a child-specific symptom that aids in the proper care and removes the controversies in children around Bipolar Disorder.  There is a need to be particular when diagnosing children.  Developmental and hormonal changes in children have their psychological effects and may be temporary.  Therefore, other treatment options should be explored before rushing to diagnose a child with Bipolar Disorder. 

Response Post #2

Against

Pediatric Bipolar Depression Disorder Debate

           Pediatric Bipolar Depression Disorder (PBDD) has been a controversial subject for decades. The concept of PBDD came about by United States researchers in the middle of the 1990s (Duffy, Carlson, Dubicka, & Hillegers, 2020). The following will provide information that supports that PBDD is not an appropriate diagnosis for children.

Against the Diagnosis

According to the diagnostic criteria form the DSM-5, pediatric diagnosis of Bipolar Depression Disorder can be made with irritability rather than depression, sleep disturbances, psychomotor agitation, inappropriate guilt, problems concentrating, fatigue, and/or thoughts of death. The question I present is: How does a provider determine if those symptoms are due to trauma, ADHD, or other mental health concerns? Another question is: Why is the United States the one country who embraces the diagnosis of PBDD?

A case review highlighted by the NCTSN showed that a 12 year old child who had been subjected to extreme neglect, sexual abuse, domestic violence, and parental substance use was diagnosed with Oppositional Defiant Disorder and Pediatric Bipolar Disorder (2019). Further screening and assessment by a trauma-informed clinician found that the symptoms she was presenting was linked to complex trauma. Perry and Levin (2012) highlighted that not only trauma, but ADHD, can lead to the presentation of symptoms that are congruent with the diagnosis of PBDD.

In the facility I work, we provide trauma-informed care. Many of the children we care for are diagnosed with ADHD, anxiety, ODD, and Bipolar Disorder. We are finding that once we have switched to trauma informed care, children are leaving our care with LESS diagnoses. Duffy et al. (2020) highlights that the determination of PBDD does not take into account the environmental factors, social factors, and adverse childhood factors that may be contributing to the presenting symptoms.

Conclusion

           The controversy of over medicating children and causing significant long-term harm has been an issue that all providers need to be aware of. What if a child is diagnosed with PBDD and treated with medications that are not warranted? What if a trauma-informed approach could decrease or even eliminate the symptoms? Are you willing to make a lifelong diagnosis, treat the child with medications that may be unnecessary and harmful, and not take into account the possibility of a childhood disorder or trauma?  I know I am not.