Diversity in healthcare, psychopathology and advanced primary family

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 Parts 3 and 4 have the same questions. However, you must answer with references and different writing, always addressing them objectively, as if you were different students. Similar responses in wording or references will not be accepted. 

APA format

1) Minimum 10 pages  (No word count per page)-   Follow the 3 x 3 rule: minimum of three paragraphs per page 

You must strictly comply with the number of paragraphs requested per page.  

The number of words in each paragraph should be similar

Part 1: minimum 2 pages (24 hours)

Part 2: minimum 2 pages (24 hours)

Part 3: minimum 3 pages (24 hours)

Part 4: minimum 3 pages (24 hours)

Submit 1 document per part

2)¨******APA norms

        The number of words in each paragraph should be similar

        Must be written in the third person

         All paragraphs must be narrative and cited in the text- each paragraph

         The writing must be coherent, using connectors or conjunctive to extend, add information, or contrast information. 

         Bulleted responses are not accepted

         Don’t write in the first person 

  Do not use subtitles or titles      

         Don’t copy and paste the questions.

         Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph

Submit 1 document per part

3)****************************** It will be verified by Turnitin (Identify the percentage of exact match of writing with any other resource on the internet and academic sources, including universities and data banks) 

********************************It will be verified by SafeAssign (Identify the percentage of similarity of writing with any other resource on the internet and academic sources, including universities and data banks)

4) Minimum 3 references (APA format) per part not older than 5 years  (Journals, books) (No websites)

Part 3 and 4: Minimun 6 references (APA format) per part not older than 5 years  (Journals, books) (No websites) 

All references must be consistent with the topic-purpose-focus of the parts. Different references are not allowed 

5) Identify your answer with the numbers, according to the question. Start your answer on the same line, not the next

 Example:

Q 1. Nursing is XXXXX

Q 2. Health is XXXX

Q3. Research is…………………………………………………. (a) The relationship between……… (b) EBI has to

6) You must name the files according to the part you are answering: 

Example:

Part 1.doc 

Part 2.doc

__________________________________________________________________________________

Part 1: Diversity in healthcare

The St. Fleur family is well respected in the Haitian community because they are religious with great moral values. They moved to the United States because of political issues in Haiti. Ronald, the youngest son of this family, is 27 years old and lives at home with his mother and father. Recently, he began having fevers and subsequently developed pneumonia. He was admitted to the hospital, where laboratory tests were HIV positive. Ronald was in shock when the doctor informed him that he was HIV positive. He confessed to the doctor that he was gay, but he could not tell his family. He said that he did not want to bring shame to the family. Because he couldn’t be in a formal relationship disowning to his family and the Haitian community’s view of homosexuality, he has been very promiscuous over the years.

2. What are Haitians’ views of homosexuality? (One paragraph)

a. Explain

2. If Ronald’s parents were to learn of his positive HIV status, how might they react if they are religious and traditional? (Two paragraphs)

a. Explain

3. Identify and explain three major culturally congruent strategies a healthcare provider can implement to address HIV prevention practices in the Haitian community (Tree paragraphs)

a. Major culturally congruent strategy (One paragraph)

b. Major culturally congruent strategy (One paragraph)

c. Major culturally congruent strategy (One paragraph)

Part 2: Psychopathology

Scenario:

Kel is a 42-year-old certified public accountant (CPA) who dreams each year that she will board a cruise ship the day after Tax Day and go somewhere, anywhere, except Portsmouth, Virginia. Each year the dream, like the ocean, ebbs and flows, but this year she is not even going to think about such a “ridiculous idea.” In fact, she does not even have the energy to dream; getting out of bed and preparing to go to work is simply too labor intensive. 

Each evening Kel retires to bed with a lack of energy to complete her normal tasks such as readying her clothes for work and making a lunch. She lacks the energy to shop in the evening; consequently, she eats mostly crackers and canned soup. She is not hungry, and her scale reflects this. She has lost 15 pounds over the last 2 months. She does not attend to her makeup or clothes; she finds both too taxing. The clothes she selects are drab and not ironed. At work she makes no effort to talk with her co-workers and does not initiate new contacts with clients. The normal work of filing taxes and writing reports, which she used to enjoy, are overwhelming, and she feels too disorganized to complete them. Telephone calls and e-mail messages from friends are ignored. Attendance at work is spotty.

Sue, her sister, becomes alarmed with Kel’s unanswered telephone calls and e-mails. Worried, she decides to visit her sister at home. She finds the apartment unclean and in disarray. Kel is unkempt, disheveled, and looks sad. Her voice is monotone and flat. Kel tells Sue that she feels “sad and hopeless. Nothing is ever going to change. I am a bad person and I can’t even do my work right. Although I sleep for many hours, I am still tired all the time.” Sue is alarmed at the changes in her sister and arranges for Kel to visit a health care worker at the medical clinic.

1. Generate a primary diagnosis using the DSM5 criteria and ICD 10 codes (Two paragraphs)

a. DSM5 (One paragraph)

b. ICD-10 (One paragraph)

2.  Generate a differential diagnosis using the DSM5 criteria and ICD 10 codes (Two paragraphs)

a. DSM5 (One paragraph)

b. ICD-10 (One paragraph)

3. Formulate and prioritize a treatment plan (One paragraph)

4. Identify and discuss appropriate screening instruments for a patient who has suicidal ideation. (One paragraph)

 Parts 3 and 4 have the same questions. However, you must answer with references and different writing, always addressing them objectively, as if you were different students. Similar responses in wording or references will not be accepted. 

Part 3: Advanced primary family care

Topic: Endocrine 

INITIAL VISIT NOTES:

SUBJECTIVE: Maxwell is a 40 – year – old homosexual African – American male and corporate lawyer who has been our patient for the last three years. At that time, he had not been to a primary care provider since graduating from law school. The patient admitted to a sedentary lifestyle, a weight gain of 25 pounds within the past two years, and occasional fatigue and headache.

Past medical history: None significant.

Past surgical history: Significant for a tonsillectomy at the age of 7.

Family history: Significant for thyroid disease, hypertension, type 2 diabetes, hyperlipidemia, and obesity.

OBJECTIVE: Vital s signs: 220 pounds with a height of 6 ft 1 inch and a body mass index of 29. Blood pressure: 140/88; radial pulse: 78; temperature: 98.7; and respiratory rate: 16.

Physical 3xamination: Significant for acanthosis nigricans and central adiposity.

Diagnostic test results: Fasting lipids revealed total cholesterol of 182, a low-density lipoprotein level of 106, a high-density lipoprotein level of 57, and a triglyceride level of 95. His fasting blood glucose was 95, and his A1c was 5.6. His thyroid-stimulating hormone level was 0.24. A routine electrocardiogram documented normal sinus rhythm and rate.

Diagnoses: Stage 1 hypertension (due to the elevation of blood pressure) and hypothyroid disease (since the thyroid stimulating hormone level was abnormally low).

Plan: The patient was started on both hydrochlorothiazide 25 mg by mouth daily and levothyroxine 0.25 mcg by mouth daily. He was counseled regarding lifestyle modifications, including preparing and eating a low-sodium and low-fat diet.  Maxwell was encouraged to start a routine exercise program of at least 30 minutes of modest aerobic activity, such as walking as if to catch a bus. He was also encouraged to lose 5% – 7% of his body weight. These lifestyle modifications have proven effective in diabetes prevention and maintenance and control of blood pressure and lipid levels. The patient was informed regarding the mechanism of action of both medications, duration of action, contraindications, and adverse effects. The patient was also instructed to take levothyroxine on an empty stomach first thing in the morning.

THREE – MONTH FOLLOW – UP VISIT

THREE-MONTH FOLLOW UP VISIT NOTES:

Vital signs: Blood pressure of 128/76.

Diagnostic test results: Thyroid stimulating hormone level = 3.37. Basic metabolic panel: Blood urea nitrogen level of 14; creatinine level of 0.98; sodium level of 137; potassium level of 3.5; and chloride level of 104.

Plan: The patient was given a list of potassium-containing foods and reminded to eat 1 or 2 daily due to a low potassium level. He was instructed to continue to take the hydrochlorothiazide.

TWO YEARS LATER

RECENT VISIT (2 years later)

SUBJECTIVE: Maxwell has been very busy climbing the corporate ladder and has not been in for a physical 3xamination or lab work for two years. He complains of extreme fatigue for the past two months and low libido. He states that he always feels fatigued, and sleep does not seem to relieve it. He can work but has limited socialization and participation in outside activities due to fatigue. He reports sleeping for 8 – 10 hours a night, with his sleep being interrupted by a need to go to the bathroom at least twice. He awakens fatigued. Sexually, he has a morning erection but not as strongly as in previous months. He has limited sexual desire. He can have an erection with intercourse, but it is less of an erection than previously. He states that he has been in a monogamous relationship for the past two years. He admits to a 15 – pound weight gain over the past two years. He reports that he experiences occasional constipation and some cold intolerance. He denies fever, night sweats, and tobacco or drug use and reports socially drinking several glasses of red wine per week.

Past medical history: Unchanged. / Past surgical history: Unchanged.

Family history: His father died recently from a heart attack.

Medications: Hydrochlorothiazide, 25 mg PO QD; levothyroxine, 0.50 mcg PO; multivitamin, one capsule PO QD; and fish oil capsules, 2000 mg PO QD. There are no known drug allergies or no known food allergies.

OBJECTIVE: Vital signs: Temperature: 98.6; radial pulse: 76; blood pressure: 134/80; oxygen saturation: 99%; height: 6 ft 1 inch; weight: 235 lb (15 – lb weight gain); and body mass index: 31. Physical 3xam is unremarkable except for the following findings:

Skin: Poor skin turgor; acanthosis nigricans.

Mouth: Dry oral mucosa.

Abdomen: Central adiposity.

Lymph: No significant lymphadenopathy.

Rectal: Hemoccult negative for occult blood.

1. Which diagnostic or imaging studies should be considered to assist with or confirm the diagnosis? (One paragraph)

2. Explain the most likely differential diagnosis (One paragraph)

a. Why

3. What is your plan of treatment(Tow paragraphs)

a. Pharmacology (One paragraph)

b. Nonpharmacology (One paragraph)

4. Explain referrals (One paragraph)

5. Does the patient’s psychosocial history impact how you might treat this patient? (One paragraph)

a. Explain

6. What if the patient were over age 65? (One paragraph)

7. What if the patient was over the age of 80? (One paragraph)

8. Are there standardized guidelines that should be used to assess and treat this patient?(One paragraph)

Part 3: Advanced primary family care

Topic: Endocrine 

INITIAL VISIT NOTES:

SUBJECTIVE: Maxwell is a 40 – year – old homosexual African – American male and corporate lawyer who has been our patient for the last three years. At that time, he had not been to a primary care provider since graduating from law school. The patient admitted to a sedentary lifestyle, a weight gain of 25 pounds within the past two years, and occasional fatigue and headache.

Past medical history: None significant.

Past surgical history: Significant for a tonsillectomy at the age of 7.

Family history: Significant for thyroid disease, hypertension, type 2 diabetes, hyperlipidemia, and obesity.

OBJECTIVE: Vital s signs: 220 pounds with a height of 6 ft 1 inch and a body mass index of 29. Blood pressure: 140/88; radial pulse: 78; temperature: 98.7; and respiratory rate: 16.

Physical 3xamination: Significant for acanthosis nigricans and central adiposity.

Diagnostic test results: Fasting lipids revealed total cholesterol of 182, a low-density lipoprotein level of 106, a high-density lipoprotein level of 57, and a triglyceride level of 95. His fasting blood glucose was 95, and his A1c was 5.6. His thyroid-stimulating hormone level was 0.24. A routine electrocardiogram documented normal sinus rhythm and rate.

Diagnoses: Stage 1 hypertension (due to the elevation of blood pressure) and hypothyroid disease (since the thyroid stimulating hormone level was abnormally low).

Plan: The patient was started on both hydrochlorothiazide 25 mg by mouth daily and levothyroxine 0.25 mcg by mouth daily. He was counseled regarding lifestyle modifications, including preparing and eating a low-sodium and low-fat diet.  Maxwell was encouraged to start a routine exercise program of at least 30 minutes of modest aerobic activity, such as walking as if to catch a bus. He was also encouraged to lose 5% – 7% of his body weight. These lifestyle modifications have proven effective in diabetes prevention and maintenance and control of blood pressure and lipid levels. The patient was informed regarding the mechanism of action of both medications, duration of action, contraindications, and adverse effects. The patient was also instructed to take levothyroxine on an empty stomach first thing in the morning.

THREE – MONTH FOLLOW – UP VISIT

THREE-MONTH FOLLOW UP VISIT NOTES:

Vital signs: Blood pressure of 128/76.

Diagnostic test results: Thyroid stimulating hormone level = 3.37. Basic metabolic panel: Blood urea nitrogen level of 14; creatinine level of 0.98; sodium level of 137; potassium level of 3.5; and chloride level of 104.

Plan: The patient was given a list of potassium-containing foods and reminded to eat 1 or 2 daily due to a low potassium level. He was instructed to continue to take the hydrochlorothiazide.

TWO YEARS LATER

RECENT VISIT (2 years later)

SUBJECTIVE: Maxwell has been very busy climbing the corporate ladder and has not been in for a physical 3xamination or lab work for two years. He complains of extreme fatigue for the past two months and low libido. He states that he always feels fatigued, and sleep does not seem to relieve it. He can work but has limited socialization and participation in outside activities due to fatigue. He reports sleeping for 8 – 10 hours a night, with his sleep being interrupted by a need to go to the bathroom at least twice. He awakens fatigued. Sexually, he has a morning erection but not as strongly as in previous months. He has limited sexual desire. He can have an erection with intercourse, but it is less of an erection than previously. He states that he has been in a monogamous relationship for the past two years. He admits to a 15 – pound weight gain over the past two years. He reports that he experiences occasional constipation and some cold intolerance. He denies fever, night sweats, and tobacco or drug use and reports socially drinking several glasses of red wine per week.

Past medical history: Unchanged. / Past surgical history: Unchanged.

Family history: His father died recently from a heart attack.

Medications: Hydrochlorothiazide, 25 mg PO QD; levothyroxine, 0.50 mcg PO; multivitamin, one capsule PO QD; and fish oil capsules, 2000 mg PO QD. There are no known drug allergies or no known food allergies.

OBJECTIVE: Vital signs: Temperature: 98.6; radial pulse: 76; blood pressure: 134/80; oxygen saturation: 99%; height: 6 ft 1 inch; weight: 235 lb (15 – lb weight gain); and body mass index: 31. Physical 3xam is unremarkable except for the following findings:

Skin: Poor skin turgor; acanthosis nigricans.

Mouth: Dry oral mucosa.

Abdomen: Central adiposity.

Lymph: No significant lymphadenopathy.

Rectal: Hemoccult negative for occult blood.

1. Which diagnostic or imaging studies should be considered to assist with or confirm the diagnosis? (One paragraph)

2. Explain the most likely differential diagnosis (One paragraph)

a. Why

3. What is your plan of treatment(Tow paragraphs)

a. Pharmacology (One paragraph)

b. Nonpharmacology (One paragraph)

4. Explain referrals (One paragraph)

5. Does the patient’s psychosocial history impact how you might treat this patient? (One paragraph)

a. Explain

6. What if the patient were over age 65? (One paragraph)

7. What if the patient was over the age of 80? (One paragraph)

8. Are there standardized guidelines that should be used to assess and treat this patient?(One paragraph)

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