My Blog

Category: Nursing

  • [Solved] disc2

    ✓ Verified Academic Solution Available

    Executive Solution Overview

    One common dilemma faced by psychiatric nurse practitioners is determining who the “client” is. Given that children are typically brought for treatment by their parents, describe how the psychiatric nurse practitioner would respond to a child who discloses they are indulging in illicit behavior and …

    Instant Solution Download

    $6.99

    Immediate access to the full model answer, formatted citations, and rubric breakdown.

    Need a Fresh Custom Paper?

    Have this question answered from scratch according to your specific instructions and deadline.

    Order on TutorsGallery →

    Assignment Prompt & Instructions

    One common dilemma faced by psychiatric nurse practitioners is determining who the “client” is. Given that children are typically brought for treatment by their parents, describe how the psychiatric nurse practitioner would respond to a child who discloses they are indulging in illicit behavior and asks you not to tell his or her parents.

    Your initial post should be at least 500 words, formatted, and cited in current APA style with support from at least 2 academic sources.

    – 2 years ago

  • [Solved] Create a reply for a discussion using APA 7 format, and scholarly references no older than 5 years.

    ✓ Verified Academic Solution Available

    Executive Solution Overview

    **Please ensure that the Discussion includes more than 200 words with scholarly articles, and the plagiarism level must remain below 20%.** **Mounjaro vs Ozempic: A Guide to Two Endocrine Disorder Treatments** Well-established pharmacological agents have made considerable advances in treating endocr…

    Instant Solution Download

    $6.99

    Immediate access to the full model answer, formatted citations, and rubric breakdown.

    Need a Fresh Custom Paper?

    Have this question answered from scratch according to your specific instructions and deadline.

    Order on TutorsGallery →

    Assignment Prompt & Instructions

    **Please ensure that the Discussion includes more than 200 words with scholarly articles, and the plagiarism level must remain below 20%.**

    **Mounjaro vs Ozempic: A Guide to Two Endocrine Disorder Treatments**

    Well-established pharmacological agents have made considerable advances in treating endocrine disorders, precisely type 2 diabetes mellitus (T2DM) and obesity. Newer agents, such as Mounjaro (tirzepatide) and Ozempic (semaglutide), are well-known for their blood sugar-regulating and weight loss-promoting effects. Both agents are incretin-based therapies but have unique pharmacological profiles that affect their clinical use.

    **Similarities**

    Mounjaro and Ozempic have many similarities, including their mechanism of action and therapeutic benefits. Both agents, as incretin mimetics, act on the glucagon-like peptide-1 (GLP-1) receptor to increase insulin release, decrease glucagon secretion, and delay gastric emptying, ultimately resulting in better control of blood sugar levels. (Jastreboff et al., 2022). Furthermore, both Exenatide and Semaglutide are injected subcutaneously and have demonstrated clinically meaningful weight loss in people with T2DM and obesity (Garber, 2022). These similarities underline their potential for aiding in ameliorating blood glucose levels and the more general metabolic derangements accompanying obesity and diabetes.

    **Differences**

    While they have similarities, Mounjaro and Ozempic vary in some important ways. Mounjaro (tirzepatide) is a dual GIP and GLP-1 receptor agonist, while Ozempic (semaglutide) is a specific GLP-1 receptor agonist (Frías et al., 2021). Mounjaro's extra GIP receptor activity provides better insulin secretion and potential additional weight loss benefits than Ozempic. Clinical trials have indicated that tirzepatide may significantly reduce HbA1c and body weight more than semaglutide (Jastreboff et al., 2022). Additionally, there are also differences in dosing; Ozempic is started at a lower dose (0.25 mg weekly) and titrated to a maximum of 2 mg weekly, while Mounjaro is available in a range of doses (2.5 mg to 15 mg weekly) to suit different patient needs (Garber, 2022).

    **Clinical Implications**

    Introducing Mounjaro and Ozempic is initiating a new phase in T2DM and obesity management. The improved weight loss and glycemic control with Mounjaro could translate into preferential usage in patients needing more robust metabolic agents. However, healthcare providers need to consider cost, willingness to take medication, and risk of complications such as gastrointestinal disturbance for proper therapy. More studies are necessary on these agents' long-term safety and cardiovascular impact.

    **Conclusion**

    Mounjaro and Ozempic are valuable agents in the pharmacologic management of diabetes and obesity, respectively; because these medications have different mechanisms of action and clinical effects, individualized treatment decisions are needed to provide the best possible patient results.

    **References**

    Frías, J. P., Davies, M. J., Rosenstock, J., Pérez Manghi, F. C., Fernández Landó, L., Bergman, B. K., & Liu, B. (2021). Tirzepatide versus semaglutide once weekly in patients with type 2 diabetes. _New England Journal of Medicine, 385_(6), 503-515. https://doi.org/10.1056/NEJMoa2107519

    Garber, A. J. (2022). Incretin-based therapies in managing type 2 diabetes: Role of GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists. _Diabetes Care, 45_(Suppl 1), S219-S227. https://doi.org/10.2337/dc21-S014

    Jastreboff, A. M., Kaplan, L. M., Frías, J. P., Wu, Q., Du, Y., Sturm, K., & Hompesch, M. (2022). Effects of tirzepatide on body weight in people with obesity: A phase 3 trial. _New England Journal of Medicine, 387_(3), 205-216. https://doi.org/10.1056/NEJMoa2206038

    Semaglutide vs Trizepatide. https://www.premieraestheticsva.com/post/semaglutide-vs-trizepatide

    – 2 years ago

  • [Solved] Create a reply for a discussion using APA 7 format, and scholarly references no older than 5 years.

    ✓ Verified Academic Solution Available

    Executive Solution Overview

    **Please ensure that the Discussion includes more than 200 words with scholarly articles, and the plagiarism level must remain below 20%.** For the treatment of diabetes mellitus (DM) type 2 and obesity the pharmacology has noted significant advances in these fields. There are two new medications to…

    Instant Solution Download

    $6.99

    Immediate access to the full model answer, formatted citations, and rubric breakdown.

    Need a Fresh Custom Paper?

    Have this question answered from scratch according to your specific instructions and deadline.

    Order on TutorsGallery →

    Assignment Prompt & Instructions

    **Please ensure that the Discussion includes more than 200 words with scholarly articles, and the plagiarism level must remain below 20%.**

    For the treatment of diabetes mellitus (DM) type 2 and obesity the pharmacology has noted significant advances in these fields. There are two new medications to come on the endocrinology scenario that are called Mounjaro (tripeptide) and Ozempic (semaglutide) because of their efficacy in these conditions DM type 2 and obesity. Both drugs are glucagon-like peptide 1 (GLP-1) receptor agonists, which imitate the natural GLP-1 hormone that helps to control the blood sugar and appetite. Like drugs, they have detailed differences: their mechanisms of action and the variety of conditions they treat will have clinical implications for their use in endocrine disorders. An important similarity between Mounjaro and Ozempic is that they act on the GLP-1 receptor, which helps regulate insulin liberation and glucagon release in response to food intake. This is about better blood sugar control. Thus, these are highly effective in treating type 2 diabetes (Latif et al., 2021). Moreover, both drugs help in weight loss, which is a key of the managing obesity frequently associated with type 2 diabetes. Clinical investigation of these two medications have shown that they guide the substantial decreases in HbA1c (a marker of long-term blood sugar control) and body weight and, therefore, are beautiful treatment options for patients with both conditions.

    However, the principal difference with the Mounjaro and Ozempic is how they work. Mounjaro, in the manuscript, was described as a doble agonist of the GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptor (Zheng et al., 2024). Another hormone that regulates insulin and glucose metabolism is Mounjaro, and it has the added capacity to target both GLP-1 and GIP receptors, expanding its potential effect on reducing blood sugar and weighing down on our overall body weight more than a single GLP1 receptor agonist like Ozempic. Its enhanced signal is expected to guide to more effective treatment options for type 2 diabetes and maturity-related conditions.

    There are many clinical implications and differences for healthcare providers using Mounjaro or Ozempic for the patients. Compared to other options, Mounjaro is more likely to be better for someone with more extreme type 2 diabetes or obesity because it has higher efficacy when it comes to both lowering blood sugar and weight loss (Zheng et al., 2024). While Ozempic is generally better studied, it has a better safety and efficacy profile, which you may prefer over the GLP 1 receptor agonists in patients who do well with them or patients who require a more well-studied medication. Both drugs can cause gastrointestinal problems, but Mounjaro's dual activity might carry a very slightly higher chance of problems. Consequently, these medications will be compared, and finally, the choice will be made based on the patient's characteristics (response and tolerance to the possible side effects of treatment and the severity of the condition).

    Mounjaro and Ozempic are both efficacious, but both hold potential clinical complications. The risk of pancreatitis inflammation of the pancreas is one primary concern because GLP-1 receptor agonists have been associated with pancreatitis (Ayoub et al., 2025). Patients with pancreatitis background should be provided these drugs, and they should be closely monitored. In fact, another gastrointestinal symptom such nausea, vomiting, and diarrhea are very frequent, and some patients have more serious side effects that make difficult for patient to follow the treatment. Compared to Ozempic, Mounjaro's dual action might make stomach pain more likely.

    **References**

    **‌** Ayoub, M., Chela, H., Amin, N., Hunter, R., Anwar, J., Tahan, V., & Daglilar, E. (2025). Pancreatitis Risk Associated with GLP-1 Receptor Agonists, Considered as a Single Class, in a Comorbidity-Free Subgroup of Type 2 Diabetes Patients in the United States: A Propensity Score-Matched Analysis. _Journal of Clinical Medicine, 14_(3), 944. [https://doi.org/10.3390/jcm14030944](https://doi.org/10.3390/jcm14030944)

    Latif, W., Lambrinos, K. J., & Rodriguez, R. (2021). Compare and contrast the glucagon-like peptide-1 receptor agonists (GLP1RAs). [https://www.ncbi.nlm.nih.gov/books/NBK572151/](https://www.ncbi.nlm.nih.gov/books/NBK572151/)

    Zheng, Z., Zong, Y., Ma, Y., Tian, Y., Pang, Y., Zhang, C., & Gao, J. (2024). Glucagon-like peptide-1 receptor: mechanisms and advances in therapy. _Signal Transduction and Targeted Therapy, 9_(1), 234. [https://www.nature.com/articles/s41392-024-01931-z](https://www.nature.com/articles/s41392-024-01931-z)

    – 2 years ago

  • [Solved] discussion

    ✓ Verified Academic Solution Available

    Executive Solution Overview

    **Hematopoietic:** J.D. is a 37 years old white woman who presents to her gynecologist complaining of a 2-month history of intermenstrual bleeding, menorrhagia, increased urinary frequency, mild incontinence, extreme fatigue, and weakness. Her menstrual period occurs every 28 days and lately there h…

    Instant Solution Download

    $6.99

    Immediate access to the full model answer, formatted citations, and rubric breakdown.

    Need a Fresh Custom Paper?

    Have this question answered from scratch according to your specific instructions and deadline.

    Order on TutorsGallery →

    Assignment Prompt & Instructions

    **Hematopoietic:**

    J.D. is a 37 years old white woman who presents to her gynecologist complaining of a 2-month history of intermenstrual bleeding, menorrhagia, increased urinary frequency, mild incontinence, extreme fatigue, and weakness. Her menstrual period occurs every 28 days and lately there have been 6 days of heavy flow and cramping. She denies abdominal distension, back-ache, and constipation. She has not had her usual energy levels since before her last pregnancy.

    **Past Medical History (PMH):**

    Upon reviewing her past medical history, the gynecologist notes that her patient is a G5P5with four pregnancies within four years, the last infant having been delivered vaginally four months ago. All five pregnancies were unremarkable and without delivery complications. All infants were born healthy. Patient history also reveals a 3-year history of osteoarthritis in the left knee, probably the result of sustaining significant trauma to her knee in an MVA when she was 9 years old. When asked what OTC medications she is currently taking for her pain and for how long she has been taking them, she reveals that she started taking ibuprofen, three tablets each day, about 2.5 years ago for her left knee. Due to a slowly progressive increase in pain and a loss of adequate relief with three tablets, she doubled the daily dose of ibuprofen. Upon the recommendation from her nurse practitioner and because long-term ibuprofen use can cause peptic ulcers, she began taking OTC omeprazole on a regular basis to prevent gastrointestinal bleeding. Patient history also reveals a 3-year history of HTN for which she is now being treated with a diuretic and a centrally acting antihypertensive drug. She has had no previous surgeries.

    **Case Study Questions**

    1. Name the contributing factors on J.D that might put her at risk to develop iron deficiency anemia.
    2. Within the case study, describe the reasons why J.D. might be presenting constipation and or dehydration.
    3. Why Vitamin B12 and folic acid are important on the erythropoiesis? What abnormalities their deficiency might cause on the red blood cells?
    4. The gynecologist is suspecting that J.D. might be experiencing iron deficiency anemia.

    In order to support the diagnosis, list and describe the clinical symptoms that J.D. might have positive for Iron deficiency anemia.
    5. If the patient is diagnosed with iron deficiency anemia, what do you expect to find as signs of this type of anemia? List and describe.
    6. Labs results came back for the patient. Hb 10.2 g/dL; Hct 30.8%; Ferritin 9 ng/dL; red blood cells are smaller and paler in color than normal. Research list and describe for appropriate recommendations and treatments for J.D.

    **Cardiovascular**

    Mr. W.G. is a 53-year-old white man who began to experience chest discomfort while playing tennis with a friend. At first, he attributed his discomfort to the heat and having had a large breakfast. Gradually, however, discomfort intensified to a crushing sensation in the sternal area and the pain seemed to spread upward into his neck and lower jaw. The nature of the pain did not seem to change with deep breathing. When Mr. G. complained of feeling nauseated and began rubbing his chest, his tennis partner was concerned that his friend was having a heart attack and called 911 on his cell phone. The patient was transported to the ED of the nearest hospital and arrived within 30 minutes of the onset of chest pain. In route to the hospital, the patient was placed on nasal cannula and an IV D5W was started. Mr. G. received aspirin (325 mg po) and 2 mg/IV morphine. He is allergic to meperidine (rash). His pain has eased slightly in the last 15 minutes but is still significant; was 9/10 in severity; now7/10. In the ED, chest pain was not relieved by 3 SL NTG tablets. He denies chills.

    **Case Study Questions**

    1. For patients at risk of developing coronary artery disease and patients diagnosed with acute myocardial infarct, describe the modifiable and non-modifiable risk factors.
    2. What would you expect to see on Mr. W.G. EKG and which findings described on the case are compatible with the acute coronary event?
    3. Having only the opportunity to choose one laboratory test to confirm the acute myocardial infarct, which would be the most specific laboratory test you would choose and why?
    4. How do you explain that Mr. W.G temperature has increased after his Myocardial Infarct, when that can be observed and for how long? Base your answer on the pathophysiology of the event.
    5. Explain to Mr. W.G. why he was experiencing pain during his Myocardial Infarct. Elaborate and support your answer.

    **Submission Instructions:**

    – Include both case studies in your post.
    – Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.

    Rubric

    **Discussion Rubric**

    Discussion Rubric

    CriteriaRatingsPts

    This criterion is linked to a Learning OutcomeIdentification of Main Issues, Problems, and Concepts

    **5** **to >4.0** **ptsDistinguished**

    **Identifies and demonstrates a sophisticated understanding of the issues, problems, and concepts.**

    **4** **to >3.0** **ptsExcellent**

    **Identifies and demonstrates an accomplished understanding of most issues, problems, and concepts.**

    **3** **to >0.0** **ptsFair**

    **Identifies and demonstrates an acceptable understanding of most issues, problems, and concepts.**

    **0** **ptsPoor**

    **Identifies and demonstrates an unacceptable understanding of most issues, problems, and concepts. Or nothing was posted.**

    5 pts

    This criterion is linked to a Learning OutcomeUse of Citations, Writing Mechanics and APA Formatting Guidelines

    **3** **ptsDistinguished**

    **Effectively uses the literature and other resources to inform their work. Exceptional use of citations and extended referencing. High level of APA precision and free of grammar and spelling errors.**

    **2** **ptsExcellent**

    **Effectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. Moderate level of APA precision and free of grammar and spelling errors.**

    **1** **ptsFair**

    **Ineffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. APA style and writing mechanics need more precision and attention to detail.**

    **0** **ptsPoor**

    **Ineffectively uses the literature and other resources to inform their work. Unacceptable use of citations and extended referencing. APA style and writing mechanics need serious attention. Or nothing was posted.**

    3 pts

    This criterion is linked to a Learning OutcomeResponse to Posts of Peers

    **2** **ptsDistinguished**

    **Student constructively responded to two other posts and either extended, expanded or provided a rebuttal to each.**

    **1** **ptsFair**

    **Student constructively responded to one other post and either extended, expanded or provided a rebuttal.**

    **0** **ptsPoor**

    **Student provided no response to a peer's post.**

    2 pts

    Total Points: 1

    APA format

    references no less than 6 years old

    will be check through turn it in

    – 2 years ago

  • [Solved] weekly clinical experience 1

    ✓ Verified Academic Solution Available

    Executive Solution Overview

    Describe your clinical experience for this week. – Did you face any challenges, any success? If so, what were they? – Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales. – Mention the …

    Instant Solution Download

    $6.99

    Immediate access to the full model answer, formatted citations, and rubric breakdown.

    Need a Fresh Custom Paper?

    Have this question answered from scratch according to your specific instructions and deadline.

    Order on TutorsGallery →

    Assignment Prompt & Instructions

    Describe your clinical experience for this week.

    – Did you face any challenges, any success? If so, what were they?
    – Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales.
    – Mention the health promotion intervention for this patient.
    – What did you learn from this week's clinical experience that can beneficial for you as an advanced practice nurse?
    – Support your plan of care with the current peer-reviewed research guideline.

    **Submission Instructions:**

    – Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources published within the last five years.

    – [\
    \
    ScreenShot2025-03-18at3.11.22PM.png](https://www.sweetstudy.com/files/screenshot2025-03-18at3-11-22pm-png "ScreenShot2025-03-18at3.11.22PM.png")

    – 2 years ago

  • [Solved] Pediatric Primary Care Foundation

    ✓ Verified Academic Solution Available

    Executive Solution Overview

    You see a child whose family believes in natural therapy for illnesses (e.g., diet therapy, massage, heat treatments). How will you incorporate the family’s beliefs into the treatment of a child with an acute upper respiratory infection? With leukemia? **Submission Instructions:** – Your initial pos…

    Instant Solution Download

    $6.99

    Immediate access to the full model answer, formatted citations, and rubric breakdown.

    Need a Fresh Custom Paper?

    Have this question answered from scratch according to your specific instructions and deadline.

    Order on TutorsGallery →

    Assignment Prompt & Instructions

    You see a child whose family believes in natural therapy for illnesses (e.g., diet therapy, massage, heat treatments).

    How will you incorporate the family’s beliefs into the treatment of a child with an acute upper respiratory infection? With leukemia?

    **Submission Instructions:**

    – Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources published within the last five years.

    – 2 years ago

  • [Solved] Adding Technology

    ✓ Verified Academic Solution Available

    Executive Solution Overview

    Examine workflow processes in your place of employment for areas that may need improvement. – Explore the literature for a technology that could be utilized to improve that workflow process. When introducing workflow redesign or a new technology there are many steps to consider. – Who does this impa…

    Instant Solution Download

    $6.99

    Immediate access to the full model answer, formatted citations, and rubric breakdown.

    Need a Fresh Custom Paper?

    Have this question answered from scratch according to your specific instructions and deadline.

    Order on TutorsGallery →

    Assignment Prompt & Instructions

    Examine workflow processes in your place of employment for areas that may need improvement.

    – Explore the literature for a technology that could be utilized to improve that workflow process.

    When introducing workflow redesign or a new technology there are many steps to consider.

    – Who does this impact?
    – What are the costs?
    – How do we know it is successful?

    For this assignment create a PowerPoint presentation using the waterfall or agile method for a workflow redesign in your project.

    #### Requirements

    – 10-12 slide presentation not including title or reference slides.
    – Discuss design from start to finish (for instance…)
    – What is your workflow redesign or technology being implemented? Why is it needed?
    – What are the costs, risks, benefits?
    – How will the optimal redesign be chosen and created?
    – How will it be implemented and by who?
    – How will you know if your redesign is successful? How long until you know?
    – What maintenance is needed (guidelines updated, new software etc)?
    – Include at least 3 recent peer-reviewed journal articles to support your proposed workflow redesign.

    – [\
    \
    GraduateAssignmentRubric.docx](https://www.sweetstudy.com/files/graduateassignmentrubric-docx "GraduateAssignmentRubric.docx")

    – 2 years ago

  • [Solved] Assessing, Diagnosing, and Treating Adults With Mood Disorders

    ✓ Verified Academic Solution Available

    Executive Solution Overview

    See attached docs – 2 years ago **files (2)** – ## en-_CaseStudy_PetuniaPark_.txt – NRNPPRAC66656675FocusedSOAPNoteTemplate.doc **## en-_CaseStudy_PetuniaPark_.txt** [MUSIC PLAYING] DR. MOORE: Hi. Good afternoon. My name is Dr. Moore. Am I understanding you're here for a mental health assess…

    Instant Solution Download

    $6.99

    Immediate access to the full model answer, formatted citations, and rubric breakdown.

    Need a Fresh Custom Paper?

    Have this question answered from scratch according to your specific instructions and deadline.

    Order on TutorsGallery →

    Assignment Prompt & Instructions

    See attached docs

    – 2 years ago

    **files (2)**

    – ## en-_CaseStudy_PetuniaPark_.txt

    – NRNPPRAC66656675FocusedSOAPNoteTemplate.doc

    **## en-_CaseStudy_PetuniaPark_.txt**

    [MUSIC PLAYING] DR. MOORE: Hi. Good afternoon. My name is Dr. Moore. Am I understanding you're here
    for a mental health assessment today? PETUNIA PARK: That's right. DR. MOORE: OK. So to make sure I have the right
    patient and the right chart, can you tell me your name
    and your date of birth? PETUNIA PARK: Yes. I'm Petunia Park. My birthday is July 1, 1995. DR. MOORE: And can you tell
    me what today's date is? PETUNIA PARK: So
    it's December 1. DR. MOORE: Do you know the year? PETUNIA PARK: 2020. DR. MOORE: And what day
    of the week is this? PETUNIA PARK: It's Tuesday. [CHUCKLING] DR. MOORE: And do you
    know where we are today? PETUNIA PARK: Yes I am here
    in the beautiful, sunny office at the clinic. DR. MOORE: OK, great. Thank you. So can you tell me a little bit
    about why you're here today? What brings you here today? PETUNIA PARK: Yes. So I have a history of taking
    medications and then stopping them. I don't think I need them. I really feel like the
    medication squashes who I am. DR. MOORE: OK, OK. So I'm going to be able
    to help you with that. But to begin, I'm going
    to ask you some questions about your family. I'm going to ask you some
    history-type questions. I'm going to ask
    you some symptoms that you might be having. And all of these
    questions are going to help me work with you
    on a treatment plan, OK? So I would like to
    begin with, when was the first time that you
    ever had any mental health or substance use
    treatment in your life? PETUNIA PARK: OK. Well, when I was a teenager,
    my mom put me in the hospital after I went four or five
    days without sleeping. I think I may have been
    hearing things at that time. [CHUCKLES] I think they
    started me on some medication, but I'm not sure. DR. MOORE: Oh, OK so
    you were hospitalized. How many times have you been
    hospitalized for mental health? PETUNIA PARK: Oh, I've been
    hospitalized about four times. The last time was
    this past spring. No detox or residential
    rehabs, though. DR. MOORE: OK, good. Were any of these
    hospitalizations due to any suicide gestures? PETUNIA PARK: One was in 2017. I overdosed on
    Benadryl, but I've not had those thoughts since then. DR. MOORE: Well, I'm very glad
    to hear that you've not had any of those thoughts since then. And I'm glad that you turned
    out OK from that overdose. I'm glad that you're here today. Can you tell me a
    little bit about what you've been diagnosed with
    during your past treatments? PETUNIA PARK: Well,
    I think depression, and anxiety, had some
    even say maybe bipolar. DR. MOORE: OK, and
    what medications have you been tried on
    before for those illnesses? And if you can remember,
    what was your reactions to those medications? PETUNIA PARK: Oh, let's see. Oh, I took Zoloft, and that
    made me feel really high. [CHUCKLES] I couldn't sleep. My mind was racing, and
    then I took risperidone. That made me gain
    a bunch of weight. Seroquel gave me weight, too. I took Klonopin, and that
    seems to slow me down some. I really can't
    remember the others. I think the one I just
    stopped taking was helping. It started with an L, I think. I don't really
    remember the name, but it squashed
    me in creativity. DR. MOORE: OK, well,
    we're going to try to help you find some
    medication that doesn't make you feel squashed or have any of
    those negative side effects today. But in order to do that, I
    need some more information. And the next questions I'm going
    to ask you are about substances you may have used. And I want you to know that you
    don't get in trouble in here if you've used some
    of these substances. It really just helps
    me to make sure that what's in your
    system that could be impacting your neurochemistry. And when we do talk
    about medications, so I don't give you something
    that would negatively interact with something
    you may be using, OK? So do you– PETUNIA PARK: OK. DR. MOORE: –use any nicotine? PETUNIA PARK: Yes. I smoke about a pack
    a day, and I'm not going to quit for you, either. [CHUCKLES] Oh. DR. MOORE: That's OK, that's OK. And what about alcohol? When was your last
    drink of alcohol? PETUNIA PARK: When I
    was 19 because alcohol and me do not work
    well together. [CHUCKLES] DR. MOORE: OK, and what
    about any marijuana? When was your last
    use of any marijuana? PETUNIA PARK: Oh no. I tried that once and
    got really paranoid. DR. MOORE: OK. What about any last
    use of cocaine? PETUNIA PARK: Never. DR. MOORE: Last use of any
    stimulants or methamphetamines? PETUNIA PARK: Never. DR. MOORE: What about
    any huffing or inhalants? PETUNIA PARK: Never. DR. MOORE: OK, have
    you used anything like Klonopin or Xanax, any
    of those sedative medications? PETUNIA PARK: Never. DR. MOORE: All right, good. What about any hallucinogenics
    like LSD, or PCP, or mushrooms? PETUNIA PARK: No, never. DR. MOORE: Wonderful. OK, what about any use of pain
    pills or opiate medications? Anything prescribed
    or anything you've obtained from the street? PETUNIA PARK: No, never. DR. MOORE: Good. And anything synthetic like
    Spice, or ecstasy, Bath Salts, Mollies, anything like that? PETUNIA PARK: Never. DR. MOORE: Oh, wonderful. Well, I'm glad to hear that. You know those things
    aren't good for your brain. So I encourage you to continue
    to stay away from those things. Have you ever had any
    blackouts or seizures from drugs or alcohol? Or seen things that you
    weren't sure were there? PETUNIA PARK: Never. DR. MOORE: Good. What about any legal
    issues or any DUIs? PETUNIA PARK: Never. DR. MOORE: OK. Good, good. All right, so I'm just
    going to ask a little bit about your family right now. Any blood relatives have any
    mental health or substance abuse issues? PETUNIA PARK: Yeah, well,
    well, why would you ask that? It's not your business. DR. MOORE: Right. I could see where you
    might find that wouldn't be any my business. But really, sometimes these
    issues can be genetic. They're alarm behaviors. So my understanding
    of your family helps me to understand you. PETUNIA PARK: Huh. Well, my mother
    was seen as crazy. I think they said she
    had bipolar or something. And my father went
    to prison for drugs. And well, we haven't heard,
    or seen, or heard from him in 8 or 10 years. My brother, while I think
    he's a little schizo, but he hasn't ever
    went to the doctor. Nobody else with anything. DR. MOORE: OK. So that sounds like
    it must be tough growing up not
    seeing your father and having some of those
    issues in your family. But any family, blood
    relatives commit suicide? PETUNIA PARK: Well, my mom
    tried, but nobody really did it, you know? DR. MOORE: OK. Have you ever done anything
    like that, or anything like cut on yourself, burn yourself? PETUNIA PARK: I already told
    you, I tried to kill myself. Why ask me that again? No, I'm not going to kill
    myself or anyone else, and I don't cut myself. DR. MOORE: OK. Well, I'm glad to hear that. And I want you to know
    that I am here for you, and we most certainly
    will make sure you have a crisis like number
    at the end of this session if you do have those
    thoughts in the future. So I'm glad to
    hear that you don't have those thoughts today. OK. What type of medical
    issues do you have? PETUNIA PARK: Oh, hoo. Let's see. I have a thyroid issue that
    I take some medicine for, that hypothyroidism. And I take a birth control
    pill for polycystic ovaries. DR. MOORE: OK, when
    was your last menses? PETUNIA PARK: Oh, well I have
    a regular one each month. So let's see. It was last month sometime. DR. MOORE: OK, so any
    chance that you're pregnant? PETUNIA PARK:
    [LAUGHS] Lordy, no. I may have a lot of sex
    around, but I'm safe. DR. MOORE: Hm. You "have a lot of sex around." Can you maybe tell
    me what that means? PETUNIA PARK: Well, it's
    exciting and thrilling to find new people to explore sex with. It helps me keep my
    moods high, high, high. [CHUCKLES] DR. MOORE: OK, so that makes
    you feel really high and kind of what, OK? PETUNIA PARK: Oh yeah. DR. MOORE: So who raised you? PETUNIA PARK: My mom and
    my older brother, mainly. DR. MOORE: And who
    do you live with now? PETUNIA PARK: Well, I
    live with my boyfriend. And sometimes, stay with my
    mom when he gets mad at me for sleeping around some. DR. MOORE: So that's
    created some issues in your relationship, I see. OK. Are you single, married,
    widowed, or divorced? PETUNIA PARK: I've
    never been married. DR. MOORE: OK. Do you have any children? PETUNIA PARK: No. DR. MOORE: All right. Are you working? PETUNIA PARK: Yes, I work part
    time at my aunt's bookstore. She's more tolerant of
    the days I don't come in from feeling too depressed. DR. MOORE: OK, so I hear some,
    maybe, feelings of depressed. OK. What is your level of education? PETUNIA PARK: Oh,
    I'm in vo-tech school right now for cosmetology. I'm going to do makeup
    for movie stars. [CHUCKLES] DR. MOORE: Oh, that
    sounds really wonderful. OK, so but what about now? What do you do for fun now? PETUNIA PARK: Well, I am
    writing my life story, and it's going to be published. I also paint like Picasso. I'm going to sell those
    paintings to movie stars, too. DR. MOORE: Well,
    that's wonderful. Maybe someday you can show
    me your paintings as well. OK, have you ever been arrested
    or convicted for anything? PETUNIA PARK: No. The police did pick me up and
    take me to the hospital once. I didn't have much
    sleep that week. And they said I was dancing
    around in my nightgown in a field with my guitar. I really don't remember
    much of that, though. I think maybe my mom made
    up that story against me because she wanted me to go
    back to my boyfriend's house. DR. MOORE: OK, so that was
    one of your hospitalizations that we talked about earlier. OK, what about any history of
    trauma with childhood or adult? Any kind of physical,
    sexual, emotional abuse? PETUNIA PARK: Well, my
    dad was pretty hard on us when he was around. But he didn't really
    touch us or anything. More just yelled at us a lot. DR. MOORE: OK. All right, so I've
    gathered some history here. Now, I want to get
    into more of some of the symptoms that brought
    you in to see me today. So you mentioned before that
    sometimes your depression keeps you from working
    at your aunt's bookstore. Can you tell me
    a little bit more about what that
    looks like for you? PETUNIA PARK: Well, about
    four or five times a year, I have these times when I just
    don't want to get out of bed. I have no energy, no
    motivation to do anything. I just can't feel any
    interest in my creativity. I feel like I'm not worth
    anything because I feel that creativity slipping away. So this is usually
    happening after I've been up for five
    days working hard on my works with my writing,
    painting, and music. Everyone says I'm
    depressed, but I'm not sure. It could be that I'm just
    exhausted from working so hard. DR. MOORE: OK, so I hear you
    talking about these creativity episodes right before you crash. Per se, this depression. Tell me a little bit more
    about those episodes. What do those look like for you? PETUNIA PARK: Oh,
    I love those times. Those are the reasons
    I don't always take my medication because
    I feel like I'm squashed. I have lots of energy
    to do a lot of things. I can go four or five days
    with very little sleep. I get lots of things
    done, but my friends tell me I talk too much
    and appear scattered. [SIGHS] They're just jealous
    of all the accomplishments I'm getting done. These are the times I
    look to explore my mind and body with feeling good
    through sex with other people. DR. MOORE: OK, how long do
    those episodes last typically when you have them? PETUNIA PARK: About a week. DR. MOORE: About a week. OK. So I want to ask a little bit
    more about some other symptoms that maybe we
    haven't talked about. Do you feel like you worry
    a lot or have any kind of anxiety and panic symptoms? PETUNIA PARK: No, no no. I'm not a worry. DR. MOORE: OK, do
    you do anything that you feel like you have to
    do repetitively over and over? And if you can't do them, you
    feel like the end of the world is coming? Something like maybe
    count on threes or wash your hands 20 times? Anything like that? PETUNIA PARK: [LAUGHS] No, no. I don't have OCD, if
    that's what you're asking. DR. MOORE: OK, what about
    hearing or seeing things you're not sure
    others see or hear? Anything like that? PETUNIA PARK: Not right now. It's been a couple of
    months since that happened. Sometimes when I'm
    not sleeping good, I hear voices telling me how
    great and wonderfully talented I am. DR. MOORE: OK. So, but no voices right now? PETUNIA PARK: No. DR. MOORE: OK, good. What about your appetite? How's your appetite? PETUNIA PARK: Well, when
    I'm really creative, I'm too busy to eat. And when I'm
    crashing and resting, I eat everything in sight. DR. MOORE: OK, so
    what about your sleep? On average, how much time
    do you think you sleep in a whole 24-hour period? And do you have any bad dreams? PETUNIA PARK: No bad dreams. Most of the time, I get
    about five or six hours. When I'm creative,
    I'm lucky to get three hours and a whole week. Ugh. And when I'm crashed, I sleep
    about 12 or 16 hours a day. DR. MOORE: OK, wonderful. So this is great. I have a lot of
    information from you that I think we will be able to
    come up with a treatment plan and maybe find some
    medication that's going to help you feel better
    without you feeling so squashed and having negative
    side effects, but really help you be able
    to function through the day. [MUSIC PLAYING]

    **NRNPPRAC66656675FocusedSOAPNoteTemplate.doc**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/nrnpprac66656675focusedsoapnotetemplate-doc-10231443)

    **NRNPPRAC66656675FocusedSOAPNoteTemplate.doc**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/nrnpprac66656675focusedsoapnotetemplate-doc-10231443)

    **## en-_CaseStudy_PetuniaPark_.txt**

    [MUSIC PLAYING] DR. MOORE: Hi. Good afternoon. My name is Dr. Moore. Am I understanding you're here
    for a mental health assessment today? PETUNIA PARK: That's right. DR. MOORE: OK. So to make sure I have the right
    patient and the right chart, can you tell me your name
    and your date of birth? PETUNIA PARK: Yes. I'm Petunia Park. My birthday is July 1, 1995. DR. MOORE: And can you tell
    me what today's date is? PETUNIA PARK: So
    it's December 1. DR. MOORE: Do you know the year? PETUNIA PARK: 2020. DR. MOORE: And what day
    of the week is this? PETUNIA PARK: It's Tuesday. [CHUCKLING] DR. MOORE: And do you
    know where we are today? PETUNIA PARK: Yes I am here
    in the beautiful, sunny office at the clinic. DR. MOORE: OK, great. Thank you. So can you tell me a little bit
    about why you're here today? What brings you here today? PETUNIA PARK: Yes. So I have a history of taking
    medications and then stopping them. I don't think I need them. I really feel like the
    medication squashes who I am. DR. MOORE: OK, OK. So I'm going to be able
    to help you with that. But to begin, I'm going
    to ask you some questions about your family. I'm going to ask you some
    history-type questions. I'm going to ask
    you some symptoms that you might be having. And all of these
    questions are going to help me work with you
    on a treatment plan, OK? So I would like to
    begin with, when was the first time that you
    ever had any mental health or substance use
    treatment in your life? PETUNIA PARK: OK. Well, when I was a teenager,
    my mom put me in the hospital after I went four or five
    days without sleeping. I think I may have been
    hearing things at that time. [CHUCKLES] I think they
    started me on some medication, but I'm not sure. DR. MOORE: Oh, OK so
    you were hospitalized. How many times have you been
    hospitalized for mental health? PETUNIA PARK: Oh, I've been
    hospitalized about four times. The last time was
    this past spring. No detox or residential
    rehabs, though. DR. MOORE: OK, good. Were any of these
    hospitalizations due to any suicide gestures? PETUNIA PARK: One was in 2017. I overdosed on
    Benadryl, but I've not had those thoughts since then. DR. MOORE: Well, I'm very glad
    to hear that you've not had any of those thoughts since then. And I'm glad that you turned
    out OK from that overdose. I'm glad that you're here today. Can you tell me a
    little bit about what you've been diagnosed with
    during your past treatments? PETUNIA PARK: Well,
    I think depression, and anxiety, had some
    even say maybe bipolar. DR. MOORE: OK, and
    what medications have you been tried on
    before for those illnesses? And if you can remember,
    what was your reactions to those medications? PETUNIA PARK: Oh, let's see. Oh, I took Zoloft, and that
    made me feel really high. [CHUCKLES] I couldn't sleep. My mind was racing, and
    then I took risperidone. That made me gain
    a bunch of weight. Seroquel gave me weight, too. I took Klonopin, and that
    seems to slow me down some. I really can't
    remember the others. I think the one I just
    stopped taking was helping. It started with an L, I think. I don't really
    remember the name, but it squashed
    me in creativity. DR. MOORE: OK, well,
    we're going to try to help you find some
    medication that doesn't make you feel squashed or have any of
    those negative side effects today. But in order to do that, I
    need some more information. And the next questions I'm going
    to ask you are about substances you may have used. And I want you to know that you
    don't get in trouble in here if you've used some
    of these substances. It really just helps
    me to make sure that what's in your
    system that could be impacting your neurochemistry. And when we do talk
    about medications, so I don't give you something
    that would negatively interact with something
    you may be using, OK? So do you– PETUNIA PARK: OK. DR. MOORE: –use any nicotine? PETUNIA PARK: Yes. I smoke about a pack
    a day, and I'm not going to quit for you, either. [CHUCKLES] Oh. DR. MOORE: That's OK, that's OK. And what about alcohol? When was your last
    drink of alcohol? PETUNIA PARK: When I
    was 19 because alcohol and me do not work
    well together. [CHUCKLES] DR. MOORE: OK, and what
    about any marijuana? When was your last
    use of any marijuana? PETUNIA PARK: Oh no. I tried that once and
    got really paranoid. DR. MOORE: OK. What about any last
    use of cocaine? PETUNIA PARK: Never. DR. MOORE: Last use of any
    stimulants or methamphetamines? PETUNIA PARK: Never. DR. MOORE: What about
    any huffing or inhalants? PETUNIA PARK: Never. DR. MOORE: OK, have
    you used anything like Klonopin or Xanax, any
    of those sedative medications? PETUNIA PARK: Never. DR. MOORE: All right, good. What about any hallucinogenics
    like LSD, or PCP, or mushrooms? PETUNIA PARK: No, never. DR. MOORE: Wonderful. OK, what about any use of pain
    pills or opiate medications? Anything prescribed
    or anything you've obtained from the street? PETUNIA PARK: No, never. DR. MOORE: Good. And anything synthetic like
    Spice, or ecstasy, Bath Salts, Mollies, anything like that? PETUNIA PARK: Never. DR. MOORE: Oh, wonderful. Well, I'm glad to hear that. You know those things
    aren't good for your brain. So I encourage you to continue
    to stay away from those things. Have you ever had any
    blackouts or seizures from drugs or alcohol? Or seen things that you
    weren't sure were there? PETUNIA PARK: Never. DR. MOORE: Good. What about any legal
    issues or any DUIs? PETUNIA PARK: Never. DR. MOORE: OK. Good, good. All right, so I'm just
    going to ask a little bit about your family right now. Any blood relatives have any
    mental health or substance abuse issues? PETUNIA PARK: Yeah, well,
    well, why would you ask that? It's not your business. DR. MOORE: Right. I could see where you
    might find that wouldn't be any my business. But really, sometimes these
    issues can be genetic. They're alarm behaviors. So my understanding
    of your family helps me to understand you. PETUNIA PARK: Huh. Well, my mother
    was seen as crazy. I think they said she
    had bipolar or something. And my father went
    to prison for drugs. And well, we haven't heard,
    or seen, or heard from him in 8 or 10 years. My brother, while I think
    he's a little schizo, but he hasn't ever
    went to the doctor. Nobody else with anything. DR. MOORE: OK. So that sounds like
    it must be tough growing up not
    seeing your father and having some of those
    issues in your family. But any family, blood
    relatives commit suicide? PETUNIA PARK: Well, my mom
    tried, but nobody really did it, you know? DR. MOORE: OK. Have you ever done anything
    like that, or anything like cut on yourself, burn yourself? PETUNIA PARK: I already told
    you, I tried to kill myself. Why ask me that again? No, I'm not going to kill
    myself or anyone else, and I don't cut myself. DR. MOORE: OK. Well, I'm glad to hear that. And I want you to know
    that I am here for you, and we most certainly
    will make sure you have a crisis like number
    at the end of this session if you do have those
    thoughts in the future. So I'm glad to
    hear that you don't have those thoughts today. OK. What type of medical
    issues do you have? PETUNIA PARK: Oh, hoo. Let's see. I have a thyroid issue that
    I take some medicine for, that hypothyroidism. And I take a birth control
    pill for polycystic ovaries. DR. MOORE: OK, when
    was your last menses? PETUNIA PARK: Oh, well I have
    a regular one each month. So let's see. It was last month sometime. DR. MOORE: OK, so any
    chance that you're pregnant? PETUNIA PARK:
    [LAUGHS] Lordy, no. I may have a lot of sex
    around, but I'm safe. DR. MOORE: Hm. You "have a lot of sex around." Can you maybe tell
    me what that means? PETUNIA PARK: Well, it's
    exciting and thrilling to find new people to explore sex with. It helps me keep my
    moods high, high, high. [CHUCKLES] DR. MOORE: OK, so that makes
    you feel really high and kind of what, OK? PETUNIA PARK: Oh yeah. DR. MOORE: So who raised you? PETUNIA PARK: My mom and
    my older brother, mainly. DR. MOORE: And who
    do you live with now? PETUNIA PARK: Well, I
    live with my boyfriend. And sometimes, stay with my
    mom when he gets mad at me for sleeping around some. DR. MOORE: So that's
    created some issues in your relationship, I see. OK. Are you single, married,
    widowed, or divorced? PETUNIA PARK: I've
    never been married. DR. MOORE: OK. Do you have any children? PETUNIA PARK: No. DR. MOORE: All right. Are you working? PETUNIA PARK: Yes, I work part
    time at my aunt's bookstore. She's more tolerant of
    the days I don't come in from feeling too depressed. DR. MOORE: OK, so I hear some,
    maybe, feelings of depressed. OK. What is your level of education? PETUNIA PARK: Oh,
    I'm in vo-tech school right now for cosmetology. I'm going to do makeup
    for movie stars. [CHUCKLES] DR. MOORE: Oh, that
    sounds really wonderful. OK, so but what about now? What do you do for fun now? PETUNIA PARK: Well, I am
    writing my life story, and it's going to be published. I also paint like Picasso. I'm going to sell those
    paintings to movie stars, too. DR. MOORE: Well,
    that's wonderful. Maybe someday you can show
    me your paintings as well. OK, have you ever been arrested
    or convicted for anything? PETUNIA PARK: No. The police did pick me up and
    take me to the hospital once. I didn't have much
    sleep that week. And they said I was dancing
    around in my nightgown in a field with my guitar. I really don't remember
    much of that, though. I think maybe my mom made
    up that story against me because she wanted me to go
    back to my boyfriend's house. DR. MOORE: OK, so that was
    one of your hospitalizations that we talked about earlier. OK, what about any history of
    trauma with childhood or adult? Any kind of physical,
    sexual, emotional abuse? PETUNIA PARK: Well, my
    dad was pretty hard on us when he was around. But he didn't really
    touch us or anything. More just yelled at us a lot. DR. MOORE: OK. All right, so I've
    gathered some history here. Now, I want to get
    into more of some of the symptoms that brought
    you in to see me today. So you mentioned before that
    sometimes your depression keeps you from working
    at your aunt's bookstore. Can you tell me
    a little bit more about what that
    looks like for you? PETUNIA PARK: Well, about
    four or five times a year, I have these times when I just
    don't want to get out of bed. I have no energy, no
    motivation to do anything. I just can't feel any
    interest in my creativity. I feel like I'm not worth
    anything because I feel that creativity slipping away. So this is usually
    happening after I've been up for five
    days working hard on my works with my writing,
    painting, and music. Everyone says I'm
    depressed, but I'm not sure. It could be that I'm just
    exhausted from working so hard. DR. MOORE: OK, so I hear you
    talking about these creativity episodes right before you crash. Per se, this depression. Tell me a little bit more
    about those episodes. What do those look like for you? PETUNIA PARK: Oh,
    I love those times. Those are the reasons
    I don't always take my medication because
    I feel like I'm squashed. I have lots of energy
    to do a lot of things. I can go four or five days
    with very little sleep. I get lots of things
    done, but my friends tell me I talk too much
    and appear scattered. [SIGHS] They're just jealous
    of all the accomplishments I'm getting done. These are the times I
    look to explore my mind and body with feeling good
    through sex with other people. DR. MOORE: OK, how long do
    those episodes last typically when you have them? PETUNIA PARK: About a week. DR. MOORE: About a week. OK. So I want to ask a little bit
    more about some other symptoms that maybe we
    haven't talked about. Do you feel like you worry
    a lot or have any kind of anxiety and panic symptoms? PETUNIA PARK: No, no no. I'm not a worry. DR. MOORE: OK, do
    you do anything that you feel like you have to
    do repetitively over and over? And if you can't do them, you
    feel like the end of the world is coming? Something like maybe
    count on threes or wash your hands 20 times? Anything like that? PETUNIA PARK: [LAUGHS] No, no. I don't have OCD, if
    that's what you're asking. DR. MOORE: OK, what about
    hearing or seeing things you're not sure
    others see or hear? Anything like that? PETUNIA PARK: Not right now. It's been a couple of
    months since that happened. Sometimes when I'm
    not sleeping good, I hear voices telling me how
    great and wonderfully talented I am. DR. MOORE: OK. So, but no voices right now? PETUNIA PARK: No. DR. MOORE: OK, good. What about your appetite? How's your appetite? PETUNIA PARK: Well, when
    I'm really creative, I'm too busy to eat. And when I'm
    crashing and resting, I eat everything in sight. DR. MOORE: OK, so
    what about your sleep? On average, how much time
    do you think you sleep in a whole 24-hour period? And do you have any bad dreams? PETUNIA PARK: No bad dreams. Most of the time, I get
    about five or six hours. When I'm creative,
    I'm lucky to get three hours and a whole week. Ugh. And when I'm crashed, I sleep
    about 12 or 16 hours a day. DR. MOORE: OK, wonderful. So this is great. I have a lot of
    information from you that I think we will be able to
    come up with a treatment plan and maybe find some
    medication that's going to help you feel better
    without you feeling so squashed and having negative
    side effects, but really help you be able
    to function through the day. [MUSIC PLAYING]

    **NRNPPRAC66656675FocusedSOAPNoteTemplate.doc**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/nrnpprac66656675focusedsoapnotetemplate-doc-10231443)

    **## en-_CaseStudy_PetuniaPark_.txt**

    [MUSIC PLAYING] DR. MOORE: Hi. Good afternoon. My name is Dr. Moore. Am I understanding you're here
    for a mental health assessment today? PETUNIA PARK: That's right. DR. MOORE: OK. So to make sure I have the right
    patient and the right chart, can you tell me your name
    and your date of birth? PETUNIA PARK: Yes. I'm Petunia Park. My birthday is July 1, 1995. DR. MOORE: And can you tell
    me what today's date is? PETUNIA PARK: So
    it's December 1. DR. MOORE: Do you know the year? PETUNIA PARK: 2020. DR. MOORE: And what day
    of the week is this? PETUNIA PARK: It's Tuesday. [CHUCKLING] DR. MOORE: And do you
    know where we are today? PETUNIA PARK: Yes I am here
    in the beautiful, sunny office at the clinic. DR. MOORE: OK, great. Thank you. So can you tell me a little bit
    about why you're here today? What brings you here today? PETUNIA PARK: Yes. So I have a history of taking
    medications and then stopping them. I don't think I need them. I really feel like the
    medication squashes who I am. DR. MOORE: OK, OK. So I'm going to be able
    to help you with that. But to begin, I'm going
    to ask you some questions about your family. I'm going to ask you some
    history-type questions. I'm going to ask
    you some symptoms that you might be having. And all of these
    questions are going to help me work with you
    on a treatment plan, OK? So I would like to
    begin with, when was the first time that you
    ever had any mental health or substance use
    treatment in your life? PETUNIA PARK: OK. Well, when I was a teenager,
    my mom put me in the hospital after I went four or five
    days without sleeping. I think I may have been
    hearing things at that time. [CHUCKLES] I think they
    started me on some medication, but I'm not sure. DR. MOORE: Oh, OK so
    you were hospitalized. How many times have you been
    hospitalized for mental health? PETUNIA PARK: Oh, I've been
    hospitalized about four times. The last time was
    this past spring. No detox or residential
    rehabs, though. DR. MOORE: OK, good. Were any of these
    hospitalizations due to any suicide gestures? PETUNIA PARK: One was in 2017. I overdosed on
    Benadryl, but I've not had those thoughts since then. DR. MOORE: Well, I'm very glad
    to hear that you've not had any of those thoughts since then. And I'm glad that you turned
    out OK from that overdose. I'm glad that you're here today. Can you tell me a
    little bit about what you've been diagnosed with
    during your past treatments? PETUNIA PARK: Well,
    I think depression, and anxiety, had some
    even say maybe bipolar. DR. MOORE: OK, and
    what medications have you been tried on
    before for those illnesses? And if you can remember,
    what was your reactions to those medications? PETUNIA PARK: Oh, let's see. Oh, I took Zoloft, and that
    made me feel really high. [CHUCKLES] I couldn't sleep. My mind was racing, and
    then I took risperidone. That made me gain
    a bunch of weight. Seroquel gave me weight, too. I took Klonopin, and that
    seems to slow me down some. I really can't
    remember the others. I think the one I just
    stopped taking was helping. It started with an L, I think. I don't really
    remember the name, but it squashed
    me in creativity. DR. MOORE: OK, well,
    we're going to try to help you find some
    medication that doesn't make you feel squashed or have any of
    those negative side effects today. But in order to do that, I
    need some more information. And the next questions I'm going
    to ask you are about substances you may have used. And I want you to know that you
    don't get in trouble in here if you've used some
    of these substances. It really just helps
    me to make sure that what's in your
    system that could be impacting your neurochemistry. And when we do talk
    about medications, so I don't give you something
    that would negatively interact with something
    you may be using, OK? So do you– PETUNIA PARK: OK. DR. MOORE: –use any nicotine? PETUNIA PARK: Yes. I smoke about a pack
    a day, and I'm not going to quit for you, either. [CHUCKLES] Oh. DR. MOORE: That's OK, that's OK. And what about alcohol? When was your last
    drink of alcohol? PETUNIA PARK: When I
    was 19 because alcohol and me do not work
    well together. [CHUCKLES] DR. MOORE: OK, and what
    about any marijuana? When was your last
    use of any marijuana? PETUNIA PARK: Oh no. I tried that once and
    got really paranoid. DR. MOORE: OK. What about any last
    use of cocaine? PETUNIA PARK: Never. DR. MOORE: Last use of any
    stimulants or methamphetamines? PETUNIA PARK: Never. DR. MOORE: What about
    any huffing or inhalants? PETUNIA PARK: Never. DR. MOORE: OK, have
    you used anything like Klonopin or Xanax, any
    of those sedative medications? PETUNIA PARK: Never. DR. MOORE: All right, good. What about any hallucinogenics
    like LSD, or PCP, or mushrooms? PETUNIA PARK: No, never. DR. MOORE: Wonderful. OK, what about any use of pain
    pills or opiate medications? Anything prescribed
    or anything you've obtained from the street? PETUNIA PARK: No, never. DR. MOORE: Good. And anything synthetic like
    Spice, or ecstasy, Bath Salts, Mollies, anything like that? PETUNIA PARK: Never. DR. MOORE: Oh, wonderful. Well, I'm glad to hear that. You know those things
    aren't good for your brain. So I encourage you to continue
    to stay away from those things. Have you ever had any
    blackouts or seizures from drugs or alcohol? Or seen things that you
    weren't sure were there? PETUNIA PARK: Never. DR. MOORE: Good. What about any legal
    issues or any DUIs? PETUNIA PARK: Never. DR. MOORE: OK. Good, good. All right, so I'm just
    going to ask a little bit about your family right now. Any blood relatives have any
    mental health or substance abuse issues? PETUNIA PARK: Yeah, well,
    well, why would you ask that? It's not your business. DR. MOORE: Right. I could see where you
    might find that wouldn't be any my business. But really, sometimes these
    issues can be genetic. They're alarm behaviors. So my understanding
    of your family helps me to understand you. PETUNIA PARK: Huh. Well, my mother
    was seen as crazy. I think they said she
    had bipolar or something. And my father went
    to prison for drugs. And well, we haven't heard,
    or seen, or heard from him in 8 or 10 years. My brother, while I think
    he's a little schizo, but he hasn't ever
    went to the doctor. Nobody else with anything. DR. MOORE: OK. So that sounds like
    it must be tough growing up not
    seeing your father and having some of those
    issues in your family. But any family, blood
    relatives commit suicide? PETUNIA PARK: Well, my mom
    tried, but nobody really did it, you know? DR. MOORE: OK. Have you ever done anything
    like that, or anything like cut on yourself, burn yourself? PETUNIA PARK: I already told
    you, I tried to kill myself. Why ask me that again? No, I'm not going to kill
    myself or anyone else, and I don't cut myself. DR. MOORE: OK. Well, I'm glad to hear that. And I want you to know
    that I am here for you, and we most certainly
    will make sure you have a crisis like number
    at the end of this session if you do have those
    thoughts in the future. So I'm glad to
    hear that you don't have those thoughts today. OK. What type of medical
    issues do you have? PETUNIA PARK: Oh, hoo. Let's see. I have a thyroid issue that
    I take some medicine for, that hypothyroidism. And I take a birth control
    pill for polycystic ovaries. DR. MOORE: OK, when
    was your last menses? PETUNIA PARK: Oh, well I have
    a regular one each month. So let's see. It was last month sometime. DR. MOORE: OK, so any
    chance that you're pregnant? PETUNIA PARK:
    [LAUGHS] Lordy, no. I may have a lot of sex
    around, but I'm safe. DR. MOORE: Hm. You "have a lot of sex around." Can you maybe tell
    me what that means? PETUNIA PARK: Well, it's
    exciting and thrilling to find new people to explore sex with. It helps me keep my
    moods high, high, high. [CHUCKLES] DR. MOORE: OK, so that makes
    you feel really high and kind of what, OK? PETUNIA PARK: Oh yeah. DR. MOORE: So who raised you? PETUNIA PARK: My mom and
    my older brother, mainly. DR. MOORE: And who
    do you live with now? PETUNIA PARK: Well, I
    live with my boyfriend. And sometimes, stay with my
    mom when he gets mad at me for sleeping around some. DR. MOORE: So that's
    created some issues in your relationship, I see. OK. Are you single, married,
    widowed, or divorced? PETUNIA PARK: I've
    never been married. DR. MOORE: OK. Do you have any children? PETUNIA PARK: No. DR. MOORE: All right. Are you working? PETUNIA PARK: Yes, I work part
    time at my aunt's bookstore. She's more tolerant of
    the days I don't come in from feeling too depressed. DR. MOORE: OK, so I hear some,
    maybe, feelings of depressed. OK. What is your level of education? PETUNIA PARK: Oh,
    I'm in vo-tech school right now for cosmetology. I'm going to do makeup
    for movie stars. [CHUCKLES] DR. MOORE: Oh, that
    sounds really wonderful. OK, so but what about now? What do you do for fun now? PETUNIA PARK: Well, I am
    writing my life story, and it's going to be published. I also paint like Picasso. I'm going to sell those
    paintings to movie stars, too. DR. MOORE: Well,
    that's wonderful. Maybe someday you can show
    me your paintings as well. OK, have you ever been arrested
    or convicted for anything? PETUNIA PARK: No. The police did pick me up and
    take me to the hospital once. I didn't have much
    sleep that week. And they said I was dancing
    around in my nightgown in a field with my guitar. I really don't remember
    much of that, though. I think maybe my mom made
    up that story against me because she wanted me to go
    back to my boyfriend's house. DR. MOORE: OK, so that was
    one of your hospitalizations that we talked about earlier. OK, what about any history of
    trauma with childhood or adult? Any kind of physical,
    sexual, emotional abuse? PETUNIA PARK: Well, my
    dad was pretty hard on us when he was around. But he didn't really
    touch us or anything. More just yelled at us a lot. DR. MOORE: OK. All right, so I've
    gathered some history here. Now, I want to get
    into more of some of the symptoms that brought
    you in to see me today. So you mentioned before that
    sometimes your depression keeps you from working
    at your aunt's bookstore. Can you tell me
    a little bit more about what that
    looks like for you? PETUNIA PARK: Well, about
    four or five times a year, I have these times when I just
    don't want to get out of bed. I have no energy, no
    motivation to do anything. I just can't feel any
    interest in my creativity. I feel like I'm not worth
    anything because I feel that creativity slipping away. So this is usually
    happening after I've been up for five
    days working hard on my works with my writing,
    painting, and music. Everyone says I'm
    depressed, but I'm not sure. It could be that I'm just
    exhausted from working so hard. DR. MOORE: OK, so I hear you
    talking about these creativity episodes right before you crash. Per se, this depression. Tell me a little bit more
    about those episodes. What do those look like for you? PETUNIA PARK: Oh,
    I love those times. Those are the reasons
    I don't always take my medication because
    I feel like I'm squashed. I have lots of energy
    to do a lot of things. I can go four or five days
    with very little sleep. I get lots of things
    done, but my friends tell me I talk too much
    and appear scattered. [SIGHS] They're just jealous
    of all the accomplishments I'm getting done. These are the times I
    look to explore my mind and body with feeling good
    through sex with other people. DR. MOORE: OK, how long do
    those episodes last typically when you have them? PETUNIA PARK: About a week. DR. MOORE: About a week. OK. So I want to ask a little bit
    more about some other symptoms that maybe we
    haven't talked about. Do you feel like you worry
    a lot or have any kind of anxiety and panic symptoms? PETUNIA PARK: No, no no. I'm not a worry. DR. MOORE: OK, do
    you do anything that you feel like you have to
    do repetitively over and over? And if you can't do them, you
    feel like the end of the world is coming? Something like maybe
    count on threes or wash your hands 20 times? Anything like that? PETUNIA PARK: [LAUGHS] No, no. I don't have OCD, if
    that's what you're asking. DR. MOORE: OK, what about
    hearing or seeing things you're not sure
    others see or hear? Anything like that? PETUNIA PARK: Not right now. It's been a couple of
    months since that happened. Sometimes when I'm
    not sleeping good, I hear voices telling me how
    great and wonderfully talented I am. DR. MOORE: OK. So, but no voices right now? PETUNIA PARK: No. DR. MOORE: OK, good. What about your appetite? How's your appetite? PETUNIA PARK: Well, when
    I'm really creative, I'm too busy to eat. And when I'm
    crashing and resting, I eat everything in sight. DR. MOORE: OK, so
    what about your sleep? On average, how much time
    do you think you sleep in a whole 24-hour period? And do you have any bad dreams? PETUNIA PARK: No bad dreams. Most of the time, I get
    about five or six hours. When I'm creative,
    I'm lucky to get three hours and a whole week. Ugh. And when I'm crashed, I sleep
    about 12 or 16 hours a day. DR. MOORE: OK, wonderful. So this is great. I have a lot of
    information from you that I think we will be able to
    come up with a treatment plan and maybe find some
    medication that's going to help you feel better
    without you feeling so squashed and having negative
    side effects, but really help you be able
    to function through the day. [MUSIC PLAYING]

    **NRNPPRAC66656675FocusedSOAPNoteTemplate.doc**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/nrnpprac66656675focusedsoapnotetemplate-doc-10231443)

  • [Solved] Disease Screenings

    ✓ Verified Academic Solution Available

    Executive Solution Overview

    – 2 years ago **files (1)** – ## DiseaseScreenings.docx **## DiseaseScreenings.docx** **Disease Screenings** A 65-year-old female patient is seen your office for an annual physical examination. The patient states that she has not seen a healthcare provider for the past 10 years because she has been …

    Instant Solution Download

    $6.99

    Immediate access to the full model answer, formatted citations, and rubric breakdown.

    Need a Fresh Custom Paper?

    Have this question answered from scratch according to your specific instructions and deadline.

    Order on TutorsGallery →

    Assignment Prompt & Instructions

    – 2 years ago

    **files (1)**

    – ## DiseaseScreenings.docx

    **## DiseaseScreenings.docx**

    **Disease Screenings**

    A 65-year-old female patient is seen your office for an annual physical examination. The patient states that she has not seen a healthcare provider for the past 10 years because she has been feeling well. She has no past medical or surgical history. She reports no complaints. The patient is new to your practice. You completed a comprehensive history and physical examination on the patient. The patient states that she does not know her family history because she was adopted and never had a chance to meet or speak to her biological families. The history and physical exam are unremarkable.

    **Discuss the following:**

    1. Considering the patient age and gender, what preventive health and screenings would you consider for this patient based on the current guidelines?

    **Submission Instructions:**

    · Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources

    **## DiseaseScreenings.docx**

    **Disease Screenings**

    A 65-year-old female patient is seen your office for an annual physical examination. The patient states that she has not seen a healthcare provider for the past 10 years because she has been feeling well. She has no past medical or surgical history. She reports no complaints. The patient is new to your practice. You completed a comprehensive history and physical examination on the patient. The patient states that she does not know her family history because she was adopted and never had a chance to meet or speak to her biological families. The history and physical exam are unremarkable.

    **Discuss the following:**

    1. Considering the patient age and gender, what preventive health and screenings would you consider for this patient based on the current guidelines?

    **Submission Instructions:**

    · Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources

  • [Solved] Discussion Mounjaro vs Ozempic

    ✓ Verified Academic Solution Available

    Executive Solution Overview

    Reply for the following discussion. at least 150 words, 2 references, APA style, Turnitin less than 10 % and 0% AI. New pharmacological treatments have been developed in response to the prevalence of obesity and type 2 diabetic mellitus (T2DM). Ozempic (semaglutide) and Mounjaro (tirzepatide) have b…

    Instant Solution Download

    $6.99

    Immediate access to the full model answer, formatted citations, and rubric breakdown.

    Need a Fresh Custom Paper?

    Have this question answered from scratch according to your specific instructions and deadline.

    Order on TutorsGallery →

    Assignment Prompt & Instructions

    Reply for the following discussion. at least 150 words, 2 references, APA style, Turnitin less than 10 % and 0% AI.

    New pharmacological treatments have been developed in response to the prevalence of obesity and type 2 diabetic mellitus (T2DM). Ozempic (semaglutide) and Mounjaro (tirzepatide) have become important treatment choices among them. (Watanabe at el, 2024).

    An estimated $92 billion is spent on healthcare each year in the United States due to overweight and obesity, and adults who are obese have an additional $2505 in medical expenses annually, which are mostly related to morbidity and mortality from cardiovascular disease (CVD). Minorities are disproportionately affected by obesity, with non-Hispanic Black adults (34.9%) and Hispanic adults (44.8%) having the greatest rates.2. Obesity is made more complex from a health equity perspective since racial and ethnic minorities are linked to worse weight loss treatment response to behavioral, pharmaceutical, and surgical therapies.5. The FDA has approved several glucagon-like peptide 1 (GLP-1) receptor agonists that have been associated with significant weight loss, which has sparked interest in demand and cost estimates. (Person at el., 2023)

    Being glucagon-like peptide-1 receptor agonists (GLP-1 RAs), Mounjaro and Ozempic increase insulin secretion, postpone stomach emptying, and decrease hunger. Since tirzepatide (Mounjaro) is a dual agonist, it can potentially increase metabolic effects beyond those of semaglutide (Ozempic), which only targets GLP-1 receptors. It does this by targeting both GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptors. (Watanabe at el, 2024)

    Tirzepatide may provide better results in weight loss and glycemic control than semaglutide, according to recent research. Patients on tirzepatide had a 1.8-fold higher chance of losing at least 5% of their body weight, a 2.5-fold higher chance of losing 10%, and a 3.2-fold higher chance of losing 15% of their body weight, according to cohort research conducted on individuals who were overweight or obese. Additionally, tirzepatide significantly increased the average reductions in body weight at 3, 6, and 12 months. (Rodriguez at el, 2024)

    Similarly, a randomized clinical trial reported that tirzepatide achieved greater reductions in hemoglobin A1c levels and body weight than semaglutide. The dual agonist activity of tirzepatide is hypothesized to contribute to these enhanced effects. (Frias at el, 20221)

    Common side effects of these drugs are mostly gastrointestinal in nature and include nausea, vomiting, and diarrhea. Between the two medications, the frequency of these adverse effects seems to be similar. Concerns have been raised recently, nevertheless, regarding possible severe side effects, such as eyesight issues linked to GLP-1 drugs like Ozempic and Mounjaro. There have been reports of non-arteritic anterior ischemic optic neuropathy (NAION), which causes abrupt blindness. Even though they are uncommon, these occurrences highlight the need for close observation.  (Watanabe at el, 2024)

    For individuals with type 2 diabetes and obesity, tirzepatide's improved effectiveness in weight loss and glycemic management presents a potential alternative. However, when choosing a treatment, factors like cost, patient comorbidities, and possible side effects are very important. For optimal therapy customization, healthcare providers must consider these aspects. The long-term safety characteristics of these drugs must be thoroughly clarified by ongoing research and post-marketing surveillance. (Frias at el, 2021)

    The pharmaceutical treatment of type 2 diabetes and obesity has benefited greatly by the development of Mounjaro (tirzepatide) and Ozempic (semaglutide). Despite tirzepatide's increased effectiveness in recent research, clinical judgments must be based on the unique characteristics of each patient as well as any possible hazards. To maximize therapeutic approaches and guarantee patient safety, more research is necessary. (ADA, 2021)

    – 2 years ago