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14-year-old Hispanic female Patient who presents today with mother for an initial psychiatric evaluation

Respond to the following psychiatric evaluation with rationales 2 APA references no older than 5 years 

a 14-year-old Hispanic female Patient who presents today with mother for an initial psychiatric evaluation. Wt 198 lbs, BMI 37.9 Index, 

•  The Patient stated that she has been feeling depressed a lot more than before, and its taking over her to the point that she lays down on the bed and does not want to do anything, and sometimes, will have no energy to do anything. She stated that she does not have motivation at all, feeling depressed and no energy to do anything. This started since October 2021. She stated that she could remember that it started because of the pressure from school work because they were being overloaded with a lot of home works especially during Pandemic. She mentioned that it started first by her pulling, cutting herself on the arms and legs, though it has stopped. Current presenting symptoms: trichotillomania, no motivation, feeling of hopeless, feelings of insecurity and often does not want to take her mask off, and always putting her Jacket on, feelings of self worthlessness, low self-esteem, crying frequently, fatigue, appetite changes, insomnia ( 5 hours), social withdrawal, anhedonia. laying on bed and does not want to do anything, feeling guilt, concentration issue, anxiety and worrying a lot, racing thoughts, irritable, sad, feeling on edge, no focus. She complains of hearing voices so loud she believes were her thoughts. She is not able to sleep at night. 

The Patient rated her mood at 5/10 and anxiety at 7/10 on a scale of 1-10 with 1 being the least and 10 being the worst. Alleviating factor: laying on bed. Aggravating factor: any stressful situation. She denies using any illicit drug or alcohol or smoking cigarette. She denies physical, emotional or sexual abuse. She denies SI/HI/AH/VH. Medication reconciliation done

•  Home Environment: living arrangements: living with parents and 2 siblings plus uncle and auntie. , no violence in the home , no exposure to violence in the neighborhood , no smoker in the home. Education: school name: Ida B Wells Middle School, Washington DC , does not enjoy school/is bored in school , no concerns from school about learning or behavior , , goals when finishes school: Physician. Exercise: plays outside , goes to the park , spends most of the time watching TV or playing video/computer games. Activities: Denies , activities with friends and have no issues with peer pressure, no issues with bullying , no gang involvement. Suicide/Depression/Mental Health: feels stressed/anxious most of the time , low self-esteem , has friend/family member to talk to if having problems , has good anger management skills , no behavior problems at school she endorses frequent crying or depressed mood , withdrawal from family, friends or school , no issues with bullying , no history of suicidal thoughts. There was history of self-harm (i.e. cutting), but , no history of violence towards others , no history of homicidal thoughts , no history of emotional, physical or sexual abuse. Safety: feels safe at home , feels safe at school , feels safe in neighborhood (no gangs/territory groups) , uses internet and social media safely. Sleep Patterns: gets less than 8 hours of sleep, have trouble falling asleep , bedtime established , goes to bed at (time): 10:30P , no television / screens in the bedroom 

Diagnosis  Major Depressive Disorder

• Plan: Psychoeducation provided Supportive therapy provided Safety plan setup and encouraged Options reviewed for dealing with triggers for self-harm Appropriate sleep hygiene reviewed Healthy diet encouraged Exercise discussed Mature coping skills reviewed Medication side effects, risks, and potential interactions reviewed medication dosage, frequency, and other instructions Reviewed how long it may take for medication to work. 

• Perform blood analyses, including CBC, TSH/T4, Hemoglobin A1C levels, lipid panel, 

Preventative Medicine

Activity: Get involved in activities that you enjoy and are interesting to you. These activities may be related to school, after school programs, volunteering or community organizations. Try to limit watching TV or playing video games. Consider a family media plan including time for physical activity and unplugged family time. Exercise is also very important. You should get at least 60 minutes of exercise every day. Be careful when using the internet; being online is the same thing as being in public. Remember that anything you share on line you are sharing with many people and it cannot be erased. Do not meet up with strangers you connect with online. All internet use should be in public areas of the home so parents can ensure online activity is safe.. Sleep: Sleep is very important at your age and you need plenty of sleep to do well in school. You should get at least 8 hours of sleep per night. Some tips for improving your sleep include: Not watching TV/ phone or screens while going to sleep, avoid napping during the day, avoid caffeine and chocolate a couple hours before bedtime, avoid large meals right before going to bed, and establish a regular bedtime.. Mental Health: Sometimes people get angry, upset, stressed or sad about a certain situation. It is not ok to hurt yourself or others when this happens. It is also not good to use violence (ex: fighting) to solve problems. There are healthier ways to deal with your feelings. If you ever feel angry, upset or sad please talk to an adult or your doctor. You can also call the Access HelpLine at 1(888)7WE-HELP or 1-888-793-4357 at any time. Safety: Everyone should wear seatbelts while riding in a car. Younger adolescents may still need to be in booster seat, low-profile backless boosters may be more acceptable to the adolescent. Your child should continue to ride in the back seat until 13 years of age. Youth under 16y should not ride ATVs. Model safe behavior by always wearing your seat belt. Make sure your child is always wearing a helmet while riding a bike/scooter/skating etc. Use sunscreen with SPF greater than 15, reapply every 2 hours. Develop safety rules with your child such as not riding in a vehicle with someone who has been using drugs or alcohol. Guns, knives and other weapons are extremely dangerous and should not be used to fix problems. It is best not to have a firearm in your home, however if necessary firearms should be stored unloaded and locked with ammunition locked separately. Do not listen to loud music in ear buds

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Dagoberto Gilb (b. 1950) was born in Los Angeles to a Mexican mother and an Anglo father from East Los Angeles

Love in L.A.

Dagoberto Gilb

Dagoberto Gilb (b. 1950) was born in Los Angeles to a Mexican mother and an Anglo father from East Los Angeles. He earned bachelor’s and master’s degrees from the University of Santa Barbara, and currently teaches in the Master of Fine Arts Creative Writing Program at Southwest Texas State University. Gilb’s first published work was Winners on the Pass Line (1985), but The Magic of Blood (1993) established his reputation. Hailed as a classic of the American Southwest, it won the 1994 PEN/Hemingway Award. There followed The Last Known Residence of Mickey Acuña (1994), Woodcuts of Women (2001), and Gritos (2003), a collection of essays. Subtly layered irony and satire come together in “Love in L.A.,” appropriately set in a city where reality, fantasy, and image vie for prominence.

Jake slouched in a clot of near motionless traffic, in the peculiar gray of concrete, smog, and early morning beneath the overpass of the Hollywood Freeway on Alvarado Street. He didn’t really mind because he knew how much worse it could be trying to make a left onto the onramp. He certainly didn’t do that every day of his life, and he’d assure anyone who’d ask that he never would either. A steady occupation had its advantages and he couldn’t deny thinking about that too. He needed an FM radio in something better than this ’58 Buick he drove. It would have crushed velvet interior with electric controls for the L.A. summer, a nice warm heater and defroster for the winter drives at the beach, a cruise control for those longer trips, mellow speakers front and rear of course, windows that hum closed, snuffing out that nasty exterior noise of freeways. The fact was that he’d probably have to change his whole style. Exotic colognes, plush, dark nightclubs, maitais and daiquiris, necklaced ladies in satin gowns, misty and sexy like in a tequila ad. Jake could imagine lots of possibilities when he let himself, but none that ended up with him pressed onto a stalled freeway.

Jake was thinking about this freedom of his so much that when he glimpsed its green light he just went ahead and stared bye bye to the steadily employed. When he turned his head the same direction his windshield faced, it was maybe one second too late. He pounced the brake pedal and steered the front wheels away from the tiny brakelights but the smack was unavoidable. Just one second sooner and it would only have been close. One second more and he’d be crawling up the Toyota’s trunk. As it was, it seemed like only a harmless smack, much less solid than the one against his back bumper.

Jake considered driving past the Toyota but was afraid the traffic ahead would make it too difficult. As he pulled up against the curb a few carlengths ahead, it occurred to him that the traffic might have helped him get away too. He slammed the car door twice to make sure it was closed fully and to give himself another second more, then toured front and rear of his Buick for damage on or near the bumpers. Not an impressionable scratch even in the chrome. He perked up. Though the car’s beauty was secondary to its ability to start and move, the body and paint were clean except for a few minor dings. This stood out as one of his few clearcut accomplishments over the years.

Before he spoke to the driver of the Toyota, whose looks he could see might present him with an added complication, he signaled to the driver of the car that hit him, still in his car and stopped behind the Toyota, and waved his hands and shook his head to let the man know there was no problem as far as he was concerned. The driver waved back and started his engine.

5

“It didn’t even scratch my paint,” Jake told her in that way of his. “So how you doin? Any damage to the car? I’m kinda hoping so, just so it takes a little more time and we can talk some. Or else you can give me your phone number now and I won’t have to lay my regular b.s. on you to get it later.”

He took her smile as a good sign and relaxed. He inhaled her scent like it was clean air and straightened out his less than new but not unhip clothes.

“You’ve got Florida plates. You look like you must be Cuban.”

“My parents are from Venezuela.”

“My name’s Jake.” He held out his hand.

10

“Mariana.”

They shook hands like she’d never done it before in her life.

“I really am sorry about hitting you like that.” He sounded genuine. He fondled the wide dimple near the cracked taillight. “It’s amazing how easy it is to put a dent in these new cars. They’re so soft they might replace waterbeds soon.” Jake was confused about how to proceed with this. So much seemed so unlikely, but there was always possibility. “So maybe we should go out to breakfast somewhere and talk it over.”

“I don’t eat breakfast.”

“Some coffee then.”

15

“Thanks, but I really can’t.”

“You’re not married, are you? Not that that would matter that much to me. I’m an openminded kinda guy.”

She was smiling. “I have to get to work.”

“That sounds boring.”

“I better get your driver’s license,” she said.

20

Jake nodded, disappointed. “One little problem,” he said. “I didn’t bring it. I just forgot it this morning. I’m a musician,” he exaggerated greatly, “and, well, I dunno, I left my wallet in the pants I was wearing last night. If you have some paper and a pen I’ll give you my address and all that.”

He followed her to the glove compartment side of her car.

“What if we don’t report it to the insurance companies? I’ll just get it fixed for you.”

“I don’t think my dad would let me do that.”

“Your dad? It’s not your car?”

25

“He bought it for me. And I live at home.”

“Right.” She was slipping away from him. He went back around to the back of her new Toyota and looked over the damage again. There was the trunk lid, the bumper, a rear panel, a taillight.

“You do have insurance?” she asked, suspicious, as she came around the back of the car.

“Oh yeah,” he lied.

“I guess you better write the name of that down too.”

30

He made up a last name and address and wrote down the name of an insurance company an old girlfriend once belonged to. He considered giving a real phone number but went against that idea and made one up.

“I act too,” he lied to enhance the effect more. “Been in a couple of movies.”

She smiled like a fan.

“So how about your phone number?” He was rebounding maturely.

She gave it to him.

35

“Mariana, you are beautiful,” he said in his most sincere voice.

“Call me,” she said timidly.

Jake beamed. “We’ll see you, Mariana,” he said holding out his hand. Her hand felt so warm and soft he felt like he’d been kissed.

Back in his car he took a moment or two to feel both proud and sad about his performance. Then he watched the rear view mirror as Mariana pulled up behind him. She was writing down the license plate numbers on his Buick, ones that he’d taken off a junk because the ones that belonged to his had expired so long ago. He turned the ignition key and revved the big engine and clicked into drive. His sense of freedom swelled as he drove into the now moving street traffic, though he couldn’t stop the thought about that FM stereo radio and crushed velvet interior and the new car smell that would even make it better.

[1993]

Exploring the Text – These questions are for you to answer for yourself.

1. Based on what you know about Los Angeles from movies, television, or personal experience, how does the setting affect your interpretation of events in the story?

2. How does the syntax of the first sentence of the second paragraph, “Jake was thinking about this freedom of his so much that when he glimpsed its green light he just went ahead and stared bye bye to the steadily employed,” reflect the picture of life in Los Angeles that the author is portraying? Does the sound of this sentence resonate with its sense? How?

3. In what ways does Jake show himself to be an “actor”—not literally, perhaps, but in assuming different roles or performances during this encounter?

4. The saying goes that America has a love affair with the automobile, the freedom of the road being yet another inalienable right. How does this idea find its way into “Love in L.A.”? What do the kinds of cars the characters drive—or daydream about driving—lead you to infer about their attitudes toward relationships?

5. Consider the exchange between Mariana and Jake in light of the fact that she copied down his license plate number. What does this suggest about her character? Do you think she gave Jake her real phone number or even her real name? Whom should the reader believe here? Who won this round, Jake or Mariana?

6. What conclusions do you think Dagoberto Gilb intended readers to draw concerning the nature of love in L.A.? Is he suggesting that Jake and Mariana might be kindred spirits in the world depicted in the story? Is he being cynical, playful, or realistic about love and relationships?

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Should the staff encourage the daughter to inform her mother that she is sexually active?

See all articles attached.You are a consulting psychologist for a local clinic and have been asked to follow up on a consultation you completed four years ago. There are current developments in this case that require further consideration. Please review the case file study attached or detailed information on the current case under review. Explain how the APA Ethical Principles and Code of Conduct can be used to guide decisions in this ethically complex situation. Provide a suggested course of action for the clinic staff. Given the daughter’s age and the situation presented, integrate concepts developed from different psychological content domains to support your suggested course of action. Be certain to use evidence-based psychological concepts and theories to support your arguments. You may wish to consider the following questions as you construct your evaluation(1)Should the staff encourage the daughter to inform her mother that she is sexually active?(2)Would knowledge regarding her daughter’s sexual activity influence the mother’s stance regarding disclosure?(3)Should the staff break confidentiality and inform the mother that her daughter is sexually active?(4)Should the staff encourage the mother to inform the daughter of both her and her daughter’s HIV status?(5)Does the daughter’s boyfriend have any rights in this situation? If so, what are they?(6)Based on the daughter’s age, does the mother have a right to not disclose the diagnosis to her daughter?(7)Does the mother have a right to the privacy regarding her own diagnosis, which could be threatened if her daughter learns of her own status?(8)Are there other approaches the staff can take? If so, what are they?(9)Is further information required in order for you to create an ethically sound suggested course of action?

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Explicate Goodison’s “Mother, the Great Stones Got to Move

1.  Explicate Goodison’s “Mother, the Great Stones Got to Move.”  Identify the poem’s setting and situation.  What is the subject of the poem?  What message does the poem communicate about its subject (this is the poem’s theme)? 

2. What does the poetry assigned communicate about the importance of literature and the role of the artist/writer in society?  Does the artist play a purely aesthetic, social, political, or moral role through his/her art/poetry?  Please cite specific examples from the various poems to defend your position.

3. What do Blake, Amichai, and Goodison have to teach us about living with disappointment?

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A mother calls you to report that her 15-year-old daughter has run away from home

A mother calls you to report that her 15-year-old daughter has run away from home. She has access to her daughter’s e-mail account and says her daughter has a number of emails in her inbox suggesting she has run away to be with a 35-year-old woman. Write a 3 to 4 page paper/report (not including title or reference page) explaining how you should proceed.

Writing Requirements

  • 3-4 pages in length  (excluding cover page, abstract, and reference list)
  • Include at least two peer reviewed sources that are properly cited
  • APA format.
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Claudia (G2P2) is a 36-year-old mother who recently delivered a child 9 months ago.

Discussion

Case Study Advanced Pharmacology

Purpose

Problem-based learning is a methodology designed to help students develop the reasoning process used in clinical practice through problem solving actual patient problems in the same manner as they occur in practice. The purpose of this activity is to develop students’ clinical reasoning skills using a case-based learning exercise. Through participation in an online discussion forum, students identify learning issues in a self-directed manner which facilitates learning for the entire group.

Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

1. Synthesize clinical knowledge, didactic learning and research findings to provide appropriate pharmacological care to primary care patients. (CO 1, 2, 3, 4 & 5)

Case Study & Discussion Questions

Claudia (G2P2) is a 36-year-old mother who recently delivered a child 9 months ago. She has been using condoms for birth control for the last 7 months. Today she is requesting a more convenient method of birth control. She is not sure of her current pregnancy plans, however, she does not wish to discuss sterilization or an IUD. She has no religious contraindications for treatment.

PMH: positive for mild hypertension with first pregnancy, seasonal allergies.

Surgeries: Left inguinal hernia and tonsillectomy.

Family history: Mother-HTN; Father-Colon CA (both deceased)

Social History: Denies tobacco use, wine one to two glasses a week, denies recreational drugs, exercises twice a week.

Drug allergies-Sulfa causes a rash.

Current medications-MVI with Fe, Calcium chews, Allegra 10mg daily prn for allergies.

Vitals: Height 67 inches, weight 157 pounds, BP 110/75, P 70, R 16. PAP collected today, breast exam WNL, urine pregnancy negative.

Physical exam is normal.

1. What are your treatment goals for Claudia today?

2. What are two possible medications (in different classes) that you can recommend for Claudia? Please provide detailed rationale and mechanism of actions for each medication. Make sure that all recommendations are cited with guidelines or scholarly, peer-reviewed articles and always include medication, strength, dosage form, route, frequency and duration when making recommendations.

3. Pick one of the medications from your response above and list five (5) patient-centered teaching points to communicate to the patient.

4. What would your contraceptive choice be if Claudia smoked 10-15 cigarettes per day? Explain your answer.