Write an explanation of how the use of CBT in families compares to CBT in individual settings.
Provide specific examples from your own practicum experiences.
Then, explain challenges counselors might encounter when using CBT in the family setting. Support your position with specific examples from this week’s media.
Assignment 2: Individual Power Plan
What can you do to develop your individual power base? This week, you have heard and read about several types and sources of power. For this Assignment, consider your goals and how enhancing your own power may help you to achieve them.
To Prepare Reflect on your personal current sense of power within your organization and the profession; Do a self–assessment of your leadership skills by doing the How Good are your Leadership Skills? assessment at http://www.mindtools.com/pages/article/newLDR_50.htm How did you score? You do need not to reveal this in your paper, but hopefully it will guide you in how to apply the concepts to your own situation. Reflect on your motivation for increasing your power within your organization and/or within the nursing profession. Do a self–assessment of your leadership motivation by doing the assessment The Leadership Motivation Assessment found at http://www.mindtools.com/pages/article/newLDR_01.htm Again, it is not necessary to post your score but hopefully it will guide you in how to discuss your motivation at this point in time. Review the information on power in the Learning Resources and conduct additional research on your own to examine strategies that seem relevant and worthwhile for helping to enrich your power as a nurse leader. Identify specific strategies you can use to develop and leverage sources and types of power to achieve desired outcomes.
To Complete
Write a 2– to 3–page paper, not including the cover and Reference page, describing: A self–assessment of your current sense of power within your organization and the profession; A self–assessment of your motivation for increasing your power base; Write a detailed plan for enhancing your power as a nurse and a leader–manager, including specific strategies for achieving that plan. Be sure to include strategies for mobilizing the power of nursing for social change, empowering others, and building a personal power base.
Reply to Amanda
Do you take any medications?
Some medications (Lithium) are notorious for causing hypothyroid.
Have you ever been diagnosed with a thyroid disorder?
Surgeries to the thyroid may result in hypothyroid.
Are you allergic to anything?
Relevant to treatment regimen.
Have you experienced any significant life changes? Additional stress etc?
Depression may manifest similar symptoms.
PE:
Hypothyroidism is six times more common in women than men, and is most common in older women (Carson, 2009). A thorough physical assessment should be completed. Clinical signs and symptoms may include paleness, brittle appearing hair and skin, elevated blood pressure, and bradycardia (Carson, 2009). The patient may have a “puffy” appearance to her face, irregular periods, and report sustained fatigue (Roberts et al, 2009).
Differential Diagnoses
Anemia, Depression
Diagnostics
TSH – Will be elevated in Hypothyroid
Free T4 – Result will be low in Hypothyroid
Cholesterol – Often elevated with Hypothyroid
CBC – To rule out anemia
CMP – To monitor other electrolytes
EKG – to assess for any blocks, prolonged QRS, or electrolyte abnormalities
Treatment
Patients with symptomatic hypothyroidism should be treated to prevent long-term complications (Roberts et al, 2004) Depending on the results of her TSH & T4 I would initiate a daily regimen of Levothyroxine. 4-6 weeks after the initiation of Levothyroxine I would recheck the patients TSH. After the TSH has reached a therapeutic level – I would recheck it again in 6 months.
References
Carson, M. (2009). Assessment and management of patients with hypothyroidism. Nursing Standard (through 2013), 23(18), 48-56; quiz 58. Retrieved from https://prx-herzing.lirn.net/login?url=https://search.proquest.com/docview/219883523?accountid=167104 (Links to an external site.)Links to an external site.
Roberts, C. G. P., & Ladenson, P. W. (2004). Hypothyroidism. The Lancet, 363(9411), 793-803. doi:http://dx.doi.org/10.1016/S0140-6736(04)15696-1
reply to Quiana What additional questions should you ask the patient and why?
Some questions include: How much weight has been gained? What kinds of meals/foods do you typically take? Do you exercise? Quantifying the amount of weight provides perspective. A gain of 5 lbs does not carry the urgency that a 20 lb weight gain does. Asking about her lifestyle habits can offer some insight into factors that can aggravate what sounds like hypothyroidism. This creates teachable opportunities for improving lifestyle habits. Are you still menstruating and if so, how regularly? This can rule out pregnancy or hormone changes that precipitate menopause. Also, with hypothyroidism, this condition can disrupt a normal menstrual cycle. For a woman in menopause, hypothyroid symptoms can be masked or ignored when it is assumed that it is a lack of ooestrogen that is causing her concerns (Baisier, Hertoghe, & Eeckhaut, 2000). Bowel habits, specifically any problem with constipation? (Chaker, Bianco, Jonklaas, & Peeters, 2017) Any hx of depression? Her reported complaints are common findings for hypothyroid but they can also be related to depression. Though the rate of depression in hypothyroid patients is >60% (Bathla & Singh, 2016), the patient should be screened for depression. Her symptoms could be psychosomatic. What should be included in the physical examination at this visit? Included items to address are skin for dryness, hair for thinning or irregular growth pattern, eyes for exopthalmus, neck/throat and thyroid for possible goiter, cardiac sounds for bradyarrhythmias, and also for peripheral manifestations like delayed relaxation of deep tendon reflexes (Chaker, et al., 2017). What are the possible differential diagnoses at this time? Hypothyroidism Depression Anemia What tests should you order and why? TSH and free T3 and T4 EKG CMP CBC Lipid Panel A depression screen can be done in office
Hypothyroidism can increase lipids and alter cardiac function (Chaker, et al., 2017). EKG may reveal cardiac abnormalities. CBC can reveal anemia. The metabolic panel can reveal diabetes or problems with hepatic or renal function. Hypothyroidism continues to be researched as far as the specific link to renal and hepatic dysfunction (Chaker, et al., 2017). The depression screen serves, like the other lab orders, to exclude causes of her symptoms. The most obvious test is a thyroid panel. To assess the circulating amount of hormone in the body is to judge her thyroid function. How should this patient be managed? Pending the diagnosis, the patient should be encouraged to complete all lab work in a timely fashion. Since these labs can be resulted within 24hrs, if not same day, that would be my biggest priority for completion. For hypothyroidism, pending the thyroid results, the patient should start on hormone replacement with a drug like levothyroxine. Often, levothyroxine 50-100mcg is a starting dose (Dunphy, Winland-Brown, Porter, & Thomas, 2015), it should be taken daily, on an empty stomach, in the morning. She should return in about 1 mo to reassess symptoms and lab value. If the patient is difficult to manage, due to comorbid conditions or lack of therapeutic response, endocrine may be consulted.
References
Baisier, W. V., Hertoghe, J., & Eeckhaut, W. (2000). Thyroid insufficiency. is TSH measurement the only diagnostic tool? Journal of Nutritional & Environmental Medicine, 10(2), 105-113. Retrieved from https://prx-herzing.lirn.net/login?url=https://search.proquest.com/docview/215623935?accountid=167104
Bathla, M., & Singh, M. (2016). Reply to “how prevalent are depression and anxiety symptoms in hypothyroidism?”. Indian Journal of Endocrinology and Metabolism, 20(6) doi:http://dx.doi.org/10.4103/2230-8210.192913
Chaker, L., Bianco, A. C., Jonklaas, J., & Peeters, R. P. (2017). Hypothyroidism. The Lancet, 390(10101), 1550-1562. doi:http://dx.doi.org/10.1016/S0140-6736(17)30703-1
Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2015). Primary care: The art and science of advanced practice nursing, (4th ed.). [VitalSource Bookshelf version]. Retrieved from https://bookshelf.vitalsource.com/books/9780803655621
This job was done; overall it was a great job. However, the instructor wanted me to provide some information I missed. I just need to add some info, nothing is wrong with the piece.
Competence:
Recommend evidence-based ways to expand the scope of interventions to target a critical health care issue.
This is the instructor feedback: Criterion: Recommend evidence-based ways to expand the scope of interventions to target a critical health care issue. Non-Performance
Does not recommend ways to expand the scope of interventions to target a critical health issue.
Faculty Comments:“
Your paper does not recommend ways to expand the scope of interventions to target a critical health issue. To earn a distinguished grade, you need to recommend evidence-based ways to expand the scope of interventions to target a critical health issue in terms of cost, efficiency and access, and effectiveness. You also need to classify the interventions as conventional or unconventional interventions.
For this part, refer back to current interventions, and then determine what else needs to be done in Hawaii to expand on these current practices in order to address obesity. Please reach out to the course tutor is you have any questions.
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