1. What was your biggest “take away” from any/all of the simulations?
2. What did you find most challenging from the simulations? 
3. How is what you learned from the assignments applicable to the medical field?
4. Give examples of how such knowledge can affect your direct patient care. 

 This soft drink brand is recognized worldwide. The drink has one of the most recognized corporate logos and is sold in over 200 countries through 250 bottlers throughout the world.

This company’s story began in Atlanta, Georgia, in 1886, when pharmacist John Pemberton was experimenting with a recipe that he later mixed with carbonated water and began to sell at his drugstore. Two years after its invention, Pemberton sold his secret formula to a businessman by the name of Asa Candler, who formed a corporation to bottle and distribute the trendy drink. He later sold the rights to two other businessmen who wanted to bottle the drink to enhance distribution. Candler sold syrup that his company produced to these distributors, but not his secret formula. They simply mixed the syrup with carbonated water and bottled it. From there, the product became a household name as more people began to take the drink home to enjoy.

Competitors soon emerged. To ensure that people could tell the original from the competition, the distributors created the trademarked contour bottle in 1916 so that customers would recognize the original product. Candler ultimately sold his company in 1919 to a group of investors, with Robert Woodruff as the president. The new group wanted to make the drink available anytime and anyplace. To accomplish this, the new company started adding bottling plants all over the world.

The six Ps of the company vision statement highlight its purpose and desired future objectives—people, portfolio, partners, planet, profit, and productivity.

To assist in accomplishing its vision, the company established a foundation in 1984. This entity focuses on helping and giving back to communities worldwide. Some of the issues supported in various countries include water stewardship (providing safe, clean drinking water), lifestyle and behavioral change programs (e.g., nutrition, exercise, and behavior modification), recycling, and education.

Assignment Details

Answer the following questions 

1. What is your opinion of this company? Explain.
2. Based on what you know or what you read on the Internet or in other sources, do you believe that the company is customer-focused? Why or why not?
3. How does the company’s community involvement potentially affect its image in the eyes of customers or potential customers?

PLEASE RESPOND TO THE FOLLOWING IN 50 WORDS OR MORE:

• The Nursing Legislation and Advocacy page on the FNA website identifies 4-different ways for you to get involved with advocacy.  Discuss which way(s) you would most likely get involved with and why?

One way I would get involved with is by participating in the FNA advocacy days. Each Advocacy Days, nurses from across the state gather in Tallahassee during legislative sessions to learn about current legislative issues and specific bills that may affect their practice or the overall healthcare environment in Florida. This allows nurses to meet with legislators face to face. Nurses are able to voice their concerns and take part in helping shape the life of nurses. 

• Find and peruse the Barbara Lumpkin Toolkit (BLT).  What are your thoughts about the information provided in the toolkit and what did you learn that you didn’t know before?

The Barbara Lumpkin Toolkit is a resource that can be used by nurses to speak to legislators. The toolkit discusses ways for nurses to get in contact with legislators as well as offering tips on how to do so. The BLT also details the correct way to communicate nursing concerns to legislators. Something I didn’t know is that it would be more helpful to communicate with new legislators than legislators who have a lot of experience. As new legislators could be more sympathetic to our concerns then experienced ones would. 

• The Florida Keys community experiences unique healthcare needs.  Identify 1-healthcare issues or trends you would consider advocating for that would have an impact on nursing in the Florida Keys.  Based on the BLT how would you go about advocating for the healthcare issue?

In the Florida Keys there is a critical nursing shortage. Leading to higher nurse-patient ratios that are unsafe. Per BLT to advocate for safe nurse-patient ratios I would make a list of the media in the Florida Keys. In the Keys news travels very quickly. An advantage we have is that Key West is a fairly small town and alot of people know each other. If we use the correct media tools we can recruit nurses while also providing benefits, higher pay, and different incentives to retain our staff. If this does not work, writing letters and using other ways of getting in contact with legislators to decrease the turnover and patient-nurse ratios can be also helpful. As well as joining the Advocacy Days to advocate for a safe work environment.

Florida Nurses Association. Barbara Lumpkin Institute. (n.d.). https://www.floridanurse.org/Links to an external site.  

Unit 9 ADHD Medications. 800w. 4 references. Due 10-26-23

Thomas Deliver, a 36-year-old male patient, enters your office for his initial appointment.  According to the intake paperwork, Mr. Deliver is a computer programmer who is complaining of problems with concentration, completing tasks, and being terrible at listening during company meetings and even at home.  He explains that he has difficulty starting and completing work projects and trouble being on time or keeping appointments and commitments.  He has divorced 3 months ago and has joint custody of two daughters ages 6 and 10 years old.  On most days, he sleeps late and he has trouble keeping a regular schedule and getting his children to their lessons and extracurricular appointments on time. 

Mr. Deliver believes the lack of concentration and poor communication with his wife led to the divorce, and Mr. Deliver worries that his trouble with organization and attention may affect his custody agreement and prevent him from keeping his job. 

Mr. Deliver’s employer and his family and friends have suggested to him that he should get evaluated for ADHD, but he has resisted because of concerns about the stigma of a psychiatric diagnosis and the risks of taking a psychotropic medication.

Mr. Deliver is 5'11″ and his weight is 165 lb.  He takes a men’s multivitamin daily, HCTZ at 25 mg for hypertension, fish oil 1,000 mg at bedtime for hyperlipidemia, and a rescue inhaler that he keeps with him although he hasn’t had to use it for many years.

1. What screening tools can be used to affirm your initial diagnosis that Mr. Deliver meets the criteria for ADHD?

2. Further assessment determines that Mr. Deliver does meet the criteria for ADHD, inattentive type. What is the current recommendation for pharmacological treatment for Mr. Deliver?

Assume that instead of Mr. Deliver being 36-years-old, Thomas is a 13-year-old male that also meets the diagnostic criteria for ADHD, hyperactive type (Thomas is not on any medications at this age).  How will your pharmacological treatment change?

Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.

Please be sure to validate your opinions and ideas with in-text citations and corresponding references in APA format.

Please review the rubric to ensure that your response meets the criteria.

1. What screening tools can be used to affirm your initial diagnosis that Mr. Deliver

meets the criteria for ADHD?

 The first tool I would use to affirm that this patient meets the criteria for ADHD would be

the DSM-5. The DSM-5 lists the diagnostic criteria for ADHD as needing six or more of

the symptoms in either category 1 (inattention) or category 2 (hyperactivity and

impulsivity) that last for at least 6 months and to a degree that negatively impacts social,

academic or occupations activities. These symptoms also need to be present in two or

more settings, be present prior to age of 12 years and do not occur exclusively during

the course of schizophrenia or another psychotic disorder and are not better explained

by another mental disorder (American Psychiatric Association, 2013). There are also

many screening tools to use in addition to the DSM-5. Rating scales are used in

conjunction with the DSM-5 to help with diagnosis of ADHD. Rating scales specifically

designed for use in adults include: Brown Attention-Deficit Disorder Symptom

Assessment Scale for Adults (BADDS); Adult ADHD Clinical Diagnostic Scale (ACDS);

ADHD Rating Scale-IV With Adult Prompts (ADHD-RS-IV); and the Adult ADHD SelfReport Scale (ASRS) (Gualtieri & Johnson, 2005).

This study source was downloaded by 100000769192234 from CourseHero.com on 10-21-2023 15:58:26 GMT -05:00

https://www.coursehero.com/file/123197904/discussion-9docx/

2. Further assessment determines that Mr. Deliver does meet the criteria for ADHD,

inattentive type. What is the current recommendation for pharmacological

treatment for Mr. Deliver?

I would recommend either an amphetamine or methylphenidate. I am slightly

concerned about this patient’s history of hypertension and hyperlipidemia, as both

of these psychostimulant classes have been shown to raise blood pressure. Long

term studies have shown that stimulant use is not associated with increased risk of

heart attacks, cardiac death or stroke. Those with well-controlled hypertension have

been shown to manage ADHD symptoms effectively with amphetamines and

methylphenidates. This still does not negate the fact however, that the product

labels of stimulants state that “caution is indicated” when treating patients with preexisting hypertension (Fairman et al., 2018). I would also be sure to encourage this

patient to partake in behavioral therapy as well as using prescription medication.

3. Assume that instead of Mr. Deliver being 36-years-old, Thomas is a 13-year-old male

that also meets the diagnostic criteria for ADHD, hyperactive type (Thomas is not on

any medications at this age). How will your pharmacological treatment change?

For an adolescent patient the treatment plan is not a lot different than for adults

with ADHD. Stimulants are more effective than non-stimulants, but there can be a

risk for growth restriction. There are other non-stimulant medications that could be

tried first (atomoxetine, guanfacine, clonidine, bupropion, and modafinil). As with

adults with ADHD, I would also recommend concurrent behavioral therapy (Heldt,

2017).

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(5th ed.). Arlington, VA: American Psychiatric Publishing

Fairman, K. A., Davis, L. E., Peckham, A. M., & Sclar, D. A. (2018). Diagnoses of

Cardiovascular Disease or Substance Addiction/Abuse in US Adults Treated for ADHD

with Stimulants or Atomoxetine: Is Use Consistent with Product Labeling? Drugs – Real

World Outcomes, 5(1), 69–79. https://doi.org/10.1007/s40801-017-0129-2

This study source was downloaded by 100000769192234 from CourseHero.com on 10-21-2023 15:58:26 GMT -05:00

https://www.coursehero.com/file/123197904/discussion-9docx/

Gualtieri, C. T., & Johnson, L. G. (2005). ADHD: Is Objective Diagnosis Possible? Psychiatry

(Edgmont (Pa. : Township)), 2(11), 44–53.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993524/

Heldt, J. P. (2017). Memorable psychopharmacology. Createspace Independent Publishing

Platform

1.What screening tools can be used to affirm your initial diagnosis that Mr. Deliver meets the criteria for ADHD?

The DSM-5 would be the first resource I would consult to confirm if this patient satisfies the requirements for ADHD. According to the DSM-5, six or more symptoms from either group—category 1 (inattention) or category 2 (hyperactivity and impulsivity)—must be present for at least six months and have a detrimental influence on a person's ability to engage in social, academic, or occupational activities. Additionally, these symptoms must appear in two or more contexts, appear before the age of twelve, not only occasionally during the course of schizophrenia or another psychotic condition, and not be better explained by another mental illness (American Psychiatric Association, 2013).The DSM-5 is just one of several screening instruments available. The DSM-5 and rating scales are combined to assist in the diagnosis of ADHD. The Brown Attention-Deficit Disorder Symptom Assessment Scale for Adults (BADDS), the Adult ADHD Clinical Diagnostic Scale (ACDS), the ADHD Rating Scale-IV With Adult Prompts (ADHD-RS-IV), and the Adult ADHD SelfReport Scale (ASRS) are among the rating scales created expressly for use in adults (Gualtieri & Johnson, 2005).

 

 

2.Further assessment determines that Mr. Deliver does meet the criteria for ADHD, inattentive type. What is the current recommendation for pharmacological treatment for Mr. Deliver?

 

Either an amphetamine or methylphenidate is what I would advise. The patient's history of hypertension and hyperlipidemia causes me a little anxiety because it has been demonstrated that both of these kinds of psychostimulants can increase blood pressure. Studies conducted over an extended period of time have revealed no link between stimulant usage and an increased risk of heart attacks, cardiac death, or stroke. Amphetamines and methylphenidate have been demonstrated to help people with well-controlled hypertension manage their ADHD symptoms. However, this does not change the fact that while treating patients with preexisting hypertension, caution is advised on the product labels of stimulants (Fairman et al., 2018). In addition to prescription medication, I would make sure to encourage this patient to engage in behavioral treatment.

 

3.Assume that instead of Mr. Deliver being 36-years-old, Thomas is a 13-year-old male that also meets the diagnostic criteria for ADHD, hyperactive type (Thomas is not on any medications at this age). How will your pharmacological treatment change?

The treatment strategy is mostly the same for adolescents and adults with ADHD. Although stimulants are more effective than non-stimulants, there is a chance that they may limit growth. There are more non-stimulant drugs that might be tried initially (atomoxetine, guanfacine, clonidine, bupropion, and modafinil). In the same way that I would advise concurrent behavioral therapy for people with ADHD (Heldt, 2017)

Step-by-step explanation

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing

 

 Fairman, K. A., Davis, L. E., Peckham, A. M., & Sclar, D. A. (2018). Diagnoses of Cardiovascular Disease or Substance Addiction/Abuse in US Adults Treated for ADHD with Stimulants or Atomoxetine: Is Use Consistent with Product Labeling? Drugs – Real World Outcomes, 5(1), 69-79. https://doi.org/10.1007/s40801-017-0129-2

 

Gualtieri, C. T., & Johnson, L. G. (2005). ADHD: Is Objective Diagnosis Possible? Psychiatry (Edgmont (Pa. : Township)), 2(11), 44-53. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993524/ 

 

Heldt, J. P. (2017). Memorable psychopharmacology. Createspace Independent Publishing Platform.