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The project is adapted from the Chapter 4 Case Study dealing with North–South Airline In January 2012, Northern Airlines

The project is adapted from the Chapter 4 Case Study dealing with North–South Airline In
January 2012, Northern Airlines merged with Southeast Airlines to create the fourth largest U.S.
carrier. The new North–South Airline inherited both an aging fleet of Boeing 727-300 aircraft
and Stephen Ruth. Stephen was a tough former Secretary of the Navy who stepped in as new
president and chairman of the board.
Stephen’s first concern in creating a financially solid company was maintenance costs. It was
commonly surmised in the airline industry that maintenance costs rise with the age of the
aircraft. He quickly noticed that historically there had been a significant difference in the
reported B727-300 maintenance costs (from ATA Form 41s) in both the airframe and the engine
areas between Northern Airlines and Southeast Airlines, with Southeast having the newer fleet.
On February 12, 2012, Peg Jones, vice president for operations and maintenance, was called into
Stephen’s office and asked to study the issue. Specifically, Stephen wanted to know whether the
average fleet age was correlated to direct airframe maintenance costs and whether there was a
relationship between average fleet age and direct engine maintenance costs. Peg was to report
back by February 26 with the answer, along with quantitative and graphical descriiptions of the
relationship.
Peg’s first step was to have her staff construct the average age of the Northern and Southeast
B727-300 fleets, by quarter, since the introduction of that aircraft to service by each airline in
late 1993 and early 1994. The average age of each fleet was calculated by first multiplying the
total number of calendar days each aircraft had been in service at the pertinent point in time by
the average daily utilization of the respective fleet to determine the total fleet hours flown. The
total fleet hours flown was then divided by the number of aircraft in service at that time, giving
the age of the “average” aircraft in the fleet.
The average utilization was found by taking the actual total fleet hours flown on September 30,
2011, from Northern and Southeast data, and dividing by the total days in service for all aircraft
at that time. The average utilization for Southeast was 8.3 hours per day, and the average
utilization for Northern was 8.7 hours per day. Because the available cost data were calculated
for each yearly period ending at the end of the first quarter, average fleet age was calculated at
the same points in time. The fleet data are shown in the following table.
Airframe cost data and engine cost data are presented below (please note, I have altered the
number presented in the text so that online solutions cannot be used) paired with fleet average
age in that table.
The project is derived from a case study located at the end of chapter 4 dealing with regression
analysis. Please note, however that some of the numbers in the project tables in the text have
been changed so students should get their complete instructions from the Project area provided in
Getting Started section of the Table of Contents. Students should use the Data Analysis add-on
pack from the standard Microsoft Excel software available in every Microsoft Office software
since 2007. The project requirements are:
1. Prepare Excel Data Analysis Regression Tables demonstrating your excellence at
determining Northern and Southeast Costs to Average Age. Besides the data tables,
copied from the project instructions, four regression models are required each on a
separate tab. STUDENTS CANNOT USE MULTIPLE REGRESSION as this is not part
of Excel software. Place each regression model with supporting data labels, line fit plots,
and other required items on a separate worksheet tab.
2. On each worksheet tab (other than the data table tab) include:
a. a copy of your data entry screen (Use Alt Print Screen to copy picture of
Regression Data Entry from Data Analysis in Excel and paste on correct
worksheet tab).
b. The regression model derived from the data tables.
c. Line Fit Plot for each Worksheet tab.
d. Labels of the data included.
e. Highlight with yellow and label the following four items on each regression
model:
i. Coefficient of determination
ii. Coefficient of correlation or covariance
iii. Slope, and
iv. Beta or intercept
3. Finally prepare a formal response, using Microsoft Word, from Peg Jones’s to Stephen
Ruth explaining your numbers and calculations. Which costs are correlated with the
average age of the aircraft? What is the slope and beta? Explain the coefficient of
determination and covariance. Explain how this information benefits each airline. Finally,
Stephen wants to know:
a. If Northern’s average age gets to 20,000 hours how much will the Airframe and
Engine cost.
b. If Southeast’s average age gets to 12,000 hours how much will the Airframe and
Engine cost.
Submit your Excel Worksheet with five tabs (data, plus 4 tabs for the regressions) to the
assignment drop box. Also include your formal response in a Microsoft Word document. Late
work will not be accepted. The Excel worksheet and Word documents must be submitted
BEFORE then end of Unit 7. This project is worth 160 points.
Note: Dates and names of airlines and individuals have been changed in this case to maintain
confidentiality. The data and issues described here are real.
Northern Airline Data (numbers have been changed from text)
Airframe Cost Engine Cost Average Age
Year per Aircraft per Aircraft (Hours)
2001 61.80 33.49 6,512
2002 54.92 38.58 8,404
2003 69.70 51.48 11,077
2004 68.90 58.72 11,717
2005 63.72 45.47 13,275
2006 84.73 50.26 15,215
2007 78.74 80.60 18,390
Southeast Airline Data (numbers have been changed from text)
Airframe Cost Engine Cost Average Age
Year Per Aircraft per Aircraft (Hours)
2001 14.29 19.86 5,107
2002 25.15 31.55 8,145
2003 32.18 40.43 7,360
2004 31.78 22.10 5,773
2005 25.34 19.69 7,150
2006 32.78 32.58 9,364
2007 35.56 37.07 8,259

CASE ANALYSIS EXERCISE 2 Click or tap here to enter text. 1

CASE ANALYSIS EXERCISE 2

Click or tap here to enter text. 1

Case Analysis Exercise

This Case Analysis projects focus is on depression, specifically depression in adolescents. Mental health is a specialty up until recent years has been silent disorders that society didn’t talk about, with many suffering in silence especially children and adolescents. This disorder and this client was chosen by this writer because she suffered from depression and anxiety for majority of her life. Due to the stigma of mental disorders being the product of supernatural forces and demonic possessions which lead to harmful effects including reluctance to seek help or treatment, lack of understanding by family or friends which leads to negative effect on recovery among individuals suffering with severe mental illness. Today’s society places pressure on adolescents to look and act in a manner that places additional pressure where this age group is already struggling with transitioning between childhood and adulthood, i.e. developmentally, intellectually, personality and social developmental all of which can have a negative impact on mental health. This writer had the opportunity of interacting with this client on intake and have the privilege of following her progress. This 16 years old female reports having struggled with depression for the last 2-3 years prior to seeking treatment, on intake the client was diagnosed with major depression disorder (MDD) without psychotic features.

This writer and preceptor interviewed the client together on intake, each follow-up visit and collaborated in medication management with ongoing assessment to evaluate medication compliance, efficacy, and side effects of treatment. The treatment goal is to maintain a balance with CBT therapeutic treatment, least amount of medication, and the use of self-help strategies i.e. eating healthy, daily exercise, good sleep habits and journaling. As a novice PMHP provider, having the opportunity to participate in this client’s case has increased the knowledge on medication management and experience the process of the treatment plan coming together allowing the client to move forward in managing their mental health disorder. The experience from intake has allowed this writer to form a therapeutic relationship with the client, watch her flourish and progress these last few visits. As the client’s mental disorder continue to improve the therapeutic plan of care will be adjusted and the goal is to utilize the tools learned from therapy allowing the client to manage symptoms with or without the aid of medication, leading to the end goal of a symptom free or manageable symptoms for a fulfilling life. All of which meets the criteria for the course practicum objectives to increase this students’ skills and overall knowledge in caring for an adolescent with depression (Meets Practicum Objective 3). The continuation to participate in the care of this client, allows for the therapeutic client-provider relationship to strengthen, as well as that of the parent (Meets Practicum Objective 1). This assignment has provided the opportunity to participate and monitor the plan of care, adjust the plan according to the progress (Meets Practicum Objective 6). Continue to collaborate with other members of the healthcare team to provide the most effective evidence-based treatment, with the goal of symptom management (Meets Practicum Objective 7).

SOAP

Subjective: L.P. is a 16-year-old Caucasian female who reports not finding enjoyment in things she once found pleasurable, reports feeling down majority of the time, experiencing fatigued all the time and sleeping about “10-12 hours per day”. Client is in high school, will complete the sophomore year in June. Client states the symptoms have become progressively worsened over the last six months, reporting family members and friends have noticed a change in her demeanor. Prior to beginning therapy, the client reports family and friends made many attempts to encourage participation in family gatherings, school events in hopes to “brighten my mood”. Client reports the feeling of being made fun of by classmates, being self-conscious of her appearance and weight (client denies weight gain/loss). Client reported “I am tired of feeling down all the time, this is not how I want to live my life.”

The client’s mother and the client deny prior psychiatric treatment. The client reports her grades have declined due to lack of energy, poor concentration and desire and want to “get back on track with her life and school”. The client states her goal is to attend Virginia Commonwealth University’s School of Nursing after graduation from high school in 2024.

Chief Complaint: “I am tired of feeling down all the time”

History of Present Illness: Client presents for routine follow-up, counseling for symptoms of major depression and treatment plan of medication and CBT. Client reports compliance with medication and weekly therapy sessions with counselor, denies medication side effects.

Allergies: NKDA

Past Medical History: None

Past Psychiatric History: None

Home Medications: Zoloft 50 mg by mouth daily

Family History: Father: Hypertension and Type 2 Diabetes.

Social History: Nonsmoker. Denies illicit drug use. Denies alcohol use. Lives with mother, father and 10-year-old sister. Reports good family support and good support of close friends.

Diet: “whatever mom makes”

Physical Activity: Currently none, reports use to play softball

ROS: Clients reports feeling fatigue, reports sleeping a lot, “about 10-12 hours per night”. Client denies weight loss/gain, denies GI distress, Client denies HA, dizziness, reports concentration is poor. Cleint confirms appetite is “ok”, Client denies suicidal or homicidal ideation, plan, or intention. No perceptual disturbances.

Screenings: On intake PHQ-9 score 19 GAD-7 score 8

Objective: Vitals: BP 119/64. P 78. Ht 5’6. Wt 145 lbs. LMP 1/27/2022

Labs: CBD, CMP, TSH, T4, Vit D level all WNL.

Mental Status Exam:

Appearance: Caucasian female. Average build. Looks stated age. Appropriately dressed for the season and clean. Sitting upright in chair.

Attitude: Pleasant and cooperative.

LOC: Alert

Orientation: oriented to person, place, time, and situation.

Attention: Good.

Psychomotor Activity: No psychomotor agitation or retardation noted.

Eye Contact: good

Speech: clear, articulate. Normal rate, rhythm, and tone.

Mood: “Slightly better, rates mood 5/10.”

Affect: Full.

Mood congruence: congruent

Thought Process: linear and goal-directed.

Thought Content: Denies SI, HI plan or intention.

Thought Perception: Denies AH, VH. Denies delusions.

Insight/Judgement: good, aware illness and need for treatment.

Fund of Knowledge: Appropriate for age.

Abstraction: abstract thinking

Assessment: DSM-V F32.9 Major Depressive Disorder, Single Episode, Unspecified

CPT billing code: 99214

Plan:

Continue Zoloft 50 mg PO daily

Discuss importance of medication compliance and reviewed side effects.

Emergency plan in place for SI, HI plan or intention. If thoughts of suicide contact the office, call suicide hotline, or go to the nearest hospital. If any side effects of the medication contact the office

Continue weekly sessions with licensed counselor.

Continue to work on healthy eating habits and begin exercise routine.

Return in 4 weeks or PRN

Differential Diagnosis

Persistent Depressive Disorder (Dysthymia) (F34.1)

Attention Deficit Hyperactivity Disorder Unspecified Type (F90.9)

Bipolar Disorder, Current Episode Depressed, Moderate (F31.32)

Major depressive disorder (F33.1)

Epidemiology and Etiology

Persistent Depressive Disorder (Dysthymia):

This disorder is similar to MDD with less acute symptoms, with more protracted, chronic disease course and without a manifestation of psychotic symptoms. Symptoms go undetected and therefore go untreated for years. Vegetative symptoms (i.e. sleep, appetite, weight changes) much less common in dysthymic disorder than MDD. More common in the 18 and older population. 15-25% of people diagnosed with dysthymic disorder will have a lifetime episode of MDD. Individuals with onset of symptoms before the age of 21 have a 75% likelihood of a lifetime episode of MDD. Women are 2-3 times more likely to develop DD then men. This patient’s symptoms, and length of symptoms, did not meet the criteria for this diagnosis (Association, 2013).

The etiology of DD may present in the context personal stress and environmental factors and can be present with dysphoria that occurs in the presence of psychological stressors. Despite this, the diagnosis of dysthymic disorder could be used if the patient’s symptoms did not meet the criteria .

Attention Deficit Hyperactivity Disorder:

It is estimated that five percent of children and at least 2.5 % of adults suffer from ADHD with the prevalence of children of school age being between 9-15% (Association, 2013). The prevalence of ADHD globally is between 2-18% depending on the population and diagnostic criteria. ADHD is the most prevalent mental health diagnosis of children predominantly being more common in boys, with a 4:1 ratio (Krull, 2021).

ADHD is a disorder that manifests in childhood, with symptoms of impulsivity hyperactivity, and, or inattention (Krull, 2021). There are several biological and psychosocial deficits are associated with ADHD, including abnormalities of the frontal cortex, basal ganglia, and reticular activating systems have been noted. The neurotransmitters, dopamine and norepinephrine have been implicated in ADHD (Sadock et al., 2010). Prenatal complications, such as exposure to alcohol and low birth weight may be a factor, as well as childhood exposure to neglect and family conflict. (Association, 2013).

Bipolar Disorder:

Currently, the diagnosis of pediatric bipolar is controversial and the prevalence is unclear. According to surveys, the prevalence of pediatric bipolar disorder in this population of school-age children and adolescents, with the youngest age being seven years. Despite these surveys, Pediatric bipolar disorder may occur in children of preschool age, however, the prevalence in this age group is unknown. The global lifetime prevalence of the disorder in children is 2% (Birmaher, 2021).

Research suggests that both biological and psychosocial factors are implicated, and the etiology and pathophysiology of this disorder is unknown. According to Neuroimaging there are several networks within the brain such as the dorsolateral prefrontal cortex, and amygdala that are involved. Which may implicate an anatomical and functional abnormalities in the brain, decreasing the volume in the prefrontal cortex (Birmaher, 2021).

Major Depressive Disorder:

MDD is common in children and adolescence with the risk is increasing with adolescence. The risk of MDD for children 3 to 5 years of age is 0.5 percent, 6 to 11 years of age, 1.4 percent, and 3.5 percent for children and adolescents 12 to 17 years of age. MDD affects approximately 5 % of the adult population and is the leading cause of disability in the U.S. (De Aquino et al., 2018) The ratio of adolescent females to males is two to one, similar to adults, with the gender difference emerging during puberty, with the risk higher in females. Before puberty, the risk of developing MDD is greater in males than females (Johnson et al, 2016). This patient’s symptoms met the criteria for MDD.

In children and adolescents, risk factors for MDD include having a first-degree relative with MDD, female gender, environmental stressors. The etiology of MDD includes psychological and neurobiological theories. Genetic predisposition, and neurotransmitter dysregulation involving dopamine, serotonin, and norepinephrine (Association, 2013). The etiology of MDD appears to involve three sets of risk factors, which often occur together. They include internalizing factors, or emotions, externalizing, or behavioral factors, and adversity factors, such as trauma, lack of parental warmth, parental loss, and divorce of parents. MDD runs in families. Children with the highest risk are those that have parents that experienced depressive symptoms at a young age (Sadock et al., 2015).

Diagnostics and Clinical Manifestations

Persistent Depressive Disorder (Dysthymia):

The intake interview should consist of a thorough H&P of present symptoms and must include the timeframe of symptom onset, progression, and remission, if any symptoms. Details should include living situation, relationship with family and friends, social history, OTC, prescriptive and street drug use, and any alcohol use.

MSE: Similar to MDD, no vegetative findings- Chronic depressed mood that occurs for most of the day, more days than not and for at least 2 years- However, for children and adolescents it is 1 year (Association, 2013).

Appearance: Unkempt, disheveled, poor hygiene, significant weight change from baseline

Mood: Sad, depressed, irritable, or anxious

Affect: Blunted, sad, anxious, or irritable

Speech: Low volume and intensity, monotone

Thought Process: Organized or disorganized, slow, ruminative

Thought Content: SI, HI plan or intention, anger, frustration, or guilt

Abstraction: Abstract thinking, if concrete, assess for psychotic findings

Insight/Judgement: May be good or poor. (Sadock et al., 2015).

Diagnostic tests:

No specific lab findings

CBC, CMP, TSH, Vitamin D and B12 level, Folate and Drug Screen. Sleep study if suspicion of sleep disorder

Screening Tools: MSE, Life Event Checklist, PHQ-9, GAD-7, ACT, CT or MRI, Columbia-Suicide Severity Rating Scale (Johnson et al., 2016).

ADHD

Detailed history of present illness. Social history, Medications. Functional history assessment. Collaborative history from parents/guardian.

MSE: Inattention, poor memory/concentration, distractible or over productive speech patterns

Appearance: Nonspecific

Mood: Varied from Good, distracted, or irritable

Affect: May be full or agitated.

Speech: Hyperverbal with increased tone.

Thought Process: Organized or disorganized or distracted.

Thought Content: Easily distracted or unremarkable.

Abstraction: May be loose associations or unremarkable.

Insight/Judgment: Varied good, fair, or poor (Sadock et al., 2015).

Diagnostic tests:

Nonspecific

Vanderbilt ADHD Parent and Teacher Rating Scale

Conner’s Parent and Teacher Rating Scale (Johnson et al., 2016).

Bipolar II Disorder:

The intake interview should consist of a thorough H&P of present symptoms and must include the timeframe of symptom onset, progression, and remission, if any symptoms. Details should include living situation, relationship with family and friends, social history, OTC, prescriptive and street drug use, and any alcohol use

MSE: Observe for abnormal or persistent elevated, expansive, or irritated mood lasting 1 week

Appearance: May be unkempt, disheveled, poor hygiene, or may be well-groomed, appropriately, or inappropriately dressed

Mood: May range from anxious, irritable, sad, depressed, to elated.

Affect: Blunted, restricted, or euphoric

Speech: May be clear, articulate with normal volume/tone to monotonal or loud and pressured

Thought Process: Logical or illogical and flight of ideas.

Thought Content: Paranoid, grandiose, delusional, hallucinating

Abstraction: Abstract thinking

Insight/Judgement: Impaired and result in sexual indiscretions, spending sprees. (Sadock et al., 2015).

Diagnostic tests:

PHQ-9

CBC, CMP, TSH, Vitamin D level and Drug Screen

Young Mania Rating Scale

KSADS Mania Rating Scale

MRS

General Behavior Inventory

Child Mania Rating Scale for Parents

Child Behavior Inventory (Johnson et al., 2016).

MDD:

The intake interview should consist of a thorough H&P of present symptoms and must include the timeframe of symptom onset, progression, and remission, if any symptoms. Details should include living situation, relationship with family and friends, social history, OTC, prescriptive and street drug use, and any alcohol use.

MSE: 5 or more of the 9 symptoms during the same 2-week period

Appearance: Normal, tired, or unkempt, disheveled, poor hygiene, change in weight, poor eye contact

Mood: Frustrated, sad, depressed, irritable

Affect: Anxious, sad, blunted, constricted or tearful

Speech: Slow to respond, low volume, low intensity, monotone

Thought Process: Organized, slow or if psychosis is present then disorganized. Easily distracted.

Thought Content: Guilt, worthlessness, hopelessness, SI, HI plan or intention.

Abstraction: Abstract thinking

Insight/Judgement: Intact or impaired d/t thoughts of worthlessness (Sadock et al., 2015).

Diagnostic tests:

No specific lab findings

CBC, CMP, TSH, Vitamin D level, Folate and Drug Screen. Sleep study if suspicion of sleep disorder

Screening tools: GAD, CAGE, PHQ9, PHQ2, Beck Depression Inventory for Primary Care, Trauma screening and WHO-5 (Williams & Nieusman, 2020).

Final Assessment

Differential Diagnosis

Pertinent positive and negative symptoms (positives are bolded)

Persistent Depressive Disorder:

DSM diagnostic criteria is a mild to moderate depression that is similar to MDD however does not go away. Symptoms last most of the day, for more days than not as indicated by subjective account or observation by others and lasts for at least 2 years for adults and 1 year for children or adolescents. The behaviors of sadness, dark or low mood must be present in addition to two or more of other depressive symptoms. (Association, 2013).

ADHD

DSM Diagnostic criteria to include six or more inattention symptoms for a minimum of six months that have impaired development and functioning. There must be a minimum of six hyperactivity symptoms, and poor impulse control must be persistent for at least six months. The symptoms must be present before the age of twelve years. These symptoms must occur in two or more settings, and other diseases, disorders, or conditions cannot be attributed to the symptoms (Association, 2013).

The individual must display symptoms:

Hyperactivity Symptoms:

-Squirming while seated, fidgeting with hands and/or feet

-Display marked restlessness that is difficult to control.

-Appearance of being “on the go”

-Lacks the ability to play or engage in leisure activities in a quiet manner.

-Inability to stay seated in class

-Overly talkative

Impulsivity Symptoms:

-Difficulty waiting their turn

– Interrupts or intrudes into conversations and activities of others

-Impulsively blurt out answers before a question is completed

-Display poor listening skills

-Loses or misplaces items

– Difficulty completing activities or tasks i.e., schoolwork or activities requiring concentration

-Sidetracked by unimportant or external stimuli

-Fail to focus on details and/or making careless mistakes on schoolwork or assignments (Association, 2013).

Bipolar II Disorder

DSM diagnostic criteria to include a current or past hypomanic state AND current or past MDD episode:

A specific period of abnormally and persistent expansive, elevated, for irritable mood, and abnormally increased energy/activity that lasts at least four consecutive days, for most of the day, nearly every day. During the period of disturbance in mood/increased energy/activity, three (or more) of the following symptoms must have persisted and make a noticeable change from the individual’s usual behavior and be present for a significant degree: Inflated self-esteem or grandiosity, a decreased need for sleep, the individual is more talkative than normal, or feel pressure to continue talking. The individual must have racing thoughts and/or flight of ideas, be easily distracted, engage in increased goal-directed activity, and have excessive involvement in activities that may result in negative consequences (Association, 2013).

Major Depressive Disorder (MDD)

DSM diagnostic criteria to include five of the nine symptoms must be present: anhedonia, depression of mood, difficulty concentrating, experience insomnia or hypersomnia, decreased energy, feelings of worthlessness or guilt, psychomotor agitation or retardation, recurrent thoughts of death or suicide. Depressed mood or anhedonia must be present (Association, 2013).

Final Diagnosis

This patient meets the DSM-V diagnostic criteria for MDD. Client reports feelings of sadness, guilt, decreased self-worth. At the time of her initial visit, these symptoms were present every day, for most of the day, for 2-3 years (similar to DD) however, client reported worsening symptoms in the last 6 months. The client reported sleeping a lot and feeling fatigued, confirmed loss of interest in things that once enjoyed, poor concentration and expressed feeling “down.” All these symptoms reported by the client and confirmed by the mother are significant symptoms classified under MDD. The PHQ-9 score on intake was 19. The client reported no history of mental illness and did not meet the criteria for the 3 other differential diagnoses.

Management

The goal in the acute phase of MDD in ensuring the clients safety, followed by ruling out any conditions or impairments that may contribute to depression. The provider should assess for the acuity of the client’s presentation and then the clinical management if nonacute episode. When working with adolescents the provider should be collaborating with the client, parent/guardian, PCP and other mental health team members in order to devise a plan of care to set the client up for success. The gold standard for treatment backed by evidence-based practice and proven to be successful in the treatment of depression involves psychotherapy such as CBT with a therapist and the pharmacological management with SSRI’s (Sadock et al., 2015).

Treatment options depends on the severity of MDD symptoms, mild forms of depression psychoeducation and supportive interventions may be effective however, those with moderate to severe MDD will include CBT and pharmacological management. Lastly, individuals with significant impairment and/or active suicidal ideation or psychosis, hospitalization maybe required for acute treatment (Sadock et al., 2015). Depending on the severity of symptoms, the developmental level/age of the client, the comorbidities will determine the type and frequency of therapy the individual will require (Bonin, 2021).

Health Promotion and Counseling

It is vital that an accurate diagnosis be formulated allowing for the provider to implement the appropriate treatment plan which is essential in promoting good health enabling the client to achieve remission of symptoms of MDD. The gold standard treatment options is individual counseling which gives the client the tools to move forward so the individual can make changes in dealing with everyday stressors in a healthier manner. Pharmacological management will assist with the physical symptom management by controlling the neurotransmitters in the brain. Providing the client and family with education on MDD will help understand the disorder which will reduce the stigma and encourage acceptance of the disorder which are also are key elements of treatment for symptom management (Niv et al., 2016). It is essential the client and the family be educated on the compliance of taking the medication as prescribed as well as the potential side effects of stopping the medication abruptly and adverse effects. The client should continue therapy until both the client and therapist have agreed the goals have been met and therapy is no longer a necessary treatment option.

Patient/Family Education

As stated earlier, providing education to the client, family and friends is a vital part of treatment for the individual. It is essential the client and/or family understand the importance of self-love, and self-care. Involving family and/or friends in the plan of care may increase the compliance with attending therapy and medication. Offering supportive services to the family may be an added benefit to help with the stress of caring for a loved one with a mental health disorder. Providing education on the signs and symptoms of depression, discuss the s/s of SI or HI plan or intent. Discuss an emergency plan for SI, HI plan or intention. If thoughts of suicide contact the office, call suicide hotline, or go to the nearest hospital. Provide education on the adverse side effect of the medication and if any side effects of the medication instruct to contact the office.

Christian Worldview

As a PMHNP, the goal is to fix the neurotransmitters in the brain to restore balance of symptoms allowing the individual to live a normal life without the stressors of mental health disorders. The focus of providers is to develop a secure and trusting relationship by providing compassionate non-biased care plan focusing on the future and not dwell in the past. This will be accomplished by establishing a safe and trusting environment, as the combination of therapy will provide the necessary tools to make changes of past mistakes and medications to alleviate the physical symptoms both of which leads to a healthier future. According to the New International Version bible, Jeremiah verse 29:11, “For I know the plans I have for you,” declares the LORD, “plans to prosper you and not to harm you, plans to give you hope and a future”

Level of Evaluation

This visit per Ranpariya et al. (2021), qualifies as a 99214 based on the following criteria:

1 or more chronic illnesses with exacerbation, progression, or side effects of treatment

Review of consult/progress notes from other providers were reviewed.

Results of test were reviewed.

Requires an assessment of an independent historian.

Management of prescription medication.

The length of the visit was 30 minutes

References

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

De Aquino, J. P., Londono, A., & Carvalho, A. F. (2018). An update on the epidemiology of major depressive disorder across cultures. In Understanding depression (pp. 309–315). Springer Singapore. https://doi.org/10.1007/978-981-10-6580-4_25

Johnson, K., & Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner review and resource manual (4th ed.). American Nurses Credentialing Center

Krull, K. (2021). Attention deficit hyperactivity disorder in children and adolescents:

Epidemiology and pathogenesis. UpToDate. https://www.uptodate.com

Liberty University. (2020). NURS 755: Psychiatric Mental Health Nurse Practitioner

Practicum II. Measurable course learning outcomes. https://Learn.liberty.edu/

Webapps/blackboard/conent/listContent.jsp?course_id=652443_1&content_id=42263581

New International Version Bible. (2011). Zondervan. (Original work published 1978).

Niv, N., Frousakis, N., Zucker, B. G., Glynn, S., & Dixon, L. (2016). A brief family intervention for depression in primary care. Journal of Family Therapy, 40(1), 100–119. https://doi.org/10.1111/1467-6427.12147

Ranpariya, V., Cull, B., Feldman, S., & Strowd, L. (2021) Coding Guidelines: Key change

and implications. https:/www.hmpgloballearningnetwork.com/site/thederm/

article/evaluation-and-management-2021-coding-guidelines-key-changes-and

implications

Sadock, B., Sadock, V., & Ruiz., P (2015). Kaplan and Sadock synopsis of psychiatry:

Behavioral science/clinical psychiatry (11th ed.). Williams & Wilkins.

Stovall, J. (2021). Bipolar disorder in adults: Epidemiology and pathogenesis. UpToDate.

https://www-uptodate-com.ezproxy.liberty.edu/contents/bipolar-disorder-in-

adults-epidemiology-andpathogenesis?search=bipolar%disorderdisorder

epidemiology&source=search_result&selectedTitle=1~150&usage_type=defa

ult&display_rank=1

Williams, J., & Nieusman, J. (2020). Screening for depression in adults. UpToDate.

https://www-uptodate-com.ezproxy.liberty.edu/

References

BUS3041 Week 2 Project $12.00 Instructions Project: Communication Ethics This course has

The project is adapted from the Chapter 4 Case Study dealing with North–South Airline In January 2012, Northern Airlines Mathematics Assignment Help BUS3041 Week 2 Project $12.00

Instructions

Project: Communication Ethics

This course has major project assignments due in Week 3 and Week 5. It will take more than a week’s effort to adequately complete them. Plan time to start the research and work on those assignments earlier than the week in which they are due.

Communication Ethics

In this assignment, you will learn to critically evaluate the code of ethics practiced in the corporate world.

Complete the following tasks:

Find an example of an actual corporate code of ethics (you may also use the code of ethics from your current employment).

Critique the code of ethics by addressing the following questions:

What seem to be the key focal points of the code of ethics?

Does the firm urge all its employees to uphold the code and perform only in ethically acceptable ways? How?

Does the code discuss the firm’s values and reflect the corporate culture? How?

Recommend at least three improvements the organization could make to its code of ethics.

Support your answers with examples and reasoning.

Submission Details:

Submit your assignment as a 3 to 4 pages Microsoft Word document, using APA style.

Support your answers with examples, reasoning, and research.

Your Name: Date: Title and author of article: 1. Briefly state the

Your Name: Date:

Title and author of article:

1. Briefly state the main ideas of this article:

2. List three important facts that the author(s) uses to support the main ideas.

(a fact is something that can be proved or disproved):

3. Discuss how the main ideas of this article are supported. For example, does the author(s) rely on empirical research studies? Rational analysis? Legal cases? Anecdotal examples? Personal experience? etc.:

4. Identify holes or weaknesses in the author’s main arguments:

5. What is a good counterargument to the thesis of this article?

6. What point could be added to its argument to make it stronger or more convincing?

7. List any examples of propaganda, bias, or faulty reasoning that you found in this article:

1. Imagine that you are preparing for a job interview for your

1. Imagine that you are preparing for a job interview for your dream company. The salary is great, the benefits are stellar, and the work environment, from what you have heard, is right up your alley. However, other than this little bit of information from the job announcement, you are not familiar with much else. According to Uncertainty Reduction Theory, we go through three phases of reducing apprehension about an upcoming event; entry (before the communication event), personal (during the communication event), and exit (after the communication event). Using this framework, describe how you would go about reducing your uncertainty at each of these three stages? Be specific! Think about how you will be perceived at each stage and how you can control that perception to put your best face forward. Provide at least three ideas per stage.

Entry (before you arrive at the job interview):

 

Personal (during the actual interview):

 

Exit (after the interview is finished):

 

2. (5 points). Identify three specific ways in which you could network for your future professional career. How might you do this at college and/or outside of? (Hint- I will be looking for specific responses and concrete information; for example, if you state that you could connect with a professional in your field, you will need to identify more than just that. Who might be a good person to contact? What would you say to this person?)