Practicum: Decision Tree

Assignment 1 Practicum Decision Tree
For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting symptoms of a mental health disorder.
Learning Objectives
Students will:
Evaluate clients for treatment of mental health disorders
Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders
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The Assignment:
Examine Case 2: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment. Practicum: Decision Tree.
At each Decision Point, stop to complete the following:
Decision #1: Differential Diagnosis
Which Decision did you select?
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?
Decision #2: Treatment Plan for Psychotherapy
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. Practicum: Decision Tree.
Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?
Decision #3: Treatment Plan for Psychopharmacology
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different? Practicum: Decision Tree.
Also include how ethical considerations might impact your treatment plan and communication with clients and their families.
BACKGROUND
Tyrel is an 8-year-old black male who is brought in by his mother for a variety of psychiatric complaints. Shaquana, Tyrel’s mother, reports that Tyrel has been exhibiting a lot of worry and “nervousness” over the past 2 months. She states that she notices that he has been quite “keyed up” and spends a great deal of time worrying about “germs.” She states that he is constantly washing his hands because he feels as though he is going to get sick like he did a few weeks ago, which kept him both out of school and off the playground. He was also not able to see his father for two weekends because of being sick. Shaquana explains that although she and her ex-husband Desmond divorced about 2 years ago, their divorce was amicable and they both endeavor to see that Tyrel is well caredfor.
Shaquana reports that Tyrel is irritable at times and has also had some sleep disturbances (which she reports as “trouble staying asleep”). She reports that he has been more and more difficult to get to school as he has become nervous around his classmates. He has missed about 8 days over the course of the last 3 weeks. He has also stopped playing with his best friend from across the street.
His mother reports that she feels “responsible” for his current symptoms. She explains that after he was sick with strep throat a few weeks ago, she encouraged him to be more careful about washing his hands after playing with other children, handling things that did not belong to him, and especially before eating. She continues by saying “maybe if I didn’t make such a big deal about it, he would not be obsessed with germs.” Practicum: Decision Tree.
Per Shaquana, her pregnancy with Tyrel was uncomplicated, and Tyrel has met all developmental milestones on time. He has had an uneventful medical history and is current on all immunizations.
OBJECTIVE
During your assessment of Tyrel, he seems cautious being around you. He warms a bit as you discuss school, his friends at school, and what he likes to do. He admits that he has been feeling “nervous” lately, but when you question him as to why, he simply shrugs his shoulders.
When you discuss his handwashing with him, he tells you that “handwashing is the best way to keep from getting sick.” When you question him how many times a day he washes his hands, he again shrugs his shoulders. You can see that his bilateral hands are dry. Throughout your assessment, Tyrel reveals that he has been thinking of how dirty his hands are; and no matter how hard he tries to stop thinking about his “dirty” hands, he is unable to do so. He reports that he gets “really nervous” and “scared” that he will get sick, and that the only way to make himself feel better is to wash his hands. He reports that it does work for a while and that he feels “better” after he washes his hands, but then a little while later, he will begin thinking “did I wash my hands well enough? What if I missed an area?” He reports that he can feel himself getting more and more “scared” until he washes his hands again.
MENTAL STATUS EXAM
Tyrel is alert and oriented to all spheres. Eye contact varies throughout the clinical interview. He reports his mood as “good,” admits to anxiety. Affect consistent to self-reported mood. He denies visual/auditory hallucinations. No overt delusional or paranoid thought processes were apparent. He denies suicidal ideation.
Lab studies obtained from Tyrel’s pediatric nurse practitioner were all within normal parameters. An antistreptolysin O antibody titer was obtained for reasons you are unclear of, and this titer was shown to be above normal parameters. Practicum: Decision Tree.
Decision Point One
BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PMHNP GIVE TO TYREL?
In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis. Practicum: Decision Tree.
Decision Point One
Obsessive Compulsive Disorder
Decision Point Two
Begin Fluvoxamine immediate release 25 mg orally at bedtime
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Upon return to the clinic, Tyrel’s mother reported that he has had some decrease in his symptoms. She states that the frequency of the handwashing has decreased, and Tyrel seems a bit more “relaxed” overall.
She also reports that Tyrel has not fully embraced returning to school, but that his attendance has improved. She reported that over this past weekend, Tyrel went outside to play with his friend from across the street, which he has not done in a while. Practicum: Decision Tree.
Decision Point Three
Increase Fluvoxamine to 50 mg orally at bedtime
Guidance to Student
In terms of an actual diagnosis, the child’s main symptoms are most consistent with obsessive-compulsive disorder. There may also be an element of social phobia developing, but at this point, the PMHNP has not assessed the nature of the school avoidance—that is, why is the child avoiding school. Notice that nothing in the scenario tells us that the PMHNP has assessed this.
Fluvoxamine immediate release is FDA-approved for the treatment of OCD in children aged 8 years and older. Fluvoxamine’s sigma-1 antagonist properties may cause sedation and as such, it should be dosed in the evening/bedtime.
At this point, it would be appropriate to consider increasing the bedtime dose, especially since the child is responding to the medication and there are no negative side effects.
Atypical antipsychotics are typically not used in the treatment of OCD. There is also nothing to tell us that an atypical antipsychotic would be necessary (e.g., no psychotic symptoms). Additionally, the child seems to be responding to the medication, so there is no rationale as to why an atypical antipsychotic would be added to the current regimen.
Cognitive behavioral therapy is the psychotherapy of choice for treating OCD. The PMHNP should augment medication therapy with CBT. If further assessment determines that Tyrel has social anxiety disorder, CBT is effective in treating this condition as well. Practicum: Decision Tree.
P(5.u)
 

Can I Push Back Time? A Realistic Approach to Reducing Ageing Effects

Can I Push Back Time? A Realistic Approach to Reducing Ageing Effects
No one likes to grow old, especially when it means that your appearance will change, sometimes drastically. Although ageing is a natural process and we should accept it and grow old gracefully, it is difficult. Some people age quicker than others and some people are blessed with great genes, and then there are those who go to great lengths to slow down the ageing process. This module teaches you what happens to your skin as it ages and what physical signs to expect as you grow older. You will also get a better insight on how you can prevent  through a careful skincare regime. This module includes the following items: Practicum: Decision Tree.
7.1. What Happens when your Skin ages?
7.2. How your Skin Changes with Each Birthday
7.3. Ethnicity and Ageing
7.4. Ingredients to Look for in Anti-Ageing Products
7.5. Botox versus Facelift
7.1. What Happens when your Skin ages?
As a person gets older, their body produces less collagen and elastin, thus leading to the appearance of fine lines and wrinkles. If you add gravity and sun exposure to that equation, the result will be saggy skin that appears leathery and old.
As you grow older, your skin continues to change. It becomes thinner, much drier, and even more fragile as the dermis of the skin begins to thin out. The fatty areas in your chin, cheeks, and nose begin to disappear, again making the skin sag more. More facial hair is evident in women as their bodies go through a number of different hormonal changes, sometimes making the skin more prone to acne and blackhead breakouts. Practicum: Decision Tree.
People, who suffer from oilier skin, will continue to have breakouts; however, there is a positive side to this – the oilier the skin is, the longer it will remain moist and smooth.
Using a good moisturiser over the years is one way that a person can lessen the impact of wrinkles and premature ageing.
Also with age, your body’s ability to attack free radicals that damage your cells and collagen slows down.
Consciously consuming foods with more antioxidants will protect your skin against free radicals and also improve its appearance, which is why vitamins A, C and E are often found in anti-ageing supplements.
7.2. How your Skin changes with each Birthday
Your 30s
Between the ages of 30-35 is the most common time when women give birth to children. Pregnancy is good for a woman’s skin because there is a normal healthy production of the hormonesoestrogen and progesterone. Some women break out in spots due to the overgrowth of blood vessels caused by too much oestrogen. It is also common for the texture of a woman’s skin to become tougher and drier while she is pregnant because the baby takes up so many of its mother’s nutrients. Practicum: Decision Tree.
Some other common features of a woman’s skin in their 30s include:

Drier and duller in colour due to the slowing down of the production of a person’s skin cells.
Visible fine lines appear around eyes and mouth.
Smile lines do not disappear.
Collagen and elastin start to become weaker.
Smoking accentuates fine lines.
May begin to lose part of your skin tone due to the weakening of the lymph glands that are responsible for flushing out all of the body’s toxins.
Skin’s appearance is less bright.
Tendency to put on more weight with more visible cellulite due to hormonal changes.
Stretch marks are more evident through pregnancy or slimming.

Your 40s
When a person is in their 40s their lymphatic system begins to steadily slow down resulting in puffiness in and around the eye and cheek areas.  This is a period when a person, especially a woman will notice visible physical differences in their appearance due to their age.
People in their 40s will notice:

More susceptible to the environment around them, such as smoky or polluted places due to the skin’s waxy protective coating being weaker. It is weaker due to the body’s lower sebum production.
Oestrogen production slows down resulting in duller skin.
Evidence of sagging and wrinkles around the neck and chest areas.
Increased cellulite and fat deposits around the hip and thigh areas.
Practicum: Decision Tree

50 +
More visible signs of ageing can be seen on other parts of the body other than the face in a person’s 50s. Pigmentation patches on the skin are common as are age spots. Excesses over the years, such as drinking, smoking, and sun worshipping will begin to show in damaged skin like spider veins caused by damaged blood vessels caused by the sun.
People in their 50s will notice:

Increased pore size.
Flakier skin.
Wrinkles become more apparent due to dehydration of the skin caused by weaker skin cells.
Eyelids may become hooded and wrinkled.
Break down of skin’s elasticity.
Menopause begins in women and the decreased oestrogen levels slow down the production of sebum resulting in drier skin.
Facial hair in women is not uncommon due to hormone imbalances brought on by menopause.
Skin is more likely to dry out and crack.
Loss of muscle tone and definition.

7.3. Ethnicity and Ageing
A lot of how you age is related to the colour of your skin and your ethnicity.
White Skin/Caucasian
The paler or fairer you are, the more you will have to do to protect it from ageing prematurely externally. Naturally, your melanin levels are lower, which means that the harmful UVA/UVB rays can penetrate much deeper into your skin thus causing photo-ageing and contributing to your skin’s break down of elastin and collagen.
For white complexions, the most important anti-ageing weapon would be a broad spectrum SPF 30 sun cream which has both UVA and UVB protection. Apply this daily, even when it is cloudy to every bit of your skin that is exposed, especially your face and neck.
Keep your skin nice and soft with its natural oils intact by using a gentle cleanser. After cleansing, apply your broad-spectrum cream and then your make-up.
Fairer skin tones have less collagen bundles than darker skin tones, which results in getting fine lines earlier than other ethnicities.
Use night creams that contain retinoids to boost the skin-cell turnover and thicken your thinning skin to make it feel and appear smoother. Look out for products that contain antioxidants such as soy, vitamins C and E to help nourish the skin and repair it.
When fairer skin is damaged by the sun, it causes the skin to develop an uneven skin tone. To overcome this, replace your harsher facial and body scrubs with natural enzyme-based scrubs and exfoliants. If you find that retinol creams are toosevere for your face, try peptides instead as they act as a great collagen booster.
Olive Skin
Because you have a warmer skin tone, it is likely you will show signs of ageing with fine lines and wrinkles later than people that have fairer skin.
Your skin haslower melanin content than those people with darker skin, but more than people with lighter skin. Your risk of sun damage compared to the fairer skinned person is significantly lower, but there is still a risk, which is why it is important to still always wear a broad-spectrum sun cream.
Generally, olive skin tans well, but at the same time it is more susceptible to melasma, which are darker brown patches of skin on the forehead, upper lip, cheeks, and chin areas. It is possible to fade these darker patches using certain creams and lotions that contain hydroquinone, azelaic acid or kojic acid. The combination of antioxidants in the above ingredients will help protect the skin from further damage; it will also help even out the skin tone, and strengthen the skin’s outer layer to help it retain its moisture. Continue wearing a high SPF sun cream that has zinc oxide or titanium dioxide.
Olive skin tones are prone to hypigmentation as they grow older. To help combat this, use a gentle foaming cleanser to get rid of the excess oil and then follow up by applying a serum which is rich in vitamin C.
People with olive skin are also more prone to an under-the-eye hollowness as they get older. To firm up the sagging skin in these areas use a night cream that contains peptides.
Middle Eastern and Asian Skin
Middle Eastern and Asian ethnicities do not begin to show signs of ageing until their mid-forties. However, although wrinkles tend to come later, these ethnicities are more prone to getting an uneven skin tone and darker patchy areas due to hormones, irritation and too much sun exposure.
Because of the excess pigment in the skin, Asians and those from the Middle East are prone to darker circles under the eyes. These bags under the eyes are often accentuated by the loss of volume under this area as a person ages. These ethnicities also suffer from more water retention when their hormones change, which again worsens the appearance under the eyes.
To try and reduce any signs of ageing underneath the eyes, you need to apply an eye cream that has cucumber extract, caffeine, or vitamin E to make the skin plumper and fresher looking.
Cleanse your skin gently with a face cloth and lukewarm water. After cleansing, use a serum that contains kokic acid to help fade the darker areas of the skin caused by hyperpigmentation and sun damage.
The moisturiser you use should be nourishing and rich. It should also contain salicylic acid, which will prevent your pores from getting too clogged.
Black / Dark Skin
Due to the high melanin levels in darker skin, they will not see any signs of ageing until their late 40’s or even 50’s. However, over time, darker skin loses its density and could result in sagging. To fight the sagging, opt for creams containing peptides as they help the body produce more collagen.
Darker skin tones also tend to suffer from uneven skin tones. You cannot scrub this away, so to reduce the severity of this, use a gentle cleanser together with an electric brush and glycolic toner to help stimulate your skin’s collagen and fade the darker patchy areas while regulating the skin’s oil production at the same time.
Moisturise in the morning with a cream that is rich in vitamin C. This will help brighten your skin and even out the patchier areas.  In the evening, use creams that contain retinol, peptides and ceramides to hydrate the skin and prevent sagging.
Some people with darker skin benefit from semi-regular microdermabrasion treatments. This treatment is done by licensed professionals and gently buffs the skin, getting rid of all the dead skin cells to help even out and soften the skin with reduced pores.
7.4. Ingredients to Look for in Anti-Ageing Products
Retinol
Retinol comes from vitamin A. Although it may take a few weeks to start seeing results, it is the most effective anti-ageing ingredient bought over the counter. It helps smooth out the face’s wrinkles and unclogs the pores. Additionally, it helps improve the skin’s texture and lightens superficial dark spots. Retinol is quite potent, which results in some people suffering from skin irritation, especially when they come into contact with direct sunlight. Use retinol-based anti-ageing products at nighttime on dry skin and make sure you apply an SPF moisturiser in the morning.
Niacinamide
If you suffer from darker uneven spots that have been caused by acne scars, old age, or sun damage, you can use a product that contains niacinamade, which comes from vitamin B3 to lighten them and prevent melanin from rising to the skin’s surface.  As a result your skin’s moisture and collagen production will improve and slowly over time reverse the damage from the sun.
Hyaluronic Acid
Hyaluronic acid is a form of humectants, which means that it draws water from both the air and dermis. Lotions with hyaluronic acid have excellent hydrating qualities and sometimes help improve collagen production to firm up sagging skin.
Alpha Hydroxyl Acid
Alpha hydroxyl acids (AHAs) work as exfoliators. They help remove dead skin cells and encourage new cell turnover revealing more youthful skin. When you exfoliate your skin, you will also allow serums, moisturisers, and other skin treatments to absorb and penetrate the skin more effectively. Look for a product that has 8% or less AHAs – when there are high concentrations of AHAs, you will help reduce and fade brown marks, spots and fine lines, but it will also make you more vulnerable and sensitive to the sun.
L-ascorbic Acid
L-ascorbic acid is another word for vitamin C. It helps build your skin’s collagen, helps to reduce any inflammation, and at the same time it plumps up the skin and promotes elasticity.
Avobenzone
This is a common chemical ingredient found in sun creams and sun blocks. Usually, this is found in combination with oxybenzone or benzophenone-3 to help block UVB rays. Use this before applying your regularmoisturiser or serum.
Antioxidants
Antioxidants help to prevent more damage happening and they also help repair your body’stissue and cell damage. They neutralise the free radicals and promote cell grown. Popular antioxidants found in anti-ageing products include vitamins C and E, green tea, berry extracts, and pomegranate.
 
7.5. Botox versus Facelift
While Botox and facelifts are more extreme measures for looking young, they are not uncommon and it is becoming increasingly common for people, especially in the 40s and 50s, to go under the knife whereas the popularity of Botox is waning slightly.
When a person’s age begins to show from their many years of excessive sun exposure, pollutants, daily life stress, and smoking, they begin to suffer from wrinkles, some of which are deeper creases than others. It is also common for a person to suffer from sagging skin around the jaw line and neck area, which often makes them appear older than they really are.
No person really enjoys the idea of having an invasive facelift, otherwise known as rhytidectomysurgergy and the long hard recovery process that follows, but it does not stop people, especially in the US where 13 million people undergo surgery for anti-ageing purposes alone each year.
Can you explain the difference between Botox and facelifts?
A facelift is an invasive surgical procedure while Botox are injections and are non-surgical.
Some people opt for Botox because it is non-surgical; however, it really depends on the specific problems you have to know which anti-ageing beauty procedure is the right one for you. The important thing to remember is that facelifts and Botox are completely different and they are used for completely different purposes – they do complement each other, but it is essential to remember that they do not produce the same results.
Facelift
People have facelifts usually to reshape their deep facial structures. Additionally, they are used to try and remove extra skin tissue which results in a more youthful appearance; these saggy skin tissues are usually located in the lower region of the face, neck, and jowls. If a person has a lot of sagging skin, there is nothing that can be done to reduce it significantly. To reduce the skin, it needs to be removed, repositioned, and repaired. Some facelift surgeries might involve eyelid surgery, a neck lift, or a forehead lift to improve the appearance and age of a person.
Facelift surgery helps correct the following problems:

Deep under-the-eye creases and wrinkles
Deep forehead wrinkles and creases
Droopy eyebrows
Lowered cheek pads
Deep creases, folds or wrinkles along the nose
Saggy jowls
Double chin

Botox
Botox is a form of botulinum toxin. It is directed at a person’s overactive muscles to help alleviate expression lines, wrinkles, and crows’ feet. Usually Botox is used mostly in the upper parts of a person’s face,in the corners of a person’s eyes, forehead creases, and lines and wrinkles that form between the eyebrows. The muscles absorb the Botox and help them relax more. Botox injections do not really have any impact on the skin and Botox is often referred to as a “non-surgical facelift.” However, it cannot really be called a facelift because it does not involve any kind of skin removal or lifting. However, the Botox injections can help the skin’s appearance look smoother, softer, and more youthful.
Botox helps correct the following problems:

Fine facial lines and wrinkles
Expression lines e.g. laughter lines
Crows’ feet
Furrows between the eyebrows
Fine forehead lines and wrinkles
Neck bands

Scenario for Week 7 Case: You are a PMHNP

Scenario for Week 7 Case:
You are a PMHNP working in a large intercity hospital. You receive a call from the answering service informing you that a “stat” consult has been ordered by one of the hospitalists in the ICU. Upon arriving in the ICU, you learn that your consult is a 14 year old male who overdosed on approximately 50 Benadryl (diphenhydramine hydrochloride) tablets in an apparent suicide attempt. At the scene, a suicide note was found indicating that he wanted to die because his girlfriend’s parents felt that their daughter was too young to be “dating.” The client stated in the suicide note that he could not “live without her” and decided to take his own life. Although he has been medically stabilized and admitted to the ICU, he has been refusing to talk with the doctors or nurses. The hospital staff was finally able to get in touch with the clients parents (using contact information retrieved from the 14 year old’s cell phone). Unbeknown to the hospital staff, the parents are divorced, and both showed up at the hospital at approximately the same time, each offering their own perspectives on what ought to be done. The client’s father is demanding that the client be hospitalized because of the suicide, but his mother points out that he does not have “physical custody” of the child. The client’s mother demands that the client be discharged to home with her stating that her son’s actions were nothing more than a “stunt” and “an attempt at manipulating the situation that he didn’t like.” The client’s mother then becomes “nasty” and informs you that she works as a member of the clerical staff for the state board of nursing, and if you fail to discharge her child “right now” she will make you “sorry.” How would you proceed?
The Assignment (2–3 pages):
Based on the scenario, would you recommend that the client be voluntarily committed? Why or why not?
Based on the laws in your state, would the client be eligible for involuntary commitment? Explain why or why not.
Did understanding the state laws confirm or challenge your initial recommendation regarding involuntarily committing the client? Explain.
If the client were not eligible for involuntary commitment, explain what actions you may be able to take to support the parents for or against voluntary commitment.
If the client were not eligible for involuntary commitment, explain what initial actions you may be able to take to begin treating the client.

Scenario for Week 7 Case: You are a PMHNP

Scenario for Week 7 Case:
You are a PMHNP working in a large intercity hospital. You receive a call from the answering service informing you that a “stat” consult has been ordered by one of the hospitalists in the ICU. Upon arriving in the ICU, you learn that your consult is a 14 year old male who overdosed on approximately 50 Benadryl (diphenhydramine hydrochloride) tablets in an apparent suicide attempt. At the scene, a suicide note was found indicating that he wanted to die because his girlfriend’s parents felt that their daughter was too young to be “dating.” The client stated in the suicide note that he could not “live without her” and decided to take his own life. Although he has been medically stabilized and admitted to the ICU, he has been refusing to talk with the doctors or nurses. The hospital staff was finally able to get in touch with the clients parents (using contact information retrieved from the 14 year old’s cell phone). Unbeknown to the hospital staff, the parents are divorced, and both showed up at the hospital at approximately the same time, each offering their own perspectives on what ought to be done. The client’s father is demanding that the client be hospitalized because of the suicide, but his mother points out that he does not have “physical custody” of the child. The client’s mother demands that the client be discharged to home with her stating that her son’s actions were nothing more than a “stunt” and “an attempt at manipulating the situation that he didn’t like.” The client’s mother then becomes “nasty” and informs you that she works as a member of the clerical staff for the state board of nursing, and if you fail to discharge her child “right now” she will make you “sorry.” How would you proceed?
The Assignment (2–3 pages):
Based on the scenario, would you recommend that the client be voluntarily committed? Why or why not?
Based on the laws in your state, would the client be eligible for involuntary commitment? Explain why or why not.
Did understanding the state laws confirm or challenge your initial recommendation regarding involuntarily committing the client? Explain.
If the client were not eligible for involuntary commitment, explain what actions you may be able to take to support the parents for or against voluntary commitment.
If the client were not eligible for involuntary commitment, explain what initial actions you may be able to take to begin treating the client.

Assignment 1: Practicum: Decision Tree
For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting symptoms of a mental health disorder.
Learning Objectives
Students will:

· Evaluate clients for treatment of mental health disorders
· Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders

The Assignment:
Examine Case 2: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.
At each Decision Point, stop to complete the following:
· Decision #1: Differential Diagnosis
· Which Decision did you select?
· Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
· What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
· Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?
· Decision #2: Treatment Plan for Psychotherapy
· Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
· What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
· Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?
· Decision #3: Treatment Plan for Psychopharmacology
· Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
· What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
· Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
· Also include how ethical considerations might impact your treatment plan and communication with clients and their families.
BACKGROUND
Tyrel is an 8-year-old black male who is brought in by his mother for a variety of psychiatric complaints. Shaquana, Tyrel’s mother, reports that Tyrel has been exhibiting a lot of worry and “nervousness” over the past 2 months. She states that she notices that he has been quite “keyed up” and spends a great deal of time worrying about “germs.” She states that he is constantly washing his hands because he feels as though he is going to get sick like he did a few weeks ago, which kept him both out of school and off the playground. He was also not able to see his father for two weekends because of being sick. Shaquana explains that although she and her ex-husband Desmond divorced about 2 years a

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