Examine Case Study: Pakistani Woman with Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamics processes. At each decision point stop to complete the following: Decision #1 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 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 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. Note: Support your rationale with a minimum of five or more academic resources. Delusional Disorders Pakistani Female with Delusional Thought Processes BACKGROUND The client is a 34-year-old Pakistani female who moved to the United States in her late teens/early 20s. She is currently in an “arranged” marriage (her husband was selected for her since she was 9 years old). She presents to your office today following a 21 day hospitalization for what was diagnosed as “brief psychotic disorder.” She was given this diagnosis as her symptoms have persisted for less than 1 month. Prior to admission, she was reporting visions of Allah, and over the course of a week, she believed that she was the prophet Mohammad. She believed that she would deliver the world from sin. Her husband became concerned about her behavior to the point that he was afraid of leaving their 4 children with her. One evening, she was “out of control” which resulted in his calling the police and her subsequent admission to an inpatient psych unit. During today’s assessment, she appears quite calm, and insists that the entire incident was “blown out of proportion.” She denies that she believed herself to be the prophet Mohammad and states that her husband was just out to get her because he never loved her and wanted an “American wife” instead of her. She tells you that she knows this because the television is telling her so. She currently weighs 140 lbs, and is 5’ 5” SUBJECTIVE Client reports that her mood is “good.” She denies auditory/visual hallucinations, but believes that the television does talk to her. She believes that Allah sends her messages through the TV. At times throughout the clinical interview, she becomes hostile towards the PMHNP, but then calms down. You reviewed her hospital records and find that she has been medically worked up by a physician who reported her to be in overall good health. Lab studies were all within normal limits. Client admits that she stopped taking her Risperdal about a week after she got out of the hospital because she thinks her husband is going to poison her so that he can marry an American woman. MENTAL STATUS EXAM The client is alert, oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Her speech is slow and at times, interrupted by periods of silence. Self-reported mood is euthymic. Affect constricted. Although the client denies visual or auditory hallucinations, she appears to be “listening” to something. Delusional and paranoid thought processes as described, above. Insight and judgment are impaired. She is currently denying suicidal or homicidal ideation. The PMHNP administers the PANSS which reveals the following scores: -40 for the positive symptoms scale -20 for the negative symptom scale -60 for general psychopathology scale Diagnosis: Schizophrenia, paranoid type RESOURCES § Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261-276. § Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine. Retrieved from https://www.clozapinerems.com/CpmgClozapineUI/rems... § Paz, Z., Nalls, M. & Ziv, E. (2011). The genetics of benign neutropenia. Israel Medical Association Journal. 13. 625-629. Decision Point One Start Zyprexa (olanzapine) 10 mg po orally at BEDTIME RESULTS OF DECISION POINT ONE Client returns to clinic in four weeks Client's PANSS decreases to a partial response (25%) Client comes in today with a reported weight gain of 5 pounds. When questioned further on this point, she states that she can never seem to get full from her meals so she is snacking constantly throughout the day. Decision Point Two Decrease Zyprexa to 7.5 mg BEDTIME RESULTS OF DECISION POINT TWO Client returns to clinic in four weeks Patient worsens. Her PANNS increases by 10% (negative symptoms are getting worse) but weight becomes stabilized and excessive hunger abates Husband explains that she is becoming less manageable at home and he is having to take time off from work because he is fearful of leaving her alone Decision Point Three Increase Zyprexa 10 MG orally at BEDTIME Guidance to Student Weight gain is a significant problem with Zyprexa. Next to Clozaril (clozapine), Zyprexa causes the most weight gain of all the atypical antipsychotics. This is a side effect that a significant number of clients will experience. There also appears to be an increased association of newly diagnosed diabetes mellitus in clients treated with Zyprexa. Although this can be disease related in this population, Zyprexa is above what would be considered coincidental. Risperdal is a good option, although it is dosed twice daily and compliance in this population can be problematic. There is evidence that shows giving Risperdal all at once can be efficacious and therefore could be an option down the road should compliance become an issue. Weight gain is also possible with Risperdal, but it is not as great as that seen with Zyprexa. If compliance does become an issue with this client, Risperdal has a long-acting injectable formulation, Risperdal Consta, that could be used. Remember, Risperdal Consta has to be given every 2 weeks at the provider’s office, and therapeutic blood levels take time to achieve (on average 3–6 weeks or 2–3 injections). Oral overlapping therapy is required to bridge this period of time. Another option in someone who responds to Risperdal would be Invega Sustenna (paliperidone palmitate), which is the first metabolite of Risperdal and has greater activity at the D2 receptor than Risperdal. An advantage of Invega Sustenna over Risperdal Consta is that therapeutic blood levels are attained within the first 4–7 days, and overlapping oral therapy is usually not necessary. A disadvantage is that during the initiating phase of medication, the first two doses need to be given within 4–7 days of one another. This is followed by monthly injections. There is another product on the market called Invega Trinza, which is given once every 3 months. This product is for clients who have been stabilized on Invega Sustenna for at least 4 months where the last two doses were the same strength (two months of 156 mg injections). Increasing Zyprexa to 15 mg at bedtime will only worsen the weight gain side effect. While additional benefits from increasing the dose may be possible from an efficacy standpoint, side effects always need to be taken into consideration. “First, do no harm.” Qsymia is a weight loss medication that is a combination of phentermine and topiramate. It is only indicated to treat obesity. This client’s BMI (28.9 kg/M2) does not fit the definition of obesity (BMI >30 Kg/M2- Following from CDC website: Class 1: BMI of 30 to < 35, Class 2: BMI of 35 to < 40, Class 3: BMI of 40 or higher. Class 3 obesity is sometimes categorized as “extreme” or “severe” obesity). There are two things wrong with this therapy option. First, there are only a few occasions where add-on therapy to treat a side effect is acceptable, and weight gain is not one of those scenarios. Secondly, phentermine has a lot of cardiovascular toxicities (such as elevated BP, HR, and increased workload on the heart).

Cultural DifferencesRead "The Cultural Challenges of Managing Global Project Teams: a Study of Brazilian Multinationals." Comment on how cultural differences affect projects, illustrate with examples from your own experience.The Cultural Challenges of Managing Global Project Teams: a Study of Brazilian Multinationals.Authors:Rodrigues, Ivete1Sbragia, Roberto2Source:Journal of Technology Management & Innovation. 2013 Special Issue, Vol. 8, p38-52. 15p.Document Type:ArticleSubject Terms:*International business enterprise management*Organizational behavior*Globalization*Project management*Diversity in the workplaceInternational business enterprises -- BrazilCross-cultural orientationAuthor-Supplied Keywords:business internationalizationcultureglobal projectsinter-cultural competenceproject managementNAICS/Industry Codes:541611 Administrative Management and General Management Consulting Services541614 Process, Physical Distribution, and Logistics Consulting Services541619 Other management consulting servicesAbstract:The internationalization of Brazilian companies brings a new reality: the need for implementation of global projects that bring, in turn, the challenge of managing multicultural teams. Since this is a recent phenomenon with little theoretical development, this study sought to understand the relationships between cultural characteristics and management teams of global projects in Brazilian multinationals. To carry this discussion forward, we studied six cases of Brazilian multinational companies, with the aim of deepening the understanding of the management of global teams, involving the planning, deployment, development and management of human resources. Among the projects studied, it was found that there is very little concern with the specific issue of multiculturalism and little inter-cultural incentive to the development of team members, which ends up hindering the construction of a global mindset, important for the Brazilian multinational companies to performs uccessfully a broad. Faced with this situation, each of the managerial processes mentioned were presented with a number of actions to be undertaken by the project manager in three different dimensions: the project itself, the organization and the global environment. The work contributes, thus, to enable Brazilian multinational companies to manage their global teams in order to maximize the advantages of global teams, such as increased creativity and innovative capacity, but avoid the problems that multiculturalism can bring, ranging from conflicts between people to project failure. [ABSTRACT FROM AUTHOR] Copyright of Journal of Technology Management & Innovation is the property of JOTMI Research Group and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)Author Affiliations:1FIA Business School, Rua José Alves da Cunha Lima, 172, São Paulo, Brasil2School of Economics, Business and Accounting at the University of São Paulo, Av. Prof. Luciano Gualberto, 908, Cidade Universitária, São Paulo, BrasilISSN:0718-2724DOI:10.4067/S0718-27242013000300004Accession Number:124588826

I am in a funk. I have three other classes to complete. I just need someone to actually do this paper for me. Answering all the questions below. Someone who is familiar with Western Governors University papers.A. Evaluate a primary quantitative research peer-reviewed journal article (suggested length of 3–5 pages) that has healthcare implications by doing the following:1. Identify how the researcher addresses the five following areas of the selected journal article, using the attached “Evidence Table”:• background or introduction• review of the literature• discussion of methodology• data analysis• researcher’s conclusion2. Critique whether the evidence presented in each section of the journal article supports the researcher’s conclusion.3. Explain the protection of human subjects and cultural considerations of the journal article.4. Identify strengths and limitations of the study.5. Describe how the evidence informs nursing practice.B. Evaluate a primary qualitative research peer-reviewed journal article (suggested length of 3–5 pages) that has healthcare implications by doing the following:1. Identify how the researcher addresses the five following areas of the selected journal article, using the attached “Evidence Table”:• background or introduction• review of the literature• discussion of methodology• data analysis• researcher’s conclusion2. Critique whether the evidence presented in each section of the journal article supports the researcher’s conclusion.3. Explain the protection of human subjects and cultural considerations of the journal article.4. Identify strengths and limitations of the study.5. Describe how the evidence informs nursing practice.