1. Draw a schematic path of a deoxygenated red blood cell traveling from the inferior vena cava through the heart to the lungs and back to the heart and then to the aorta. Label the veins, valves, and parts of the heart it travels through and note oxygenated color change from blue to red.2. How do the thicknesses of the atrial and ventricular walls differ? How does wall thickness relate to function? 3. Which abdominal arteries are paired? Which are singular? (Word Limit: 2-3 sentences each) please show source website. thank you.
Solution:1. Blue blood – Deoxygenated blood enters right atrium – vena cavae – right atrium– right ventricle – artery – lungs – capillaries – blood gets oxygenated – red blood–…

 After completing your Reading for this week, please respond to the following questions:

In your own words, create a definition of competence in the field of human services.
Discuss why competence is essential to the helping relationship.
Use the Internet and the Kaplan Library to investigate the minimum standards of competence for human service professionals in your state. Describe these requirements.
Consider the Case Example of Rasheed regarding multicultural competencies on pages 216–217 of your text. Imagine you are a case worker at a human service agency working with Steve. What is your reaction to this case? Does it raise personal issues for you? If you were in Rasheed’s position, would you feel competent to work with Steve? What if Steve discovered that he harbored negative attitudes toward African Americans? Would that make a difference in your response to this scenario?
Develop a plan for maintaining your own competence in the human services profession. In other words, what will you do to remain competent in your work?
Discuss ethical considerations in research and publication. Give specific examples of how these issues may impact clients. Please use different examples than have been stated by your classmates.

Rasheed, an African- American professional counselor, was employed at a community mental health center. A local physician referred Steve, a 30- year- old Caucasian graduate student, because of recurrent depressive symptoms.
After Rasheed went over the informed consent forms, Steve said somewhat aggressively, “I need to tell you something about myself. I’m what you would probably consider Texan White Trash. I was raised in a trailer park in West Texas. My parents hated Black people and blamed everything that went wrong in their lives on ‘niggers.’ I grew to hate my parents. When I was 9, I was sexually abused by my uncle and after that, I decided I would do everything and anything I could to get away from my family. That’s why I moved here 12 years ago, and I haven’t had much contact with them since.”
Rasheed nodded. Steve took a breath and continued in a more subdued tone. “But my dad has cancer and my sister keeps calling me, saying that he wants to see me and that I’ve got to come back home to visit. I’m struggling to face the fact that I should go back and say good- bye to my father before he dies. And the weird thing about this is that now I’ve come to see you and you seem fine and all that, but your job is to help me go back and be with my father who spent his life hating Blacks. Are you okay with that?”

Code the first operative report, include any CPT surgery code(s), anesthesia code(s), and any modifiers applicable. Also include ICD-10-CM codes. (30 points)
Code the E&M code for the second office visit.
1. Description: Bilateral open Achilles lengthening with placement of short leg walking cast.
PREOPERATIVE DIAGNOSIS: Idiopathic toe walker.
POSTOPERATIVE DIAGNOSIS: Idiopathic toe walker.
PROCEDURE: Bilateral open Achilles lengthening with placement of short leg walking cast.
ANESTHESIA: Surgery performed under general anesthesia. A total of 10 mL of 0.5% Marcaine local anesthetic was used.
COMPLICATIONS: No intraoperative complications.
DRAINS: None.
SPECIMENS: None.
TOURNIQUET TIME: On the left side was 30 minutes, on the right was 21 minutes.
HISTORY AND PHYSICAL: The patient is a 10-year-old boy who has been a toe walker since he started ambulating at about a year. The patient had some mild hamstring tightness with his popliteal angle of approximately 20 degrees bilaterally. He does not walk with a crouched gait but does toe walk. Given his tightness, surgery versus observation was recommended to the family. Family however wanted to correct his toe walking. Surgery was then discussed. Risks of surgery include risks of anesthesia, infection, bleeding, changes in sensation and motion of the extremities, failure to resolve toe walking, possible stiffness, cast, and cast problems. All questions were answered and parents agreed to above surgical plan.
PROCEDURE IN DETAIL: The patient was taken to the operating room and placed supine on the operating table General anesthesia was then administered. The patient received Ancef preoperatively. The patient was then subsequently placed prone with all bony prominences padded. Two bilateral nonsterile tourniquets were placed on each thigh. Both extremities were then prepped and draped in a standard surgical fashion. We turned our attention first towards the left side. A planned incision of 1 cm medial to the Achilles tendon was marked on the skin. The extremity was wrapped in Esmarch prior to inflation of tourniquet to 250 mmHg. Incision was then made and carried down through subcutaneous fat down to the tendon sheath. Achilles tendon was identified and Z-lengthening was done with the medial distal half cut. Once Z-lengthening was completed proximally, the length of the Achilles tendon was then checked. This was trimmed to obtain an end-on-end repair with 0 Ethibond suture. This was also oversewn. Wound was then irrigated. Achilles tendon sheath was reapproximated using 2-0 Vicryl as well as the subcutaneous fat. The skin was closed using 4-0 Monocryl. Once the wound was cleaned and dried and dressed with Steri-Strips and Xeroform, the area was injected with 0.5% Marcaine. It was then dressed with 4 x 4 and Webril. Tourniquet was released at 30 minutes. The same procedure was repeated on the right side with tourniquet time of 21 minutes. While the patient was still prone, two short-leg walking casts were then placed. The patient tolerated the procedure well and was subsequently flipped supine on to hospital gurney and taken to PACU in stable condition.
POSTOPERATIVE PLAN: The patient will be discharged on the day of surgery. He may weightbear as tolerated in his cast, which he will have for about 4 to 6 weeks. He is to follow up in approximately 10 days for recheck as well as prescription for intended AFOs, which he will need up to 6 months. The patient may or may not need physical therapy while his Achilles lengthenings are healing. The patient is not to participate in any PE for at least 6 months. The patient is given Tylenol No. 3 for pain.
2. 
HISTORY OF PRESENT ILLNESS: Mr. Smith is a 63-year-old gentleman new to our Clinic. He had been followed by Dr. Jones at Kernodle Clinic. Mr. Smith has a past medical history that includes hypertension for more than five years. It sounds like he has fairly severe white coat hypertension. Apparently, he has home readings consistently 30 points below what he gets in the office. He had been on Capoten in the past and gotten a cough with that. He had been on Norvasc in the past, but then stopped it for unclear reasons. More recently, he has been on Hyzaar. He also has hypercholesterolemia and has been on Lipitor. He has for the past year or so felt that his hands and feet were “burning up” at night. He reports that “he can almost see the heat waves from them.” He thinks this is a medication side effect. On his own, he stopped his Lipitor three weeks ago. He has not noticed any difference in his symptoms. He otherwise feels well and has no complaints.
PAST MEDICAL HISTORY: 1. Hypertension. 2. Hypercholesterolemia. 3. Status post plastic surgery after a motor vehicle collision when he was in his 20s. 4. History of depression around the time of the accident. He does report that intermittently he feels quite down, but he is able “to pick himself back up”. More recently, however, he has been in a more prolonged period. 5. He has significant moles and he is followed by an outside dermatologist. 6. He has had normal PSA and rectal exams. He had a colonoscopy about five years ago and again one year ago, both of which showed many polyps, pathology not known.
MEDICATIONS: Now only Hyzaar, a baby aspirin and a multivitamin
ALLERGIES: Capoten caused a cough.
SOCIAL HISTORY: He works in computer software. He does not smoke. He drinks wine and Martinis “probably more than I need to.” No drug use.
FAMILY HISTORY: The patient’s father died of a brain aneurysm in his 50s. Mom had colon cancer in her 80s and also hypertension. Five older sisters all with hypertension and hypercholesterolemia. No known coronary artery disease.
REVIEW OF SYSTEMS:
CONSTITUTIONAL: No fevers. Weight up 15 lbs since March. HEENT: Teeth doing okay. Does not feel congested in his sinuses. CARDIOVASCULAR: No chest pains, palpitations, PND, orthopnea or edema. RESPIRATORY: No shortness of breath. He does have a chronic intermittent cough that he has had for years. He had a chest x-ray a couple of years ago to evaluate this which was apparently normal. GI: No abdominal pain. No reflux-type symptoms. No change in bowel habits. GU: No hematuria or dysuria. MUSCULOSKELETAL: No chronic joint pains. PSYCHIATRIC: Not suicidal.
PHYSICAL EXAMINATION:
VITAL SIGNS: Weight 86.7 kg which is 191 lbs, blood pressure 174/114, pulse 103.
HEENT: Conjunctivae pink. Sclerae anicteric. Oropharynx clear.
NECK: No lymphadenopathy or thyromegaly or JVD.
LUNGS: Clear to auscultation and percussion.
HEART: Regular rate and rhythm without murmur, rub or gallop.
ABDOMEN: Normal bowel sounds. Soft, nontender. No hepatosplenomegaly.
EXTREMITIES: No cyanosis, clubbing or edema.
PSYCHIATRIC: Normal affect and behavior with seemingly good insight.
ASSESSMENT AND PLAN:

Hypertension, poor control even with supposed white coat hypertension. He again is worried about side effect of his medications. We talked about many options and decided to change him to HCTA 25 mg a day and Norvasc 10 mg a day.
Hypercholesterolemia. We will check lipid panel today. We will hold off on Lipitor for now, but will likely restart this once we confirm he is not having drug side effects. He is also interested in possibly trying fish oil.
Psychiatric. He was not interested in counseling at all. He was interested in medication. We will start Celexa 20 mg a day. He will titrate this up to 40 mg after three to four weeks. He will call us in a few weeks if he is having any problems.
Health maintenance. We will hold on PSA screening for a bit as he has been screened in the past. We will repeat colonoscopy in a few years and will try to get records of prior polyp pathology. He will try to focus on drinking a bit less alcohol and getting some regular exercise and eating better. Continue baby aspirin.
Return to clinic in two months.

You have been practicing counseling skills either on a volunteer or on yourself throughout this course. This paper is an opportunity to reflect on everything you learned. It is also an opportunity to examine yourself as a potential counselor. You may write in the first-person perspective in this assignment.
Write a 550-word paper addressing the following:

What is the most significant information you learned about the skills required to be an effective counselor? Were there any skills that surprised you as you worked through the course? 
What are your strengths as a potential counselor? These could be attending or communication skills, attitudes or behaviors that will be an asset in the counseling role.
What skills do you think will be most difficult for you? What might be your handicaps as a counselor?
What are some specific actions you will take to prepare yourself for your future practicum experience? 
Review your text regarding consultant-counselor and the additional reading on the topic. Explain the role of consultant-counselor. Do you see yourself acting in this role? Why or why not?  ent
Week 8 | Termination and Maintenance
Current All

Assignment Self-Reflection (Obj. 8.4)

Due Date: Jun 21, 2017 23:59:59       Max Points: 60Details:
You have been practicing counseling skills either on a volunteer or on yourself throughout this course. This paper is an opportunity to reflect on everything you learned. It is also an opportunity to examine yourself as a potential counselor. You may write in the first-person perspective in this assignment.

Write a 500-750-word paper addressing the following:

What is the most significant information you learned about the skills required to be an effective counselor? Were there any skills that surprised you as you worked through the course? 

What are your strengths as a potential counselor? These could be attending or communication skills, attitudes or behaviors that will be an asset in the counseling role.What skills do you think will be most difficult for you? What might be your handicaps as a counselor?What are some specific actions you will take to prepare yourself for your future practicum experience? Review your text regarding consultant-counselor and the additional reading on the topic. Explain the role of consultant-counselor. Do you see yourself acting in this role? Why or why not?  
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

This assignment meets the following CACREP Standard: 2.F.5.c. Theories, models, and strategies for understanding and practicing consultation.
 Please Note: Assignment will not be submitted to the faculty member until the “Submit” button under “Final Submission” is clicked.

TitleAttached DocumentsTurnitin ReportSimilarity IndexFinal Submission Click ‘New Attempt’ to start assignment or attach documents
Error Details
 
Apply Rubrics

Self-Reflection (Obj. 8.4)

1 Unsatisfactory 0.00%

2 Less than Satisfactory 74.00%

3 Satisfactory 79.00%

4 Good 87.00%

5 Excellent 100.00%

70.0 %Content
 
20.0 % Counseling Skills

Discussion of the most significant information you learned about the skills required to be an effective counselor and any skills that surprised you is not present or not discernible to the reader.

Discussion of the most significant information you learned about the skills required to be an effective counselor and any skills that surprised you is incomplete or flawed.

Discussion of the most significant information you learned about the skills required to be an effective counselor and any skills that surprised you is accurate and complete.

Discussion of the most significant information you learned about the skills required to be an effective counselor and any skills that surprised you is thorough and well-reasoned.

Discussion of the most significant information you learned about the skills required to be an effective counselor and any skills that surprised you is thorough and well-reasoned. Information provided is fully supported and rich in detail.

10.0 % Strengths as a Potential Counselor

Discussion of your strengths as a potential counselor is not present or not discernible to the reader.

Discussion of your strengths as a potential counselor is incomplete or flawed.

Discussion of your strengths as a potential counselor is accurate and complete.

Discussion of your strengths as a potential counselor is thorough and well-reasoned.

Discussion of your strengths as a potential counselor is thorough and well-reasoned. Information provided is fully supported and rich in detail.

10.0 % Difficult Skills as a Potential Counselor

Discussion of the skills that you think will be most difficult for you and what might be your handicaps as a counselor is not present or not discernible to the reader.

Discussion of the skills that you think will be most difficult for you and what might be your handicaps as a counselor is incomplete or flawed.

Discussion of the skills that you think will be most difficult for you and what might be your handicaps as a counselor is accurate and complete.

Discussion of the skills that you think will be most difficult for you and what might be your handicaps as a counselor is thorough and well-reasoned.

Discussion of the skills that you think will be most difficult for you and what might be your handicaps as a counselor is thorough and well-reasoned. Information provided is fully supported and rich in detail.

20.0 % Preparing for Practicum

Discussion of some specific actions you will take to prepare yourself for your future practicum experience is not present or not discernible to the reader.

Discussion of some specific actions you will take to prepare yourself for your future practicum experience is incomplete or flawed.

Discussion of some specific actions you will take to prepare yourself for your future practicum experience is accurate and complete.

Discussion of some specific actions you will take to prepare yourself for your future practicum experience is thorough and well-reasoned.

Discussion of some specific actions you will take to prepare yourself for your future practicum experience is thorough and well-reasoned. Information provided is fully supported and rich in detail.

10.0 % Consultant-Counselor Role

Discussion of the role of consultant-counselor and whether you see yourself acting in this role or not is not present or not discernible to the reader.

Discussion of the role of consultant-counselor and whether you see yourself acting in this role or not is incomplete or flawed.

Discussion of the role of consultant-counselor and whether you see yourself acting in this role or not is accurate and complete.

Discussion of the role of consultant-counselor and whether you see yourself acting in this role or not is thorough and well-reasoned.

Discussion of the role of consultant-counselor and whether you see yourself acting in this role or not is thorough and well-reasoned. Information provided is fully supported and rich in detail.

20.0 %Organization and Effectiveness
 
7.0 % Thesis Development and Purpose

Paper lacks any discernible overall purpose or organizing claim.

Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear.

Thesis and/or main claim are apparent and appropriate to purpose.

Thesis and/or main claim are clear and forecast the development of the paper. It is descriptive and reflective of the arguments and appropriate to the purpose.

Thesis and/or main claim are comprehensive. The essence of the paper is contained within the thesis. Thesis statement makes the purpose of the paper clear.

20.0 %Organization and Effectiveness
 
8.0 % Argument Logic and Construction

Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.

Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.

Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.

Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.

Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

20.0 %Organization and Effectiveness
 
5.0 % Mechanics of Writing (includes spelling, punctuation, grammar, language use)

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used.

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, and/or word choice are present.

Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.

Writer is clearly in command of standard, written, academic English.

10.0 %Format
 
5.0 % Paper Format (use of appropriate style for the major and assignment)

Template is not used appropriately or documentation format is rarely followed correctly.

Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.

Appropriate template is used. Formatting is correct, although some minor errors may be present.

Appropriate template is fully used. There are virtually no errors in formatting style.

All format elements are correct.

5.0 % Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)

Sources are not documented.

Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.

Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.

Sources are documented, as appropriate to assignment and style, and format is mostly correct.

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

One of the great controversies in the field of psychology relates to how we define normal and abnormal behavior. There is general agreement with the official definitions of abnormal behavior; that is, abnormal behavior is severe or maladaptive enough to need diagnosis and psychological or psychiatric treatment. These official definitions are contained in the Diagnostic and Statistical Manual of Mental Disorders (DSM). There have been many revisions of this manual over the years. Currently, we are using the fifth edition, or the DSM-5 (APA, 2013).
Children and adolescents who display certain behaviors that cause them to have significant difficulty in their everyday functioning are likely to be diagnosed with one of the disorders in the DSM. Some of those diagnoses are temporary, whereas others are life-long.
Review the following case:
Anna, a four-year-old Mexican-American girl, lives with her mother and father. Anna’s parents immigrated to the United States years before her birth. Her mother speaks only Spanish with her, while her father speaks only English. Anna’s parents are migrant workers who must move regularly. Anna and her parents have moved over ten times since her birth. They hope to provide Anna with more stability, now that she is approaching school age. Therefore, they are seeking other forms of employment.
Anna recently completed kindergarten orientation. The school psychologist recommended that her parents have her evaluated further, as her speech development is significantly delayed. She speaks very little; her vocabulary was screened at the kindergarten orientation and was found to be at least two years behind typical speech development. During the kindergarten screening, Anna was hyperactive, unable to sit still, distracted, and unable to complete the tasks. She was unable to complete them partially due to their difficulty level, but also due to her inability to focus sufficiently.
After a thorough evaluation at the local mental health center, Anna was diagnosed with attention-deficit/hyperactivity disorder (ADHD). She began participating in a behavioral modification program with a bilingual therapist, who speaks both English and Spanish. She will be evaluated in a few weeks by the psychiatrist, who will decide whether to prescribe stimulant medication for the ADHD.
Based on your analysis of the case, respond to the following:

Analyze the pros and cons of diagnosing Anna with a mental health disorder. Identify at least three benefits and at least three costs Anna and her family may experience as a result of her diagnosis. When deciding which pros and cons to identify, consider benefits and costs related to at least fourof the following categories:

Stigma
Prescription of psychiatric medication to children
Selection of a psychotherapy approach
Multicultural factors
Labeling or mislabeling of children
Early intervention

Write your initial response in 300­­–500 words. Apply APA standards to citation of sources, including in-text citations and full references. Incorporate information from at least two academic sources to support your statements or ideas. Academic sources could include your textbook, required readings for this week, or academic journal articles found in the online library.
 Provide a statement of clarification, a point of view with rationale, challenge a point of discussion, or draw a relationship between one or more points of the discussion of at least two other students. Consider commenting on the following:

Consider how you may have responded if Anna had a different cultural background.
Address one of the categories you did not choose from the list.
Explain whether you agree with the benefits and costs identified by your peers, and why.
Request more information from peers who may have listed less than three benefits or three costs.
Suggest interesting resources, Web sites, or articles you located for this assignment, and provide references for academic research articles that you have found in your research. Summarize the researched information for your peers.

American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.).Washington, DC: Author.