Explore one of the agencies for quality improvement listed in this module’s lecture. Write a one-page summary of what the agency does, who it affects, and how it is utilized. Below is the list of agencies. 

Agencies for Health Care Quality

There are many agencies that assist hospitals in becoming expert in using continuous quality improvement. Key organizations include:

• The Institute of Medicine,
• The Agency for Healthcare Research and Quality,
• The National Quality Forum,
• The Joint Commission,
• The Magnet Recognition Program,
• The Institute for Healthcare Improvement,
• and, of course, the nursing student’s friend, Quality and Safety Education for Nurses (QSEN).

Although no formal assignment is due for this week, I would like everyone to discuss the outcomes of their cultural assessment evaluation. 

Please document your outcomes (written in Microsoft Word) and think of strategies you will employ to enhance your cultural knowledge as you prepare for Cultural Health Issues.  No less than 500 words.

 Analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research.Scenario:

Kel is a 42-year-old certified public accountant (CPA) who dreams each year that she will board a cruise ship the day after Tax Day and go somewhere, anywhere, except Portsmouth, Virginia. Each year the dream, like the ocean, ebbs and flows, but this year she is not even going to think about such a “ridiculous idea.” In fact, she does not even have the energy to dream; getting out of bed and preparing to go to work is simply too labor intensive. 

Each evening Kel retires to bed with a lack of energy to complete her normal tasks such as readying her clothes for work and making a lunch. She lacks the energy to shop in the evening; consequently, she eats mostly crackers and canned soup. She is not hungry, and her scale reflects this. She has lost 15 pounds over the last 2 months. She does not attend to her makeup or clothes; she finds both too taxing. The clothes she selects are drab and not ironed. At work she makes no effort to talk with her co-workers and does not initiate new contacts with clients. The normal work of filing taxes and writing reports, which she used to enjoy, are overwhelming, and she feels too disorganized to complete them. Telephone calls and e-mail messages from friends are ignored. Attendance at work is spotty.

Sue, her sister, becomes alarmed with Kel’s unanswered telephone calls and e-mails. Worried, she decides to visit her sister at home. She finds the apartment unclean and in disarray. Kel is unkempt, disheveled, and looks sad. Her voice is monotone and flat. Kel tells Sue that she feels “sad and hopeless. Nothing is ever going to change. I am a bad person and I can’t even do my work right. Although I sleep for many hours, I am still tired all the time.” Sue is alarmed at the changes in her sister and arranges for Kel to visit a health care worker at the medical clinic.

Questions:

Remember to answer these questions from your textbooks and NP guidelines. At all times, explain your answers. 

1. Describe the presenting problems.
2. Generate a primary and differential diagnosis using the DSM5 and ICD 10 codes.
3. Formulate and prioritize a treatment plan. 
4. Identify and discuss appropriate screening instruments for a patient who has suicidal ideation.

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.  Your initial post is worth 8 points.
• You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 
• All replies must be constructive and use literature where possible.
• Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
• Late work policies, expectations regarding proper citations, acceptable means of responding to peer feedback, and other expectations are at the discretion of the instructor.
• You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.

Advanced Psychopharmacology and Health Promotion

Unit 7 Discussion Case Study 600W. APA. 4 references due 10-17-23.

Case Study:

· Your patient is a 36-year-old woman with bipolar disorder and anxiety. She has been stable on a combination of fluoxetine and olanzapine for two years.  She is morbidly obese at 340 pounds at 5’5” in height, has type II diabetes, hypertension, and hyperlipidemia.  She has concerns about her weight and has tried numerous ‘fad diets’ to no avail.  She explains she has lost, at most, 15 pounds and has been able to keep it off for three months. 

· She has three children, one of which is severely disabled, and a husband who has a terminal diagnosis. She expresses worry that her weight will impact her ability to care for her disabled child when her husband dies.  She reports she eats out frequently due to her children’s busy schedules.  She is a stay-at-home mother but gets little exercise and performs no regular physical activity. 

· She reports feelings of shame that she can no longer orgasm on the rare occasions her husband has the energy and desire to be intimate.

  
Questions: 

· What would be your approach to managing this patient’s weight concern? (Discuss at least two aspects of your approach). Please support your answer with research-based evidence. 

· What would be our approach to the sexual side effects she is experiencing? 

· If you suggested additional medication, look up your state’s prescribing laws. Are PMHNP’s able to prescribe the medication you recommended? 

· Please include the subjective and objective information in this post.

All responses must by supported by correct APA 7th edition formatted citations and references.

1. What would be your approach to managing this patient's weight concern? (Discuss at least two aspects of your approach). Please support your answer with research-based evidence. 

1. Non-pharmacological Approach

2. Pharmacological Approach

2. What would be our approach to the sexual side effects she is experiencing?

· Lifestyle changes, avoidance of stress or anxiety, drug therapy, physical activity, and psychological support. 

3. If you suggested additional medication, look up your state's prescribing laws. Are PMHNPs able to prescribe the medication you recommended?

· Additional medication is Flibanserin, the PMHNP can prescribe this without the supervision of a psychiatrist since PMHNP is Psychiatric-Mental Health Nurse Practitioner which is Board Certified. And/or hormonal therapy which is usually prescribed by a gynecological physician.

Please see the explanation below. 

Step-by-step explanation

Approach to solving the question:

· Identification of clinical problems that a bipolar patient attained, classification of nonpharmacological and pharmacological treatment of a patient, planning for therapies essential in treating the patient, and evaluation of the process for positive outcomes.

1. What would be your approach to managing this patient's weight concern? (Discuss at least two aspects of your approach). Please support your answer with research-based evidence. 

1.
Non-pharmacological Approach

·
Detailed explanation: this is an approach that is essential in managing a patient's weight concern without the involvement of drugs to treat the weight problem. This aim is to provide alternative prevention in treating weight gain without any chemical side effects on the body. 
(Focus (American Psychiatric Publishing). 2021)

·
Examples: (1) Physical activity such as aerobic exercises, can help the patient maintain her within the normal range which will enhance her conditions of type II diabetes, hypertension, and hyperlipidemia and help in improving her sexual desire, (2) Healthy food intake such as fruits, vegetables, whole grains, nonsalty and fatty foods, can reduce the risk of weight gain, and increase blood pressure and cholesterol which can improve her well being, and (3) Peer support which is very helpful in getting motivation from those people who are experiencing the same situation with the patient which increase the chance of preventing to expose her self to stress and anxiety. 

2.
Pharmacological Approach  

·
Detailed explanation: this is an approach that is essential in managing a patient's weight concern with the involvement of drugs to treat the weight problem. This aim is to provide drug prevention to avoid the progression of the presenting clinical manifestation and development of complications. 
(Focus (American Psychiatric Publishing). 2021)

·
Examples: (1) Phentermine-topiramate which is helpful in cutting the cravings, and lessens the appetite during stress and anxiety. This is helpful to increase the chance of weight gain especially when the patient attempted to expose herself to overeating.

2. What would be our approach to the sexual side effects she is experiencing?

· The approach
 to the sexual side effects the patient is experiencing are lifestyle changes, avoidance of stress or anxiety, drug therapy, physical activity, and psychological support. Sexual side effects based on the scenario are linked to the stress, anxiety, and weight gain of the patient. It is important that as a healthcare provider, you must assess the related factors to the presenting problem. For a patient with bipolar disorder, it is important to have a care plan to follow so that the patient will be encouraged to do. Lifestyle changes such as physical activity and eating healthy food are the most important since the patient tends to eat out frequently due to her children's busy schedules, gets little exercise, and performs no regular physical activity. If the patient is healthy, their sexual desire will improve and help her to have orgasms since her hormones are healthy. Avoidance of stress and anxiety is helpful in sexual desire because a patient who is stressed can affect the sympathetic nervous system limiting the blood flow to the genitals to achieve genital arousal. Also, therapies are helpful in correcting abnormal hormones in the body system. 
(Lancet Public Health. 2021)

3. If you suggested additional medication, look up your state's prescribing laws. Are PMHNPs able to prescribe the medication you recommended?

· Since the patient is already taking combinations of olanzapine which is useful in treating schizophrenic episodes and fluoxetine which is an antidepressant used in bipolar disorder and linked to weight loss, the additional medication that I may recommend is Flibanserin which is an antidepressant helpful in correcting the imbalance of the neurotransmitters in the brain increasing the chance to sexual desire. The PMHNP can prescribe this medication in all states because Flibanserin should be prescribed by a psychiatrist physician and certified nurse practitioners. Another additional medication that I would like to conclude is hormonal therapy like estrogen therapy because the abnormal level of hormones in the body affects the body in sexual desires and can lead to stress and anxiety. 
(Psychiatr Serv. 2018)

REFERENCES:

· Vancampfort D, Firth J, Correll CU, et al.. The impact of pharmacological and non-pharmacological interventions to improve physical health outcomes in people with schizophrenia: a meta-review of meta-analyses of randomized controlled trials. 
Focus (American Psychiatric Publishing).2021;19:116-28. 

· Mitchell K.R., Lewis R., O'Sullivan L.F., Fortenberry J.D. What Is Sexual Wellbeing and Why Does It Matter for Public Health? 
Lancet Public Health. 2021;6:e608-e613. doi: 10.1016/S2468-2667(21)00099-2.  

· Blackmore M.A., Carleton K.E., Ricketts S.M. Comparison of collaborative care and colocation treatment for patients with clinically significant depression symptoms in primary care. 
Psychiatr Serv. 2018;69(11):1184-1187. doi: 10.1176/appi.ps.201700569.

What are the advantages and disadvantages of collaborating with physician organizations when pursuing FPA legislation?