week 4

Write the background/ introduction 

TOPIC:  hospital readmission after being discharged to homecare services 
1. Background knowledge-brief summary of current knowledge of problem being addressed, and
characteristics of the organization(s) in which it occurs.
2. Local problem-nature and severity of the problem.
3. Intended improvement – describes the changes and improvements in care processes and
patient outcomes of the proposed interventions
4. Study questions-clearly states precisely the primary improvement-related question that the
study intervention is designed to answer 

Cite any sources in APA format.

discuss

1.Post a brief description of the situation you experienced and explain how incorporating or not incorporating patient preferences, social determinants of healthLinks to an external site., and values impacted the outcome of their treatment plan. Be specific and provide examples. Then, explain how including patient preferences, social determinants of health, and values might impact the trajectory of the situation and how these were reflected in the treatment plan. Finally, explain the value of the patient decision aid you selected and how it might contribute to effective decision making, both in general and in the experience you described. Describe how you might use this decision aid inventory in your professional practice or personal life. 

Use 3 sources 

2. Post an explanation of how you anticipate enacting personal and professional commitment for advocacy to positively impact your patients, communities, and the profession. Be specific. Then, explain how your role as a DNP-prepared nurse contributes to advocacy for positive social change. 

Use 3 sources 

Centers for Disease Control and Prevention. (2021). Social determinants of health: Know what affects health.Links to an external site.https://www.cdc.gov/socialdeterminants/index.htm

Healthcare in the United States and Around the World

In the lecture this week on health care in the US, hopefully you gained a general overview into how our system works and the way we pay for it.  What is your opinion on our current system? Is it working well for Americans or do you see any areas that are in need of improvement?  If so what are they specifically and how can we solve those issues?  Be sure to address any potential issues with your “solution” since we know nothing this complicated is solved easily! If you think it’s working well, please point out specifically why you think so.

Self Assessment Questions

Summary of strengths:

Opportunities for growth:

Four (4) possible goals and objectives for this practicum experience. Ensure that they follow the SMART Strategy, as described in the Learning Resources. 

1.  Goal:

a.  Objective:

b.  Objective:

c.  Objective:

2.  Goal:

a.  Objective:

b.  Objective:

c.  Objective:

3.  Goal: 

a.  Objective:

b.  Objective:

c.  Objective:

4.  Goal:

a.  Objective:

b.  Objective:

c.  Objective:

Research on Positive Impact on Nursing Diversity

How does nursing diversity lead to a positive impact on patient outcomes and healthcare quality? 

Please check the rubric ( minimum 6 pages) 

FEEDBACK

PLEASE FOLLOW ALL DIRECTIONS 

Dehydration

due 10-11-23 @10am

Unit 10 Peer response. Medications for Dementia. 800W. APA. 4 references due 10-10-23.

Advanced Psychopharmacology and Health Promotion

Unit 10 Peer response. Medications for Dementia. 800W. APA. 4 references due 10-10-23.

Instructions:

Please read and respond to at least two of your peers' initial postings. You may want to consider the following questions in your responses to your peers:

· Compare and contrast your initial posting with those of your peers.  

· How are they similar or how are they different?

· What information can you add that would help support the responses of your peers?

· Ask your peers a question for clarification about their post.

· What most interests you about their responses? 

Please be sure to validate your opinions and ideas with citations and references in APA format.

Mojgan

Week 10, Medications for Dementia

Based on the test scores above, do you believe that Mrs. Outcome does have dementia?

        Dementia is characterized by a significant cognitive dysfunction from patients’ usual functioning level, impacting their daily activities and quality of life (Stahl, 2021). The Functional Activity Questionnaire (FAQ) is a validated instrument used to assess functional activity levels in older adults. It evaluates activities that require advanced skills, such as managing finances or preparing meals. The purpose of this questionnaire is to identify individuals with functional impairments, particularly in the elderly population (Vik et al., 2023). Mrs. Outcome's score of 13/30 suggests that she is experiencing disruptions in her daily functioning and may be dealing with cognitive issues.

        The GAD-7 scale (Generalized Anxiety Disorder 7-item scale) is a validated tool that is increasingly utilized for screening and clinical research. It is applicable to both adults and adolescents, in both general population and individuals with anxiety disorders. This scale consists of seven items and is designed to evaluate the level of anxiety in patients (Todorović et al., 2023). Mrs. Outcome's score of 7/21 suggests she is experiencing mild anxiety.

        The Mini-Mental Status Examination (MMSE) has a maximum score of 30 points, with higher scores indicating better cognitive function. It comprises 11 questions that assess aspects such as orientation to time, orientation to place, immediate memory, serial seven
 calculation, delayed memory, naming, repetition, oral instruction, writing instruction, spontaneous writing, and copying a design (Naito et al., 2023). Mrs. Outcome's score of 20/30 suggests mild cognitive impairments. Given Mrs. Outcome medical history, which includes incidents like “losing it,” a fire in her house, and confusion between day and night, there is a clear decline from her previous level of functioning. The test results also indicate cognitive decline. Mrs. Taylor is indeed experiencing some degree of cognitive issues, which could be indicative of dementia

What are the differences between delirium and dementia?

        Delirium and dementia differ in several ways. Delirium is a sudden-onset neuropsychiatric condition triggered by a medical issue. Delirium is characterized by disturbances in consciousness and cognitive function, with fluctuating symptoms, often affecting vulnerable individuals (Heijden et al., 2023). On the other side, dementia has a gradual onset and progresses over time (Stahl, 2021). While delirium is typically linked to a patient's medical conditions, often occurring in hospitals, and may be reversible if the underlying cause is resolved, dementia is usually progressive and generally not reversible. In delirium, patients experience impaired attention and reduced awareness of their environment, while those with dementia typically have relatively preserved attention and stable awareness. Dementia primarily affects memory and other cognitive areas in the early stages. Delirium can lead to impairments in various cognitive areas, including memory, language, and executive functions. Dementia patients have a higher risk of developing delirium compared to the general population (Fong & Inouye, 2022).

What two categories of medications are often used to treat dementia and how do these medications work?

        As per Stahl (2021), there are two main groups of medications that can help patients with dementia. The first group is Cholinesterase inhibitors, including medications like donepezil, rivastigmine, and galantamine. Cholinesterase inhibitors work by inhibiting the enzyme responsible for breaking down acetylcholine, a key neurotransmitter that is often reduced in dementia patients. This group of medications functions by increasing acetylcholine levels, which can improve cognitive function, particularly in the early stages of Alzheimer's disease. Galantamine, a cholinesterase inhibitor, was initially derived from snowdrops and has a unique mechanism of action, involving both the inhibition of cholinesterase and the regulation of nicotinic cholinergic receptors (Stahl, 2021).

        The second group of medications consists of NMDA receptor antagonists, with memantine being a prominent example. These medications modulate the activity of glutamate, another neurotransmitter with a crucial role in learning and memory processes. By controlling glutamate levels, these medications may slow down the progression of dementia symptoms, particularly in cases of moderate to severe dementia (Stahl, 2021).

References

Fong, T. G., & Inouye, S. K. (2022). The inter-relationship between delirium and dementia: the importance of delirium prevention.
 Nature Reviews. Neurology, 18(10), 579-596. https://doi.org/10.1038/s41582-022-00698-7

Heijden, E. F. v. d., Kooken, R. W. J., Zegers, M., Simons, K. S., & van den Boogaard, M. (2023). Differences in long-term outcomes between ICU patients with persistent delirium, non-persistent delirium and no delirium: A longitudinal cohort study.
 Journal of Critical Care, 76https://doi.org/10.1016/j.jcrc.2023.154277

Naito, T., Suzuki, Y., Yamasue, K., Saito, K., Umemura, M., Kojima, N., Kim, H., Osuka, Y., Ishikawa, Y., & Tochikubo, O. (2023). Relationship between cognitive function and sway of body in standing posture: A cross-sectional study.
 Geriatrics, 8(2), 29. 
https://doi.org/10.3390/geriatrics8020029Links to an external site.

Stahl, S. M. (2021). 
Stahl’s essential psychopharmacology: Neuroscientific basis and practical application (5th ed.)

Todorović, A., Baumann, C., Blanchin, M., & Bourion-Bédès, S. (2023). Validation of Generalized Anxiety Disorder 6 (GAD-6)—A Modified structure of screening for anxiety in the adolescent French population.
 International Journal of Environmental Research and Public Health, 20(8), 5546. https://doi.org/10.3390/ijerph20085546

Vik, A., Kociński, M., Rye, I., Lundervold, A. J., & Lundervold, A. S. (2023). Functional activity level reported by an informant is an early predictor of Alzheimer’s disease.
 BMC Geriatrics, 23, 1-15. https://doi.org/10.1186/s12877-023-03849-7

Mihaela

Unit 10 – Medications for Dementia

1.
Based on the test scores above, do you believe that Mrs. Outcome does have dementia?

Considering the test results given it seems probable that Mrs. Outcome is experiencing dementia. The score of 20/30, on the NMSE indicates cognitive impairment (Korsnes, 2020). The clock drawing test score of 2/5 indicates challenges with visuospatial abilities, which are often affected in individuals with dementia (Palsetia et al., 2018). Furthermore, her FAQ score of 13/30 suggests that she is experiencing functional impairment in daily activities (Gonzalez et al., 2022). The GAD-7 and PHQ-9 scores indicate mild levels of anxiety and depression which are often seen in individuals with dementia (Stocker et al., 2021). Taking into account these scores, along with other observations like confusion regarding day and night, calling out for assistance, and daytime sleepiness it seems likely that she may be dealing with dementia.

1.
What are the differences between delirium and dementia?

Delirium and dementia are two conditions that can lead to cognitive impairment and have notable distinctions. Delirium typically manifests suddenly and exhibits fluctuating symptoms often triggered by a medical condition or medication side effect. It can usually be reversed by addressing the underlying cause (Grover & Avasthi, 2018). In contrast, dementia refers to a progressive deterioration in cognitive abilities over time and is irreversible (Duong et al., 2018).

1.
What two categories of medications are often used to treat dementia and how do these medications work?

There are two types of medications that are commonly used for treating dementia: cholinesterase inhibitors and N methyl D aspartate (NMDA) receptor antagonists. Cholinesterase inhibitors such as donepezil, rivastigmine, and galantamine work by increasing the levels of acetylcholine in the brain, which helps improve cognitive function to some extent (Battle et al., 2021). On the other hand, NMDA receptor antagonists like memantine help regulate glutamate activity in the brain and may slow down the progression of symptoms associated with moderate-to-severe Alzheimer's disease (Wang et al., 2018). According to the World Health Organization, Alzheimer’s disease is the major cause of dementia, for approximately 60–70% of cases. This chronic neurodegenerative condition exhibits a progression of symptoms over time starting with forgetfulness and gradually affecting language skills, orientation, and behavior, and leads to severe loss of memory and impairment of certain bodily functions until the ultimate death (Wang et al., 2018).

References

Battle, C. E., Abdul-Rahim, A. H., Shenkin, S. D., Hewitt, J., & Quinn, T. J. (2021). Cholinesterase inhibitors for vascular dementia and other vascular cognitive impairments: A network meta-analysis. 
Cochrane Database of Systematic Reviews
2021(2). 
https://doi.org/10.1002/14651858.cd013306.pub2Links to an external site.

Duong, S., Patel, T., & Chang, F. (2018). Dementia. 
Canadian Pharmacists Journal / Revue des Pharmaciens du Canada
150(2), 118–129. 
https://doi.org/10.1177/1715163517690745Links to an external site.

González, D., Gonzales, M. M., Resch, Z. J., Sullivan, A., & Soble, J. R. (2021). Comprehensive evaluation of the functional activities questionnaire (faq) and its reliability and validity. 
Assessment
29(4), 748–763. 
https://doi.org/10.1177/1073191121991215Links to an external site.

Grover, S., & Avasthi, A. (2018). Clinical practice guidelines for management of delirium in elderly. 
Indian Journal of Psychiatry
60(7), 329. 
https://doi.org/10.4103/0019-5545.224473Links to an external site.

Korsnes, M. (2020). Performance on the mini-mental state exam and the montreal cognitive assessment in a sample of old age psychiatric patients. 
SAGE Open Medicine
8, 205031212095789. 
https://doi.org/10.1177/2050312120957895Links to an external site.

Palsetia, D., Rao, G., Tiwari, S. C., Lodha, P., & De Sousa, A. (2018). The clock drawing test versus mini-mental status examination as a screening tool for dementia: A clinical comparison. 
Indian Journal of Psychological Medicine
40(1), 1–10. 
https://doi.org/10.4103/ijpsym.ijpsym_244_17Links to an external site.

Stocker, R., Tran, T., Hammarberg, K., Nguyen, H., Rowe, H., & Fisher, J. (2021). Patient health questionnaire 9 (phq-9) and general anxiety disorder 7 (gad-7) data contributed by 13,829 respondents to a national survey about covid-19 restrictions in australia. 
Psychiatry Research
298, 113792. 
https://doi.org/10.1016/j.psychres.2021.113792Links to an external site.

Wang, R., & Reddy, P. (2018). Role of glutamate and nmda receptors in alzheimer’s disease. 
Journal of Alzheimer's Disease
57(4), 1041–1048. 
https://doi.org/10.3233/jad-160763Links to an external site.

Reading Between the Lines: Emotions

 

Edit your plan based on any instructor or collegial feedback from Week 4. Proof and finalize the plan. It should include the following information:

  • Company synopsis: This is a snapshot of the company, what it sells, and the number of employees.
  • Management’s philosophy on employee communication: An example of a management philosophy could be that any important communication about the company’s activities are shared internally before being shared externally on the Internet or in a news release.
  • Goals of the communication plan: One possible goal could be to help employees be more productive by establishing a clear and effective employee communication plan. The plan can be viewed as an organizational diagnostic that provides employees with consistent, accurate, and regular information about the company’s business goals and objectives.
  • Target audience characteristics: The plan should take into account cultural, gender, and linguistic differences to help employees understand the goals of the organization.
  • Communication tools: These can include various deliverables, including e-mails, newsletters, e-blasts, brochures, reports, conferences, employee meetings, and more.
  • Communication channels: Communication channels include internal and external Web sites, public relations venues, visits or speeches from management, and more.

This week, add the following sections to your final plan:

  • Review the evaluation methods for your plan. How will you communicate results to management on a regular basis? Consider a monthly report, management briefings, updates, and a yearly summary for board presentations.
  • Describe how you plan to deal with the negative emotions (from employees or other audience groups) that often accompany bad news or other information.

Finally, prepare the opening of the oral presentation that will describe your completed plan to management.

Presentation Notes

In your presentation notes, add 1 strategy for each of the following:

  • Reading the emotions of management: What to look for and how to respond
  • Dealing with any negative responses or emotions to the plan: Ways to resolve any possible conflict in the meeting
  • Finding approval for the plan: Continuing the meeting by moving past any negative emotions (resulting in a win-win for everyone involved)

Add your presentation notes to the end of the plan.

Provide 5–6 sources other than your textbook to support your answer. Use APA style for citations.

The materials found in the MUSE may help you with this assignment such as the presentation Emotions in Communication

U.S. health care system

Research the delivery, finance, management, and sustainability methods of the U.S. health care system. Evaluate the effectiveness of one or more of these areas on quality patient care and health outcomes. Propose a potential health care reform solution to improve effectiveness in the area you evaluated and predict the expected effect. Describe the effect of health care reform on the U.S. health care system and its respective stakeholders. Support your post with a peer-reviewed journal article.