Nursing

 Describe the three health care settings that you explored as proposed sites for an EBP QI project. ( Community Mental Health Clinic, Crisis inpatient. Substance Use Clinic.  

Case Study

Case Study week 8ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS

Psychopharmacologic Approaches to Treatment of Psychopathology (waldenu.edu)

Examine
 Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamics processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

· Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

· Which decision did you select?

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

· Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

References to Include:

· American Psychiatric Association. (2022). 


Diagnostic and statistical manual of mental disorders

Links to an external site.
 (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787

· Fernandez-Mendoza, J., & Vgontzas, A. N. (2013). Insomnia and its impact on physical and mental health. 



Current Psychiatry ReportsLinks to an external site.


, 15(12), 418. https://doi.org/10.1007/s11920-012-0418-8

informatics

identify at least 3 key concepts from the selected part of the textbook and provide clear and correct explanations. Writing shows a clear logical link between those concepts. Synthesize information from multiple sources (lectures, readings, activities) and derive a conclusion in your own words. The terminology used is clearly defined. 

Reflection on Learning Week 6

 

Write 1-2 paragraphs reflecting on your learning for the week. Guiding questions are provided or you may write about what you felt was most significant to you for the week.

  • As you contemplate your future NP practice, how do you view your role in the implementation of EBP?
  • What thoughts do you have about how you will engage in scholarship in your NP role?
  • What are some barriers you see to implementing evidence-based practice?

I am looking into infectious disease  (HIV)

the etiology, pathophysiology of the pituitary, thyroid, adrenal, and parathyroid glands.

Consider what you’ve learned about the topic you presented.

  • How does this topic relate to something you might see in clinical practice?
  • Which ideas make the most sense and why?
  •  How does this topic to current events?
  • What might make this problem more treatable?

vulnerable populations

Compare vulnerable populations. Describe an example of one of these groups in the United States or from another country. Explain why the population is designated as “vulnerable.” Include the number of individuals belonging to this group and the specific challenges or issues involved. Discuss why these populations are unable to advocate for themselves, the ethical issues that must be considered when working with these groups, and how nursing advocacy would be beneficial.  

reply1,2

·
List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.

When assessing this patient, it's important to ask questions that will help the provider understand the underlying causes and potential treatment options. Given the patient's recent loss and significant life changes, it's crucial to approach the assessment with sensitivity. Here are three questions I'd like to ask, along with their rationales:

1. Have you observed any changes in your sleep pattern, mood, or feelings since your husband passed away?

Rationale: This question allows the patient to provide insight into the nature and duration of her sleep disturbances and changes in her mood or feelings. Understanding the onset and progression of depression symptoms can related to her recent bereavement following her husband's passing.

2. Could you describe your emotions and have you ever experienced thoughts of self-harm or suicide?

Rationale: This question aims to comprehend a person's emotional state and evaluate the presence of suicidal thoughts or self-harm ideation. It's important to ask such questions without delay in treatment. Since the patient has a history of major depressive disorder (MDD), and her depression has worsened, it's crucial to explore her emotional state.

3. How have you been coping with the loss of your husband, and have you sought support or counseling to help you through this difficult time?

Rationale: Inquiring about coping strategies and support systems is essential for assessing the patient's resilience and identifying potential sources of assistance. Grief counseling or therapy can be invaluable in helping individuals navigate the complex emotions associated with loss. Additionally, it's important to assess whether the patient has been utilizing any resources to manage her depression.

·
Identify people in the patient's life you would need to speak to or get feedback from to further assess the patient's situation. Include specific questions you might ask these people and why.

To gain a more comprehensive understanding of the patient's situation and evaluate her social support network, I would identify individuals in the patient's life, such as family members or close friends. Engaging in conversations with these individuals can be beneficial because they may have insights into the patient's emotional well-being and daily functioning. I would ask Questions like: “Could you please share any observations regarding alterations you may have noticed in the patient's behavior, mood, or sleep patterns following her husband's passing?” Family members and close friends are often the first to detect significant shifts in a person's behavior and emotional state. Their observations can offer valuable insights into the patient's emotional condition and the way the loss of her husband has affected her daily life.

·
Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.

In evaluating a 75-year-old patient with a chief complaint of insomnia and depression, diabetes (DM), and hypertension (HTN), a thorough assessment should include both physical exams and diagnostic tests: A physical examination should include checking blood pressure, heart rate, heart sounds, peripheral pulses, respiratory rate, and temperature. It should also involve assessing the patient's overall appearance and evaluating their general health.  In addition, assessing mental status, cognitive function, and neurological signs can help identify any neurological issues that may be contributing to sleep disturbances. Consider arranging a sleep study, also known as polysomnography (PSG). This medical test monitors various physiological functions while a person sleeps.

Diagnostic Tests include the following Blood Tests: Complete Blood Count (CBC) will check for anemia or other blood-related issues that can affect sleep and overall health; a Comprehensive Metabolic Panel (CMP), assess kidney and liver function, electrolytes, and glucose levels; The HbA1c (Glycated Hemoglobin) test can monitor her long-term blood glucose control, can provide valuable insights into her diabetes management. The results of these exams and tests will inform a comprehensive treatment plan tailored to the patient's specific needs.

·
List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.

When assessing a patient with insomnia, along with chronic medical conditions like diabetes and hypertension, this patient likely has Major Depressive Disorder (MDD). She had no history of MDD before her husband's passing, and the current worsening of her depression may be attributed to his death. Although anxiety can cause insomnia problems, MDD with Bereavement seems most likely. However, we need to ensure there aren't other underlying causes, such as sleep problems or medical issues. To do that, we should conduct thorough assessments and laboratory tests. She needs to seek help from both her regular doctor and a mental health professional to find the right treatment and support.

·
List two pharmacologic agents and their dosing that would be appropriate for the patient's antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.

When selecting pharmacologic agents for this 75-year-old patient, the choice of antidepressant therapy should consider pharmacokinetics and pharmacodynamics. Reduced kidney and liver function in elderly individuals can potentially affect both pharmacokinetics and pharmacodynamics.

SSRIs, such as sertraline (Zoloft) and escitalopram (Lexapro), are two preferred for elderly patients. They are generally well-tolerated and have a lower risk of certain side effects, such as sedation or anticholinergic effects, which can be problematic for older adults. Sertraline (Zoloft) 150mg once daily or Escitalopram (Lexapro) 20 mg daily would be appropriate for this patient.

The patient has been taking Sertraline (Zoloft), her start dose was 100mg daily; increase slowly, no more than a maximum Dose of 200 mg once daily; sertraline increases serotonin levels and can be effective in treating depression. Escitalopram is considered perhaps the best-tolerated SSRI, with the fewest cytochrome P450 (CYP450)-mediated drug interactions. (Stahl, 2021). Escitalopram (Lexapro) 20 mg daily is also the appropriate choice.

·
For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on ethical prescribing or decision-making. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making?

When prescribing antidepressant therapy, it's important to consider drug contraindications and alterations. For the selected antidepressant, escitalopram (Lexapro), don't use it with MAOIs or within 14 days after stopping an MAOI to prevent serotonin syndrome. This is a contraindication due to the risk of serotonin syndrome, a potentially life-threatening condition characterized by agitation, confusion, rapid heart rate, and other symptoms. Escitalopram is primarily metabolized in the liver; it should be used with caution in patients with severe hepatic impairment or elderly with decreased liver function. In such cases, a lower initial dose and slower titration may be considered, as drug clearance may be reduced.

In all cases, ethical prescribing involves a thorough assessment of the patient's medical history, medication history, and potential contraindications. Dosing adjustments, when necessary, should be made to maximize therapeutic benefits while minimizing risks and adverse effects.

·
Include any “checkpoints” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.

In depression treatment, scheduled follow-up appointments are vital for assessing progress, managing side effects, and adjusting treatment. Common intervals are every 4 weeks. At the checkpoint, like follow-up data at weeks 4, 8, 12, etc., make treatment decisions based on the patient's response, side effects, and goals. If there's significant improvement with few side effects, stick with the current dose. If there's limited improvement or major side effects, consider increasing the dose (if not already at the maximum) or trying a different antidepressant. In cases of long-term remission with a low risk of recurrence, think about tapering or discontinuing the medication.

At Week 4 (four weeks after initiating treatment), it's the time to evaluate the patient's initial response to medication. Inquire about changes in mood, sleep patterns, energy levels, and any side effects.

At Week 8 (eight weeks after starting treatment), it's time to reassess the patient's mood and overall well-being. Keep an eye on side effects, whether they're taking the medication as prescribed, any changes in their medical conditions, and any suicidal ideation.

At Week 12 (12 weeks after starting treatment), continue monitoring the patient's mood and how they're responding to treatment. Check for any signs that their depression might be coming back or getting worse.

Ongoing Follow-up (Regularly, every 3-6 months): Continue to monitor the patient's mental health, medication adherence, and any emerging side effects. Evaluate the need for ongoing treatment.

 


Reference:

Levenson JC, Kay DB, Buysse DJ. The pathophysiology of insomnia. Chest. 2015 Apr;147(4):1179-1192. doi: 10.1378/chest.14-1617. PMID: 25846534; PMCID: PMC4388122.

Stahl, S. M. (2021). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (5th Ed.) Cambridge University Press.

Lexapro Labeling-508; Reference ID: 4036381 https://www.fda.gov/media/135185/download

Module 4, finding the evidence

Student Name________________

Write your topic and final PICO(T) question below:

My topic:__Health and wellbeing of nurses___________

My PICO(T) question: ____”In nurses working in specialized care units, how does the implementation of stress reduction and focused mental care techniques compared to everyday self-care practices affect their overall health and wellbeing outcomes over a period of one year?”____

My article:

1. Published within the last five years? Yes___ No___

2. Has a nurse author OR published in a nursing journal? Yes___ No___

3. Is it a single report of a quantitative research study? Yes___ No___

4. Is it a prospective study? Yes___ No___

5. Give an APA style reference of the article here:

______Diehl, E., Rieger, S., Letzel, S., Schablon, A., Nienhaus, A., & Dietz, P. (2021). Burdens, resources, health and wellbeing of nurses working in general and specialized palliative care in Germany – results of a nationwide cross-sectional survey study.
BMC Nursing,
20(162), 1-15.

https://doi.org/10.1186/s12912-021-00687-z
_________________________________

In order to be acceptable, you must be able to say yes to the four questions above. Remember, your article cannot be a retrospective study, a mixed methods study, a qualitative study, a systematic review, a quality improvement article, or an evidence based practice article.

CRITICAL CARE WK 6

 

MY NUMBER ASSIGNED WAS 7 WHICH IS:  Tension hemo/pneumothorax – when does this occur, s/s, treatment, and complication 

Each student will be assigned a number randomly.  Whatever your number is, select the corresponding topic below, then post a minimum of 5 bullet points about the topic.  

Your bullet points should address key components of the topic, such as what, how, who, & why.  This information should not be basic things you learned in Med/Surg, but rather advanced critical care based.  

Think about this as a group effort to create a study guide. Use ONLY your textbook, but do not cut & paste from the book.  

Then create, find, or borrow a test style question about your topic & post at the bottom of your bullet points. The format needs to be multiple choice or select all that apply. Think NCLEX style. 

PART 2:

Take a few minutes and ask 2 people about their personal coping mechanisms for dealing with the stress of working in healthcare during this unique time of Covid. Stress can be physical, emotional, spiritual, or any combination of triggers. Ask a diverse variety of people, don’t forget those in other departs at different points of hierarchy. For example, ask your unit manager, environmental services, volunteers, patients, fellow nurses, etc.  Write 2-3 paragraphs on your findings and impressions while respecting the person’s identity. 

Discussion

Discussion: PICOT Question

Over the course of the next eight weeks, we will be examining concepts related to nursing research and the translation of evidence to practice. To help you better understand the process, you will be identifying a practice issue for nurse practitioners.
 You will develop a PICOT question associated with the issue, find evidence to support a change in practice, and present your recommendations for change to your peers. This week, we will work on helping you refine your area of interest so that you will be able to develop a concise question for next week’s assignment. You are encouraged to use the area of interest you chose for the project in NR500NP and/or NR501NP; however, you may choose a different area if you wish.

Select an issue in nurse practitioner (NP) practice that is of interest to you and in which you would like to see a practice change occur. Conduct a review of literature to see what is currently known about the topic. In 1-2 paragraphs, describe the scope and relevance of the issue and your recommended change. Provide reference support from at least two outside scholarly sources to support your ideas. 
Please pick something you can do as a NP in your practice that is patient focused. Your intervention needs to relate to a measurable patient health outcome. Please avoid anything that would require a policy or law change, such as full-practice authority. Burnout and satisfaction surveys also are not appropriate topics as they are not patient centered. 

Review this 4-minute video to gain a better understanding of the requirements of a PICOT question. The PICOT question is not a research question, but a quality improvement issue that requires a practice change. 

Hello, my name is Dr. Lynch. Hey, I'm an assistant professor a Chamberlain University College of Nursing. Today we're gonna talk about pico questions and best practices in formulating these questions. There are five parts to a pico question. Patient intervention, comparison, outcome in time. The slides subsequently we will discuss each part of this question. The first ingredient for cooking up a pico question is population. Pick a broad topic, drill down, focus down so that then your population is very specific. Type two diabetic female patients age 30 to 40 who consume over 400 g of carbohydrates per day. A bunch more specific population then patients with diabetes intervention. What intervention do you think will make a difference? Is that supported by the scholarly literature? What is being done in clinical practice today? Are there better alternatives? You must use an intervention based on scholarly literature? Remember the definition of scholarly literature is a US based peer reviewed journal article geared for clinicians published in the past five years, or the latest clinical practice guideline. Comparison. So what is the standard of care currently? Patients without the intervention, patients without a condition, patients without risk factor. This part defines another population who will be used as a comparison against the group receiving the intervention. What is your desired outcome? The outcome should relate directly to the intervention and outcomes should be measurable. Time. This is a specific timeframe to demonstrate the outcome. In quality improvement efforts, the timeframe has to be realistic and manageable. Not over years, may not be even over months, but it could be. But it is usually a short timeframe to make an improvement effort. Many students ask what the differences between pico research and quality improvement questions. This chart will help you understand the difference. The pico question used here is in postoperative kidney transplant adults aged 65 to 75, how does a health coach compared with no health coaching affect hospital readmission rates within 90 days of discharge? This is a perfect pico question compared to the research question or QI question that also could be asked about this matter. Here's an example. In real life, you're a nurse practitioner working in a skilled nursing facility, the rate of false as unacceptable. And your care team has come together to discuss what should be done about this. Your pico question is, in elderly patients between age 65.75 residing in a sniff, how do fall prevention programs with risk assessment compared to fall prevention programs without risk assessment effect fall rates within 90 days after the intervention. So you can see how this question will guide how you view the literature on this topic. You will be looking for fall prevention with risk assessment in the scholarly literature to see what has worked in other places. What are the crucial ingredients in an outpatient fall prevention program? The literature holds the key, holds the answer to these questions. If you need further assistance, please contact your instructor directly. You can also contact the librarians at the Chamberlain library who can be accessed through many means, email, chat on real time. This material comes from Malbec and find out overhauled book evidence-based practice in nursing and health care, a guide to best practice, which is a great addition to your library.