• Add references to your posts and be aware that TURNITIN IS ON.
• The purpose of the discussion is to elevate the level of knowledge regarding disease symptom management.  
• Discussion Questions:  MENTION THE CONTEXT YOU WILL BE DISCUSSING AND DEVELOP YOUR POINTS. 

A patient who has Parkinson’s disease takes levodopa and carbidopa. The patient reports experiencing tremors between doses. The primary care NP should:

a. add amantadine.

b. increase the dose of levodopa.

 c. discontinue the carbidopa.

d. add entacapone.

       2. 

A patient who takes levodopa and carbidopa for Parkinson’s disease reports experiencing freezing episodes between doses.The primary care NP should consider using:

a. selegiline.

b. apomorphine.

c. modified-release levodopa.

d. amantadine.

       3.

A 65-year-old patient is diagnosed with Parkinson’s disease. The patient has emphysema and narrow-angle glaucoma. The primary care NP should consider beginning therapy with:

a. ropinirole hydrochloride.

b. selegiline.

c. carbidopa/levodopa.

d. benztropine.

please follow all directions and  use attached article 

Please help me with this assignment. The case study has been attached. 

Make a follow-up of a student's weekly discussion and respond with your opinion regarding to her post

——You don't have to post this in APA format necessarily, it's just giving feedback to the student .

Claire Steininger

Identify and describe practice barriers for all four APNs' roles in your state and discuss these barriers on a state and national level. The four roles include the nurse midwife, nurse anesthetist, nurse practitioner, and clinical nurse specialist.

Nurse midwives often struggle with scope of practice limitations and the necessity for collaborative agreements, which can sometimes disrupt their ability to provide comprehensive care. Nurse anesthetists may face restrictions, such as supervision requirements and inconsistent reimbursement policies, limiting their autonomy in anesthesia care. Nurse practitioners and clinical nurse specialists confront barriers like collaborative agreements and scope of practice restrictions, which can affect their capacity to deliver primary and specialized care independently. These state-level obstacles are further complicated by variations in laws and regulations across the country. At the national level, lack of consistency and autonomy make it challenging for APNs to provide consistent, high-quality healthcare (Peterson, 2018).

Identify forms of competition on the state and national level that interfere with APNs' ability to practice independently.

At the state level, one form of competition arises from established healthcare hierarchies and interests. Physicians' groups and medical associations often lobby for laws and regulations that restrict APN autonomy to protect their traditional roles in healthcare. With a limited scope of practice, APNs are sometimes forced to adhere to physician regulations. On the national level, Medicare reimbursement rates and federal funding allocations can be influenced by powerful stakeholders, including pharmaceutical companies, insurance providers, and large healthcare systems. These sources may advocate for regulations that favor their interests instead of that of others (Galvani et al., 2020).

Identify the specific lawmakers by name at the state level (i.e., key members of the state's legislative branch and executive branch of government)

In Florida, the governor Ron DeSantis, is the head of the executive branch. Jeanette Nunez is the lieutenant governor, Ashley Moody is the attorney general, Jimmy Patronis is the chief financial officer, and Wilton Simpson is the agricultural commissioner. On the legislative side, the senate president is Kathleen Passidomo, the house speaker is Paul Renner, the majority leader for the senate is Ben Albritton and for the house is Michael Grant. Lastly, the minority leader for the senate is Lauren Book and for the house is Fentrice Driskell (BallotPedia, 2022).

Discuss interest groups that exist at the state and national levels that influence APN policy.

At the state level, physician groups often advocate for policies that maintain their traditional roles and may oppose measures that grant APNs greater autonomy. Oppositely, nursing associations like the American Association of Nurse Practitioners (AANP) and American Association of Nurse Anesthetists (AANA) work to advance APN practice, pushing for full scope of practice and reimbursement policy changes to enhance access to care. On the national level, there are also national nursing organizations like the National Council of State Boards of Nursing (NCSBN) and the National Council of Nurse Practitioners (NCNP) that actively advocate for APN policy changes that can promote independent practice (Brom et al., 2018).

Discuss methods used to influence change in policy in forms of competition, state legislative and executive branches of government, and interest groups.

Some methods used to influence change in policy include political campaigns and quality and safety initiatives. Supporting candidates who are sympathetic to APN issues and policy changes through campaign contributions and grassroots mobilization can influence election outcomes, ultimately affecting the composition of legislative and executive branches. APNs can also participate in quality and safety initiatives to demonstrate a commitment to high-quality care and patient well-being can enhance their credibility and influence (Cullerton et al., 2018).

BallotPedia. (2022). 
Florida's State Legislature. ballotpedia. 

https://ballotpedia.org/Links to an external site.

Brom, H. M., Salsberry, P. J., & Graham, M. C. (2018). Leveraging health care reform to accelerate nurse practitioner full practice authority. 
Journal of the American Association of Nurse Practitioners, 
30(3), 120–130. 

https://doi.org/10.1097/JXX.0000000000000023Links to an external site.

Cullerton, K., Donnet, T., Lee, A., & Gallegos, D. (2018). Effective advocacy strategies for influencing government nutrition policy: a conceptual model. 
The international journal of behavioral nutrition and physical activity, 
15(1), 83. https://doi.org/10.1186/s12966-018-0716-y

Links to an external site.

Galvani, A. P., Parpia, A. S., Foster, E. M., Singer, B. H., & Fitzpatrick, M. C. (2020). Improving the prognosis of health care in the USA. 
Lancet (London, England), 
395(10223), 524–533. https://doi.org/10.1016/S0140-6736(19)33019-3

Peterson M. E. (2018). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner Focus. 
Journal of the advanced practitioner in oncology, 
8(1), 74–81.

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