Identify 5 research articles and write a brief summary of the ethical approaches used in the research studies
Please include 400 words in your initial post and two scholarly references . Please refer to the discussion rubric. Also check for plagiarism and artificial intelligence(AI) .The work must be in your own words.Attached you can find the rubric to do the assigment
In this module you heard about careers in two somewhat similar but very different career fields. Please think about these fields and then compare and contrast careers in recreational therapy and athletic training, address how these careers are the same and how they are different. Specifically, you should describe how you think they are most different and most similar, in terms of their scope and practice. Scope and practice refers to the specific work the professionals engage in. While you may mention educational or other lifestyle differences, you must address aspects of scope and practice to earn full credit for your response. Your answer should consist of two paragraphs. Be sure to use specific details or examples in your response! Be sure to refer to the syllabus for writing expectations as well as the rubric, below, for overall grading expectations.
Please read attachment for instructions. Thank you
For the Module 10 assignment you are to create a PowerPoint presentation.
Module 10 Assignment
Scoring Rubric: Contemporary Issues and Trends
Criteria (Points)
Describe the issue you chose – 3
Discuss two significant facts about the issue – 3
Support the facts identified with at least one credible source and include the credible source(s) with your PowerPoint – 1
No more than five slides (not including the title and reference slides) – 1
Accurate Grammar (including capitalization, punctuation, spelling, word usage, no run-on sentences, no sentence fragments) – 1
Accurate APA format (including providing sources when appropriate, references, and in-text citations) – 1
Module 10 Written Assignment – Contemporary Issues and Trends
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Bottom of Form
Module 10 Content
1.
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In this written assignment, identify one specific contemporary issue or trend that you are interested in learning more about. Choose from the categories below.
· Global Healthcare and Nursing
· Healthcare Reform
· U.S. Healthcare Financing
· Nursing's Role in the U.S. Healthcare System
· Integrative Healthcare
· Nursing Leadership and Management
· Nursing Education
· Nursing Practice
· Nursing Professionalism
· Advancing Nursing as a Profession
· Client Access to Care
· Delivering Client Care
· Interdisciplinary Teamwork and Collaboration
· Ethical Practices in Healthcare
· Quality and Safety in Healthcare Delivery
· Health/Nursing Informatics
In a PowerPoint® presentation (no more than five slides not including the title and reference slides), include the following information:
· Describe the issue you chose.
· Discuss two significant facts about the issue.
· Support the facts identified with at least one credible source.
· Include the credible source(s) with your PowerPoint®.
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Can you help me with my homework.
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PICOT Question for Preventing Childhood Obesity
Tahimi Salfran Mesa
Florida National University
Professor: Yesenia Osle
September 15, 2023
PICOT Question for Preventing Childhood Obesity
Obesity is a pressing public health issue with serious long-term consequences. Obesity is a chronic medical condition characterized by excessive body fat. A body mass index (BMI) of 25 or above is considered overweight, and a BMI of 30 or higher is considered obese (WHO, 2021). Obesity has witnessed a global upswing, with a particularly alarming impact on children, sparking significant public health apprehension. Childhood obesity has become a pressing global concern, transcending the confines of adulthood. The alarming trend exposes children to immediate obesity-related health risks and casts a shadow over their future. Children are categorized as overweight or obese based on their BMI exceeding age and gender-specific thresholds. Precise height and weight assessments form a crucial aspect of routine physical examinations. Childhood obesity sets the stage for a lifelong battle, predisposing youngsters to adult obesity and a spectrum of non-communicable diseases like diabetes mellitus, hypertension, and osteoarthritis in adulthood.
Childhood obesity is driven by complex interplay of genetic, environmental, and behavioral factors. Genetic predisposition increases child's susceptibility to obesity. Environmental factors entail easy access to high-calorie, low-nutrient foods, and sedentary lifestyles influenced by modern technology and urbanization (Lister et al., 2023). Lower-income families may have limited access to fresh, nutritious foods and safe places for physical activity. Advertising of unhealthy foods and beverages targeted at children further exacerbates the problem. Behavioral factors are the psychological factors driving stress and emotional eating that hinder healthy habits. Addressing this burgeoning crisis demands urgent, comprehensive action to safeguard the well-being of our youngest generation and mitigate the far-reaching health consequences they face in adulthood. This paper explores the problem of obesity and identifies effective prevention strategies are essential to mitigate the growing concern using the PICOT framework.
Problem Statement
Childhood obesity rates have been steadily increasing worldwide. The global prevalence of overweight and obese children has risen dramatically in recent years. The World Health Organization (2021) reports that in 2020, 39 million children under five were overweight or obese. Over the past four decades, the global count of school-age children and adolescents grappling with obesity has skyrocketed by over tenfold, surging from 11 million to a staggering 124 million by 2016. Additional 216 million fell into the category of being overweight but not yet classified as obese in 2016. The numbers are projected to substantially increase by 2030.
The primary driver of obesity and overweight issues worldwide stems from a crucial energy imbalance: consuming calories exceeding those expended. The global challenge is exacerbated by an alarming surge in the consumption of energy-dense foods rich in fats and sugars and rise in physical inactivity (Fox et al., 2019). The latter can be attributed to the increasingly sedentary nature of many job roles, shifts in transportation methods, and the expanding urban landscape. These dietary habits and activity levels shifts often result from broader environmental and societal changes linked to development.
Childhood obesity elevates the risk of numerous health issues, encompassing asthma, sleep apnea, bone and joint problems, type 2 diabetes, and precursors to heart disease like high blood pressure. It also exerts substantial impact on healthcare costs. In adulthood, individuals grappling with obesity face increased susceptibility to stroke, various cancers, heart disease, type 2 diabetes, premature mortality, and mental health conditions such as clinical depression and anxiety. Therefore, childhood obesity carried over to adulthood will expose them to these problems. The problem affects both developed and developing nations. However, gender disparities are relatively minimal. Addressing the escalating obesity epidemic necessitates a comprehensive approach considering genetic predispositions and environments that encourage unhealthy behaviors. However, identifying the most effective strategies and interventions for specific populations is crucial.
PICOT Question
In school-aged children (P), does a comprehensive school-based nutrition and physical activity program (I) compared pharmacological interventions (C) reduce prevalence of obesity over 12-month period?
Explanation of PICOT Components
Population of Interest (P)
The population of interest for this PICOT question is school-aged children, typically ranging from 5 to 18 years old. The age group is particularly susceptible to obesity due to dietary habits, physical activity levels, and environmental influences. Childhood often emerges as a pivotal phase in development. It is increasingly acknowledged as a critical period influencing an individual's susceptibility to obesity in later life (Smith et al., 2020). During this window, taste preferences, dietary patterns, and lifestyle behaviors take shape and have a lasting impact. Interventions implemented during these early years possess the potential to redirect this trajectory, reshaping a child's preferences and habits before they solidify, offering a vital opportunity to mitigate the risk of obesity in the future.
Intervention of Interest (I)
The intervention of interest is a comprehensive school-based nutrition, behavioral therapy, and physical activity program. School-based nutrition interventions are strategies enacted within school environments to cultivate positive nutritional attitudes, knowledge, and behaviors in school-aged children and adolescents (O’Brien et al., 2021). These initiatives encompass various facets, including food policies, environmental enhancements, and nutrition education. Their recipients may range from school administrators, food service personnel, and teachers to parents and students. Conventional classroom educators or specialized program instructors can carry out implementation.
Physical activities are bodily engagements that require energy expenditure. They encompass exercises, sports, recreational pursuits, and daily tasks like walking or climbing stairs. Encouraging regular exercise helps children achieve and maintain a healthy weight while promoting overall well-being. Activities should be age-appropriate, enjoyable, and integrated into daily life. School-aged children and adolescents should engage in minimum of 60 minutes of daily physical activity, with at least 30 minutes devoted to structured activities like sports and supervised exercises, aligning with recommendations by the American Academy of Pediatrics (van Sluijs et al., 2021). Behavioral therapy focuses on modifying unhealthy behaviors and promoting positive lifestyle changes. It encourages self-monitoring, where children track their eating habits, physical activity, and food-related emotions. Second, the education encourages setting specific, achievable goals for healthier eating and increased physical activity tailored to their age and abilities.
Comparison of Interest (C)
The comparison of interest in this PICOT question is pharmacological intervention. Pharmacological intervention encompasses using pharmaceutical agents or drugs to manage obesity in children. These interventions include prescription medications like orlistat for reducing fat absorption in the digestive tract or metformin to regulate blood sugar levels and treat obesity-related insulin resistance (Florencia et al., 2022). Other weight management medications may also be considered, although their use in pediatric populations is generally more limited and carefully monitored due to potential side effects. Comparing the effectiveness of these pharmacological interventions with comprehensive school-based nutrition and physical activity programs is essential to determine the most appropriate and beneficial approach to address childhood obesity.
Outcome of Interest (O)
The primary outcome of interest is the body mass index (BMI) percentile reduction. BMI percentile is a commonly used metric to assess and monitor children's weight status. Decrease in BMI percentile indicates positive change in weight status and reflect progress in preventing childhood obesity.
Timeframe (T)
The proposed timeframe for implementing and evaluating the comprehensive school-based program's impact on BMI percentile is 12 months. The duration ensures comprehensive assessment of intervention's effectiveness over reasonable period.
Conclusion
Childhood obesity is a growing public health concern with far-reaching consequences. It stems from energy imbalance and has intensified due to increased consumption of energy-dense foods and reduced physical activity, driven by societal changes. Childhood obesity exposes children to immediate health risks and sets foundation fo lifelong battle with obesity-related diseases in adulthood. Interventions for combating childhood obesity should consider the complex interplay of genetic, environmental, and behavioral factors. Addressing childhood obesity requires comprehensive strategies illustrated through the PICOT framework. The outlined PICOT question focuses on school-aged children and impact of comprehensive school-based nutrition and physical activity program on BMI percentile reduction over 12 months. The question is designed to guide research and evaluation efforts in determining effectiveness of such interventions in preventing childhood obesity. Comparing the approach with pharmacological interventions is critical in determining appropriate effective path forward.
References
CDC. (2022, August 29).
Preventing Childhood Obesity: 4 Things Families Can Do. Centers for Disease Control and Prevention. https://www.cdc.gov/nccdphp/dnpao/features/childhood-obesity/index.html
Florencia, M., Gonzalez, C., Hirschler, V., & Guillermo Di Girolamo. (2022). Pharmacotherapeutic options in pediatric obesity: an urgent call for further research.
Expert Opinion on Pharmacotherapy,
23(8), 869–872. https://doi.org/10.1080/14656566.2022.2050212
Fox, A., Feng, W., & Asal, V. (2019). What is driving global obesity trends? Globalization or “modernization”?
Globalization and Health,
15(1). https://doi.org/10.1186/s12992-019-0457-y
Lister, N. B., Baur, L. A., Felix, J. F., Hill, A. J., Marcus, C., Reinehr, T., Summerbell, C., & Wabitsch, M. (2023). Child and adolescent obesity.
Nature Reviews Disease Primers,
9(1), 1–19. https://doi.org/10.1038/s41572-023-00435-4
O’Brien, K. M., Barnes, C., Yoong, S., Campbell, E., Wyse, R., Delaney, T., Brown, A., Stacey, F., Davies, L., Lorien, S., & Hodder, R. K. (2021). School-Based Nutrition Interventions in Children Aged 6 to 18 Years: An Umbrella Review of Systematic Reviews.
Nutrients,
13(11), 4113. https://doi.org/10.3390/nu13114113
Smith, J. D., Fu, E., & Kobayashi, M. A. (2020). Prevention and Management of Childhood Obesity and Its Psychological and Health Comorbidities.
Annual Review of Clinical Psychology,
16(1), 351–378. https://doi.org/10.1146/annurev-clinpsy-100219-060201
van Sluijs, E. M. F., Ekelund, U., Crochemore-Silva, I., Guthold, R., Ha, A., Lubans, D., Oyeyemi, A. L., Ding, D., & Katzmarzyk, P. T. (2021). Physical activity behaviours in adolescence: current evidence and opportunities for intervention.
The Lancet,
398(10298). https://doi.org/10.1016/s0140-6736(21)01259-9
World Health Organization. (2021, June 9).
Obesity and Overweight. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
Mental Status Exam Assignment
PNSG 1524 Mental Health
Use the interactive MSE form and interview another person. This could be a family member, roommate, classmate, etc. Keep in mind that many of the items on the form deal with observation of your “patient”; it is not just about asking questions. Look at the person you are interviewing and really think about what you are seeing. Also use your other senses, such as sound, smell, etc. All those things are important when assessing an individual’s mental status. Write 1-2 paragraphs describing how the interview went. Please answer each of the following questions:
1. What observations did you make regarding your “patient”; how did they appear and react to your questions?
1. Were there any areas you felt uncomfortable asking about?
1. Could you think of different ways to make the person you interviewed feel more comfortable?
1. What type of therapeutic communication techniques did you use?
1. How might you incorporate what you learned here when caring for patients in the future?
This form is a helpful tool that you can use when you assess any patient, it is not only for use in a mental health setting (although you can use it when you go for your mental health observation). Remember, people with mental health diagnoses are found in every clinical (and non-clinical) setting you can think of. It is just as important to assess a patient’s mental status as it is to assess their physical status.
This is for practice only; I do not need (or want) to see the results of the exam! Also, you can skip some of the areas of the MSE for this assignment that might seem too personal, such as the demographic section, but you would not want to skip any area if you were assessing a “real” patient.
Please place your completed assignment in the designated Dropbox by
the due date indicated.
Please see the 2 attachments for the instructions
Using your reading assignments in your textbook as a starting point, you will conduct additional research on the early aspects of quality assessment, improvement, and management. Your Research Report must include an
introduction, body of discussion, and a summary. You will discuss the following quality models in-depth and the experts responsible for developing the models and frameworks for quality improvement and management.
1. PDSA Cycle
2. Total Quality Management model
3. Lean Six Sigma model
4. Toyota Production System Lean Manufacturing
5. Donabedian Quality Framework
In your summary paragraph, you will discuss the connection between the development of the Donabedian Quality Framework and its application in healthcare quality measurement.
In addition to your narrative, you will create a table that contains a timeline in chronological order for the introduction of the quality models you discussed in your research paper. Your table will be an
appendix to your research report and the entries will include the name of the quality model, the year it was introduced, and its purpose. The purpose will be a synopsis from your findings and may be presented using bullet points. Be sure to follow APA standards for the use of appendices.
Here is an example of the table. Add rows to complete your timeline. Download the table from your Weekly Resources.
Year |
Quality Model Name |
Quality Model Purpose |
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Length: A minimum of 3 pages, not including the title page, reference page, and Appendix page.
Unit 7 Discussion Case Study —2 Peer Response 600w. Due 10-20-23
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.
Unit 7: Initial Discussion-Case Study RM
· A 70-year-old woman has scheduled an initial evaluation with you. Her medical diagnoses include hypertension, hyperglycemia, mild obesity, and hyperlipidemia. Her psychiatric diagnoses include anxiety and depression. Her current medications are atorvastatin 20 mg daily for seven years, Ozempic 1 mg injection weekly for three years, lisinopril 10 mg daily for 10 years, and Abilify 5 mg daily for six years.
· Labs: Fasting Blood Glucose – 115, HbgA1C – 6.9, Total Cholesterol – 200, LDL – 100, HDL – 37. Her height is 5’2” and her weight is 176 pounds. Her blood pressure was 146/83 upon arrival at the office.
· During your interview, she explains she became depressed following the death of her husband seven years ago. She became anxious about performing everyday tasks without him present. After starting Abilify, she gained 25 pounds and required an increased dose of atorvastatin and Ozempic. She has been unable to lose the weight she gained and tries to closely monitor her dietary intake due to her persistently elevated glucose but reports still craving carbohydrates. Her depression has improved slightly but she is still anxious to go out alone, so she no longer goes for daily walks to exercise.
Subjective:
CC: initial evaluation
HPI: A 70-year-old female presents to the clinic for initial evaluation. She is a new patient in the practice. She reports a current history of hypertension, hyperglycemia, mild obesity, and hyperlipidemia. She also reports currently being diagnosed with anxiety and depression. She reports taking atorvastatin 20 mg daily for 7 years for hyperlipidemia, Ozempic 1 mg injection weekly for three years for hyperglycemia, lisinopril 10 mg daily for 10 years for hypertension, and ability 5 mg daily for 6 years for depression.
PMH: Hypertension, hyperlipidemia, hyperglycemia, mild obesity, anxiety, and depression.
Allergies: none reported
Medications: atorvastatin 20 mg daily for 7 years for hyperlipidemia, Ozempic 1 mg injection weekly for three years for hyperglycemia, lisinopril 10 mg daily for 10 years for hypertension, and Abilify 5 mg daily for 6 years for depression.
SH: Patient lost her husband seven years ago and became depressed. The patient reports her anxiety increased to perform everyday tasks without her husband. The patient states, that after starting Abilify she gained 25 pounds and required an increased dose of atorvastatin and Ozempic. She has been unable to lose the weight she gained and tries to closely monitor her dietary intake due to her persistently elevated glucose but reports still craving carbohydrates. Her depression has improved slightly but she is still anxious to go out alone, so she no longer goes for daily walks to exercise.
FH: N/A
Health promotion and maintenance: N/A
ROS:
|
Constitutional |
reports weight gain of 25 lbs. |
|
Head |
N/A |
|
Eyes |
N/A |
|
Ears, Nose, Mouth, Throat |
N/A |
|
Neck |
N/A |
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Cardiovascular/Peripheral Vascular |
N/A |
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Respiratory |
N/A |
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Breast |
N/A |
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Gastrointestinal |
Reports increased cravings for carbohydrates. |
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Genitourinary |
N/A |
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Musculoskeletal |
N/A |
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Integumentary |
N/A |
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Neurological |
Alert and oriented x 3. |
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Psychiatric (screening tools: Ex: PHQ-9, MMSE, GAD-7) |
Reports anxiety to go out of her house alone and depression slightly improved |
|
Endocrine |
Reports persistent elevated glucose and carbohydrate cravings. |
|
Hematologic/Lymphatic |
N/A |
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Allergic/Immunologic |
N/A |
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Other |
|
Objective:
Her height is 5’2” and her weight is 176 pounds. Her blood pressure was 146/83 upon arrival at the office. Labs: Fasting Blood Glucose – 115, HbgA1C – 6.9, Total Cholesterol – 200, LDL – 100, HDL – 37.
·
What advice or modifications to his treatment regimen would you recommend for your new patient? (Discuss a minimum of two). Please support your answer with research-based evidence.
This 70-year-old female patient presents with diabetes as evidenced by a FBS of 115
and a HgbA1C of 6.9. A HgbA1C level equal to 6.5% or greater indicates a diagnosis of diabetes mellitus
(Centers for Disease Control and Prevention, 2023). The patient is currently at considerable risk for cardiovascular disease due to her borderline total cholesterol level of 200, LDL of 100, and HDL 37. The patient’s height is 5’2″ and weight is 176 lbs, BMI is 32.2 as per CDC (Centers for Disease Control) guidelines patient is obese which also contributes to cardiovascular disease (Centers for Disease Control and Prevention, 2022). The normal weight for the height of this patient is between 101lbs-136lbs (Centers for Disease Control and Prevention, 2022). According to Healthline, total cholesterol levels should be less than 200, LDL less than 100, HDL greater than 60, and triglycerides less than 149 for adult patients (2021). The patient has also been experiencing high blood pressure, BP 146/83 upon arrival. The patient has currently been taking lisinopril 10 mg daily for hypertension, atorvastatin 20 mg daily for 7 years for hyperlipidemia and Ozempic 1 mg injection weekly for three years for hyperglycemia.
The patient has also been taking Abilify 5 mg daily for 6 years for depression. During this time, the patient gained twenty-five pounds and required an increased dose of Ozempic and atorvastatin. The patient has been unable to lose the weight she gained and reports closely monitoring dietary intake due to persistently increased glucose levels and carbohydrate cravings. The patient’s states depression slightly improved, however, anxiety has not improved and now the patient is having trouble leaving the house alone.
According to the patient’s assessment, my treatment plan would be to continue Ozempic 1 mg injections weekly for diabetes management and add metformin IR 500mg PO BID with meals (Corcoran & Jacobs, 2023). Patient to check finger stick blood glucose levels 1-2 times daily on an empty stomach. Recommend the patient to a diabetes education program. To manage her cholesterol levels, I would titrate her atorvastatin from 20 mg to 40 mg PO daily. Re-check patient's lipid levels in 2-4 weeks (Drugs, 2023). To manage her high blood pressure, I would increase her lisinopril to 10 mg PO BID as a study shows that prescribing lisinopril twice daily vs once daily shows more improvements in SBP. Mean adjusted SBP reduction was 10.2 mm Hg greater in the twice‐daily cohort compared with the once‐daily cohort (Tsai et al., 2017). The patient will be coming back for follow-up in 2-4 weeks for further treatment outcome and if necessary, treatment plan adjustment.
The patient has chronic depression that has improved slightly; however, she does voice increased anxiety and new symptoms of fear of going out alone since her husband died seven years ago. The patient is now restricting herself from going out for walks and exercise. She is starting to exhibit symptoms of agoraphobia. The patient is currently taking Abilify 5 mg PO daily for 6 years. Typically, second-generation antipsychotics are not the first line of treatment for depression, they are used once they have tried many antidepressants with no effect. I suggest treatment augmentation with an antidepressant. Zoloft is an SSRI that does not counteract Abilify, start Zoloft at 25 mg PO daily and increase the dose weekly as needed. Zoloft is used for depression and social anxiety disorder (Psych Central, 2021). The patient will also benefit from psychopharmacology, psychotherapy, cognitive behavioral therapy.
Lastly, lifestyle change recommendations include diet and exercise modification. Work your way up to 150 minutes of moderate-intensity aerobic activity each week. This could be brisk walking 30 minutes a day, 5 days a week. Or you could do 75 minutes of vigorous-intensity aerobic activity each week, such as swimming laps. Regular physical activity provides immediate and long-term
health benefits.Links to an external site.
Physical activity and weight loss will Improve sleep quality, reduce high blood pressure, and reduce risk for type 2 diabetes, heart attack, stroke, and
several forms of cancerLinks to an external site.
. It can help reduce arthritis pain and associated disability, reduce the risk for osteoporosis and falls, and reduce symptoms of depression and anxiety (Centers for Disease Control and Prevention, 2023).
·
If you suggested additional medication, look up your state’s prescribing laws. Are PMHNP’s able to prescribe the medication you recommended?
Yes, as a practicing PMHNP for the state of Pennsylvania, prescribe drugs, devices, and Schedule II-V controlled substances if there is a written collaboration agreement with a physician (Pennsylvania Coalition of Nurse Practitioners, n.d.).
References:
Balaram, K., & Marwaha, R. (2023). Agoraphobia.
NIH.
https://www.ncbi.nlm.nih.gov/books/NBK554387/Links to an external site.
Centers for Disease Control and Prevention. (2022). Adult BMI calculator. CDC.
Centers for Disease Control and Prevention. (2023). Diabetes tests.
CDC.
https://www.cdc.gov/diabetes/basics/getting-tested.htmlLinks to an external site.
Centers for Disease Control and Prevention. (2023). Physical activity for a healthy weight.
CDC.
https://www.cdc.gov/healthyweight/physical_activity/index.htmlLinks to an external site.
Corcoran, C., & Jacobs, T.F. (2023). Metformin.
NIH.
https://www.ncbi.nlm.nih.gov/books/NBK518983/Links to an external site.
Drugs. (2023). Atorvastatin dosage.
Pennsylvania Coalition of Nurse Practitioners. (n.d.). Scope of Practice. PACNP.
Psych Central. (2021). Zoloft: What you want to know?
https://psychcentral.com/drugs/zoloft#basicsLinks to an external site.
Tsai, T., Kroehl, M. E., Smith, S. M., Thompson, A. M., Dai, I. Y., & Trinkley, K. E. (2017). Efficacy and
safety of twice- vs once-daily dosing of lisinopril for hypertension.
Journal of clinical hypertension (Greenwich, Conn.),
19(9), 868–873. https://doi.org/10.1111/jch.13011
Unit 7 Discussion Case Study MV
What would be your approach to managing this patient’s weight concern? (Discuss at least two aspects of your approach). Support your answer with research-based evidence.
In managing this patient's weight concern, a comprehensive approach that addresses both behavioral and pharmacological aspects would be necessary. First and foremost it's crucial to evaluate if the patient is prepared to make changes and how motivated she is to lose weight. We can use motivational interviewing techniques to delve into her reasons, for wanting to shed pounds and uncover any obstacles or difficulties she might encounter (Bischof et al., 2021). To address her worries, about how her weight might affect her ability to care for her child it could be advantageous to involve a team of professionals that includes a registered dietitian, an exercise specialist and a psychologist or therapist. The dietitian can work with the patient to develop a personalized meal plan that takes into consideration her busy schedule and frequent eating out habits. Emphasizing portion control, incorporating healthier food choices, and encouraging mindful eating practices have been shown to be effective in managing obesity (Foster et al., 2018). In terms of physical activity, an exercise specialist can help the patient create an individualized exercise routine that is feasible given her current responsibilities as a stay-at-home mother. Promoting regular physical activity has been found to aid in weight loss so finding activities that she enjoys and can incorporate into her daily routine will enhance adherence maintenance (Posadzki et al., 2020).
What would be our approach to the sexual side effects she is experiencing?
Regarding the sexual side effects experienced by the patient, it is crucial to address these concerns openly and compassionately. It's important to determine whether the issues are primarily caused by medication use or if they're influenced by factors, like stress or relationship dynamics. It might be beneficial to educate the patient about how fluoxetine and olanzapine can affect sexual functioning. If it is determined that the medication is causing these problems switching from fluoxetine to another antidepressant that has a less impact on sexual function could be considered. Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine have been linked to sexual dysfunction (Yuan et al., 2021). Bupropion, which is an atypical antidepressant, with a lower likelihood of causing sexual side effects could be an alternative option worth exploring (Montejo et al., 2019).
If you suggest additional medication, look up your state’s prescribing laws. Are PMHNPs able to prescribe the medication you recommend?
Before suggesting any additional medication options such as Bupropion, it is essential to review prescribing laws specific to Illinois. As a PMHNP prescribing additional medication for the above concerns would depend on state laws. According to the Illinois Nurse Practice Act (2017), advanced practice registered nurses (APRNs) including PMHNPs have prescriptive authority. However, there are specific conditions and restrictions outlined in the Act (AANP, 2022). Therefore, it is necessary to review the current regulations and guidelines set forth by the Illinois Department of Financial and Professional Regulation (IDFPR) to ensure compliance with prescribing laws when considering Bupropion as a treatment option for this patient (Kleinpell et al., 2023). Psychiatric Mental Health Nurse Practitioners (PMHNPs) in Illinois have prescriptive authority to reduce practice. Illinois state law requires a career-long regulated collaborative agreement with a psychiatrist in order for the NP to prescribe medication. The nurse practitioner-psychiatrist collaborative practice agreement outlines their working relationship. It describes the categories of care, treatment, and procedures the nurse practitioner expects to perform (AANP, 2022). In Illinois, psychiatrists are not required to be physically present with the PMHNP. The psychiatrist must be available for consultation whether in person or by phone. A collaborating psychiatrist and PMHNP are required to meet at least once a month (AANP, 2022).
Include the subjective and objective information in this post.
Subjective information:
The patient reports concerns about her weight and its impact on her ability to care for her disabled child after her husband's death. She has tried numerous 'fad diets' without long-term success, losing only 15 pounds at most and maintaining it for three months. The patient expresses feelings of shame related to sexual dysfunction, specifically difficulty achieving orgasm during intimate moments with her husband.
Objective information:
The patient's objective data include being morbidly obese at 340 pounds with a height of 5'5″. She also has type II diabetes, hypertension, and hyperlipidemia. Additionally, she eats out frequently due to her children's busy schedules and leads a sedentary lifestyle with no regular physical activity.
References
American Association of Nurse Practitioners (2022). State practice by type. Retrieved from https://www.aanp.org/legislation-regulation/state-legislation/state-practice-environment/66-legislation-regulation/state-practice-environment/1380-state-practice-by-typeLinks to an external site.
Bischof, G., Bischof, A., & Rumpf, H.-J. (2021). Motivational interviewing: An evidence-based approach for use in medical practice. Deutsches Ärzteblatt international. https://doi.org/10.3238/arztebl.m2021.0014Links to an external site.
Foster, D., Sanchez-Collins, S., & Cheskin, L. J. (2018). Multidisciplinary team–based obesity treatment in patients with diabetes: Current practices and the state of the science. Diabetes Spectrum, 30(4), 244–249. https://doi.org/10.2337/ds17-0045Links to an external site.
Kleinpell, R., Myers, C. R., & Schorn, M. N. (2023). Addressing barriers to aprn practice: Policy and regulatory implications during covid-19. Journal of Nursing Regulation, 14(1), 13–20. https://doi.org/10.1016/s2155-8256(23)00064-9Links to an external site.
Montejo, A., Prieto, N., de Alarcón, R., Casado-Espada, N., de la Iglesia, J., & Montejo, L. (2019). Management strategies for antidepressant-related sexual dysfunction: A clinical approach. Journal of Clinical Medicine, 8(10), 1640. https://doi.org/10.3390/jcm8101640Links to an external site.
Posadzki, P., Pieper, D., Bajpai, R., Makaruk, H., Könsgen, N., Neuhaus, A., & Semwal, M. (2020). Exercise/physical activity and health outcomes: An overview of cochrane systematic reviews. BMC Public Health, 20(1). https://doi.org/10.1186/s12889-020-09855-3Links to an external site.
Yuan, S., & Deban, C. E. (2021). Ssri-induced hypersexuality. American Journal of Psychiatry Residents' Journal, 16(3), 9–12. https://doi.org/10.1176/appi.ajp-rj.2021.160305Links to an external site.
