Week 5 Reflection

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  • In what ways could an understanding of systems theory and complexity science impact the role of the NP?
  • Take a few minutes to reflect on the NP practice model that is most predominant in advanced practice environments you have observed. Are you satisfied with the demonstrated level of interprofessional collaboration?
  • Briefly consider what appears to be the driving practice model for advanced practice nursing in your state. If your state lags behind in its practice model language, what might you do to facilitate change?

DP for brilliant

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1

Week 6 Discussion Forum

A theoretical framework provides a rationale for predictions about the relationship
among variables. Discuss the variables you will use in your change project and the
specific steps that are necessary to implement your change project in your
organization.

  • Week 6 Discussion Forum

CP 3

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The American Nurses Association’s (ANA) overall aims are to advance the nursing profession and improve healthcare for all. They appeal to each legislative session of the U.S.Congress, Democrats and Republicans alike, to address nursing legislative priorities. 

Six main legislative priorities were identified by the ANA for the 117th Congress. Each priority has several items

Review each and choose two items that you believe are the most important and discuss why you chose them.

Nursing

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Health Disparities Assignment.html

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Health Disparities Assignment

Population health is shaped by the social and economic conditions in which we are born, live, and work. Statistics indicate that many of us are one paycheck away from a financial crisis, especially since past recessions and the current state of inflation. In this module, you will explore the impact of poverty on health. In your professional roles and perhaps your own personal lives, you have all been exposed to the issues to some extent. The intent of this module will be to explore in more detail the prevalence of poverty, its impact on health, and barriers to attaining healthy outcomes. 

Resources:

Use the following resources to complete this assignment:

  • Read Nies & McEwen (2019) Chapters 21-23; 25; 28
  • Format your paper using 7th ed. APA formatting (i.e., Title page, headings, Reference page, etc.)

Instructions:

  1. Students will submit answers to the following questions using 3 headings, General Poverty, Food Security, and Homelessness into the appropriate NURS 410 assignment dropbox, using 7th ed. APA formatting.

    Activities  

    1. General Poverty (4 points)  

    1. Play Spent Activity:  

    The Urban Ministries of Durham have a great online poverty simulation that goes through a month in the life of a person living in poverty. To access the simulation, go to this website:  playspent.org  Summarize your experience with this simulation activity  

    • Did you have money left over?  

    • What difficult decisions did you need to make?  

    • What was your overall feeling when the month was over?  

    • Have you experienced similar financial challenges in your life?  

    • What safety nets were there to support you during this time?  

      

    1. Go to Poverty USA website at
      http://www.povertyusa.org/   

    Poverty Tour USA –Read the various information sections – What surprises you?  

    1. Interactive Poverty Map   

    1. Compare the state you live in with at least one other state.  

    1. Poverty Facts   

    1.  What is the definition of poverty and who lives in poverty?  

    1. Snapshots of Poverty   

    1.  Review at least one of the “Stories of Hope”– What are possible health implications?  

      

    1. Food Security (3 points)  

    Click on
    United States Food Drug Administration– Household Food Security  

    • USDA  

    • How is food insecurity defined?  

    • Which populations are most at risk for food insecurity?   

    • What programs are available to improve food access? Consider Supplemental Nutrition Assistance Program (SNAP)  

        

    1. Homelessness (3 points)  

    1. Who are the Homeless and why are they homeless?   

    Go to the website of the National Coalition for the Homeless.  

    • Click on Issues – Read about 2 topics that interest you.  

    • Click on Populations – read about one population.  

    • Click on Public Policy Recommendation – read about one policy recommendation  

      

    1. Describe the face of “homeless”  

    1. What are the numbers?  

    1. Who is homeless?  

    1. Why are they homeless?  

    1. How are health and homelessness related?  

    1. Identify and describe one policy project to reduce/end homelessness.  

      

    1. Go to Minnesota Interagency Council on Homelessness:  

    https://mn.gov/dhs/heading-home-minnesota/   

    1. What is purpose of this organization?  

     

     

     

Discussion

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  1. What was your biggest “take away” from any/all of the simulations?
  2. What did you find most challenging from the simulations? 
  3. How is what you learned from the assignments applicable to the medical field?
  4. Give examples of how such knowledge can affect your direct patient care. 

home wok Amy 3yres old patient

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Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes but would probably perform a simple strep test.

Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment.

 Amy, a 3 year old girl is brought to your office by her mother because she has a fever and complains that her ear hurts. She has no significant medical history. The child is not pleased to be in the provider’s office and has been crying. Her mother explains that she developed a “cold” about 3 days ago with sniffles. As she cries she continues to cough and has yellowish nasal discharge.  

Attention………Remember that your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP Notes have specific data included in every patient case. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.

Assessing individual and community needs

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Please see the attachment for the instructions

case1

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Case:

A 16-year-old boy comes to clinic with chief complaint of sore throat for 3 days. Denies fever or chills. PMH negative for recurrent colds, influenza, ear infections or pneumonias. NKDA or food allergies. Physical exam reveals temp of 99.6 F, pulse 78 and regular with respirations of 18. HEENT normal with exception of reddened posterior pharynx with white exudate on tonsils that are enlarged to 3+. Positive anterior and posterior cervical adenopathy. Rapid strep test performed in office was positive. His HCP wrote a prescription for amoxicillin 500 mg po q 12 hours x 10 days disp #20. He took the first capsule when he got home and immediately complained of swelling of his tongue and lips, difficulty breathing with audible wheezing. 911 was called and he was taken to the hospital, where he received emergency treatment for his allergic reaction.

Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation:

· The role genetics plays in the disease.

· Why the patient is presenting with the specific symptoms described.

· The physiologic response to the stimulus presented in the scenario and why you think this response occurred.

· The cells that are involved in this process.

· How another characteristic (e.g., gender, genetics) would change your response.

Hi, at least 3 references, free of plagiarism and APA format, plus introduction

Laboratory for Diagnosis, Symptom and Illness Management

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Soap Note 1 is based on the Case Study # 1 (10 Points)
You MUST use the Case Study #1 as the base of this SOAP NOTE #1 
Must use the sample template for your soap note, keep this template for when you start clinicals.

Templates used from another classes will not be accepted. Student must use the template provided in this class which must clearly contain the progress note (in the Assessment section) of the encounter with the patient ( this section is clearly mark in bold, highlighted  and underlined). No passing grade will be granted if this section is not completed properly. 

Late Assignment Policy

Assignments turned in late will have 1 point taken off for everyday assignment is late, after 7 days assignment will get grade of 0 (zero). No exceptions 

Follow the MRU Soap Note Rubric as a guide

Use APA format and must include minimum of 2 Scholarly Citations.

reply1,2

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·
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