Discussion

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 * Abortion is one of the most difficult and controversial moral issues we will consider. Listen to both sides, even if it is difficult to do. Both sides have important moral insights, even if ultimately these insights are outweighed by the insights of the other side. The goal of this discussion is not to convince you to accept one position over the other but to help you to understand both sides. As you consider this difficult issue, it is important to distinguish two questions:

1) Is abortion morally wrong?

2) Should abortion be illegal?

* Choose one of the questions above and argue both sides with supporting evidence. Please write your discussion choice in the title line. 

Unit 7 Discussion Case Study 600W. APA. 4 references due 10-17-23.

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Advanced Psychopharmacology and Health Promotion

Unit 7 Discussion Case Study 600W. APA. 4 references due 10-17-23.

Case Study:

· Your patient is a 36-year-old woman with bipolar disorder and anxiety. She has been stable on a combination of fluoxetine and olanzapine for two years.  She is morbidly obese at 340 pounds at 5’5” in height, has type II diabetes, hypertension, and hyperlipidemia.  She has concerns about her weight and has tried numerous ‘fad diets’ to no avail.  She explains she has lost, at most, 15 pounds and has been able to keep it off for three months. 

· She has three children, one of which is severely disabled, and a husband who has a terminal diagnosis. She expresses worry that her weight will impact her ability to care for her disabled child when her husband dies.  She reports she eats out frequently due to her children’s busy schedules.  She is a stay-at-home mother but gets little exercise and performs no regular physical activity. 

· She reports feelings of shame that she can no longer orgasm on the rare occasions her husband has the energy and desire to be intimate.

  
Questions: 

· What would be your approach to managing this patient’s weight concern? (Discuss at least two aspects of your approach). Please support your answer with research-based evidence. 

· What would be our approach to the sexual side effects she is experiencing? 

· If you suggested additional medication, look up your state’s prescribing laws. Are PMHNP’s able to prescribe the medication you recommended? 

· Please include the subjective and objective information in this post.

All responses must by supported by correct APA 7th edition formatted citations and references.

1. What would be your approach to managing this patient's weight concern? (Discuss at least two aspects of your approach). Please support your answer with research-based evidence. 

1. Non-pharmacological Approach

2. Pharmacological Approach

2. What would be our approach to the sexual side effects she is experiencing?

· Lifestyle changes, avoidance of stress or anxiety, drug therapy, physical activity, and psychological support. 

3. If you suggested additional medication, look up your state's prescribing laws. Are PMHNPs able to prescribe the medication you recommended?

· Additional medication is Flibanserin, the PMHNP can prescribe this without the supervision of a psychiatrist since PMHNP is Psychiatric-Mental Health Nurse Practitioner which is Board Certified. And/or hormonal therapy which is usually prescribed by a gynecological physician.

Please see the explanation below. 

Step-by-step explanation

Approach to solving the question:

· Identification of clinical problems that a bipolar patient attained, classification of nonpharmacological and pharmacological treatment of a patient, planning for therapies essential in treating the patient, and evaluation of the process for positive outcomes.

1. What would be your approach to managing this patient's weight concern? (Discuss at least two aspects of your approach). Please support your answer with research-based evidence. 

1.
Non-pharmacological Approach

·
Detailed explanation: this is an approach that is essential in managing a patient's weight concern without the involvement of drugs to treat the weight problem. This aim is to provide alternative prevention in treating weight gain without any chemical side effects on the body. 
(Focus (American Psychiatric Publishing). 2021)

·
Examples: (1) Physical activity such as aerobic exercises, can help the patient maintain her within the normal range which will enhance her conditions of type II diabetes, hypertension, and hyperlipidemia and help in improving her sexual desire, (2) Healthy food intake such as fruits, vegetables, whole grains, nonsalty and fatty foods, can reduce the risk of weight gain, and increase blood pressure and cholesterol which can improve her well being, and (3) Peer support which is very helpful in getting motivation from those people who are experiencing the same situation with the patient which increase the chance of preventing to expose her self to stress and anxiety. 

2.
Pharmacological Approach  

·
Detailed explanation: this is an approach that is essential in managing a patient's weight concern with the involvement of drugs to treat the weight problem. This aim is to provide drug prevention to avoid the progression of the presenting clinical manifestation and development of complications. 
(Focus (American Psychiatric Publishing). 2021)

·
Examples: (1) Phentermine-topiramate which is helpful in cutting the cravings, and lessens the appetite during stress and anxiety. This is helpful to increase the chance of weight gain especially when the patient attempted to expose herself to overeating.

2. What would be our approach to the sexual side effects she is experiencing?

· The approach
 to the sexual side effects the patient is experiencing are lifestyle changes, avoidance of stress or anxiety, drug therapy, physical activity, and psychological support. Sexual side effects based on the scenario are linked to the stress, anxiety, and weight gain of the patient. It is important that as a healthcare provider, you must assess the related factors to the presenting problem. For a patient with bipolar disorder, it is important to have a care plan to follow so that the patient will be encouraged to do. Lifestyle changes such as physical activity and eating healthy food are the most important since the patient tends to eat out frequently due to her children's busy schedules, gets little exercise, and performs no regular physical activity. If the patient is healthy, their sexual desire will improve and help her to have orgasms since her hormones are healthy. Avoidance of stress and anxiety is helpful in sexual desire because a patient who is stressed can affect the sympathetic nervous system limiting the blood flow to the genitals to achieve genital arousal. Also, therapies are helpful in correcting abnormal hormones in the body system. 
(Lancet Public Health. 2021)

3. If you suggested additional medication, look up your state's prescribing laws. Are PMHNPs able to prescribe the medication you recommended?

· Since the patient is already taking combinations of olanzapine which is useful in treating schizophrenic episodes and fluoxetine which is an antidepressant used in bipolar disorder and linked to weight loss, the additional medication that I may recommend is Flibanserin which is an antidepressant helpful in correcting the imbalance of the neurotransmitters in the brain increasing the chance to sexual desire. The PMHNP can prescribe this medication in all states because Flibanserin should be prescribed by a psychiatrist physician and certified nurse practitioners. Another additional medication that I would like to conclude is hormonal therapy like estrogen therapy because the abnormal level of hormones in the body affects the body in sexual desires and can lead to stress and anxiety. 
(Psychiatr Serv. 2018)

REFERENCES:

· Vancampfort D, Firth J, Correll CU, et al.. The impact of pharmacological and non-pharmacological interventions to improve physical health outcomes in people with schizophrenia: a meta-review of meta-analyses of randomized controlled trials. 
Focus (American Psychiatric Publishing).2021;19:116-28. 

· Mitchell K.R., Lewis R., O'Sullivan L.F., Fortenberry J.D. What Is Sexual Wellbeing and Why Does It Matter for Public Health? 
Lancet Public Health. 2021;6:e608-e613. doi: 10.1016/S2468-2667(21)00099-2.  

· Blackmore M.A., Carleton K.E., Ricketts S.M. Comparison of collaborative care and colocation treatment for patients with clinically significant depression symptoms in primary care. 
Psychiatr Serv. 2018;69(11):1184-1187. doi: 10.1176/appi.ps.201700569.

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Lauren Hahn



Lauren Hahn

Yesterday Sep 4 at 1:08pm

Technology is an ever-changing and advancing phenomenon that can be tricky to navigate. “Society has moved from a world dominated by paper and face-to-face interactions, to an online presence and way of communicating that is in a constant state of evolution” (Knox, 2019, p. 1). Whether the nurse be young or older, I believe that navigating technology can come with growing pains for everyone. Technology is constantly updating and progressing into programs that aid in essential parts of nursing informatics. “Informatics knowledge and skills provide the tools to understand and use technology to work more efficiently and effectively, and to work smarter, not harder” (Chamberlain College of Nursing, 2020). The nurse must be able to use technology effectively in order to provide safe and efficient patient care. Clicking around the EHR can be overwhelming to some, as there are a lot of different ends and outs of different health care programs. It is essential for the nurse to not only be able to chart on their patient, but to be able to obtain proper data and information on their patients in order to perform interventions appropriately. Nursing informatics involves the DIKW theory– which is collecting and applying data, information, knowledge, and wisdom through technology. Through nursing informatics, I believe I am going to be learning a lot about how to connect the dots through patient care in a way that benefits communication in nursing and patient safety using technology. For seasoned nurses this may be less intimidating, but I feel that there is always going to be room to grow and learn when it comes to informatics no matter the skill set. Although I feel confident in using technology I scored myself a 32 overall. I believe that I could use further education on a few categories as I scored myself “good”, but was reassured to see myself as “very good” in others. I am excited to be improving on things like recognizing the role of information technology in improving patient care outcomes and creating a safe care environment throughout this course. I don't believe that I have any additional questions at this time as I feel that the lessons and readings have provided me with great context of what this course has to offer so far. I will utilize my teacher, and the Q&A forum if I do end up having any questions. 

 

Resources 

Chamberlain College of Nursing (2020).
NR361 Information Systems in Healthcare: Week 1 Lesson. Downers Grove, IL: Online Publication. 

Knox, A. (2019). Informatics in Nursing Education: What Do We Do Next?
 Canadian Journal of Nursing Informatics, 14(4). https://chamberlainuniversity.idm.oclc.org/login?qurl=https%3A%2F%2Fwww.proquest.com%2Fscholarly-journals%2Finformatics-nursing-education-what-do-we-next%2Fdocview%2F2560299629%2Fse-2%3Faccountid%3D147674

FPA legislation

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What are the advantages and disadvantages of collaborating with physician organizations when pursuing FPA legislation?

NURSING

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Student Instructions for i-Human Virtual Simulation

NR325/NR330 Maggie Naganashe Scenario 2

PURPOSE:

The following information is to be used in guiding your preparation and participation in the virtual simulation scenario for this course. This document will provide applicable course outcomes in preparation for your simulation.

SCENARIO OVERVIEW:

Maggie Naganashe is a 62-year-old American Indian female with chronic renal failure. She also has a 15-year history of type II diabetes mellitus and a history of hypertension, and hyperlipidemia. She lives on an American Indian reservation and is a proud member of the Odawa tribe. Mrs. Naganashe reports that she was unable to go to her dialysis treatment this week because her husband had to use their only car for a job interview. She was admitted for shortness of breath, swelling, weight gain and fatigue.

LEARNER OBJECTIVES:

1. Utilize clinical reasoning skills to perform a health history and physical assessment on an adult patient. (CO 1, 2, 3, 4)

2. Construct a plan of care based by prioritizing assessment findings and nursing diagnoses (CO 4, 5, 6, 7)

3. Evaluate patient outcomes to determine the effectiveness of nursing interventions and need for ongoing care (CO 4, 8)

4. Communicate and collaborate with the patient, family, and interdisciplinary healthcare team members (CO 3, 6)

STUDENT ROLES DURING SIMULATION:

You are the staff nurse at the hospital who will be conducting a comprehensive assessment. After completing your assessment, you are expected to document your findings as a nurse’s note in SBAR format.

KEY FEATURES OF i-HUMAN:

· As the nurse, you are expected to complete the case scenario using the following tabs: EHR, History, Physical, Analyze, Actions, Nursing Notes, Summary

· There are required questions and/or additional information provided related to this case. The questions, information, and videos must be completed/reviewed prior to progressing to the next tab.

· Nursing Notes: At the end of the simulation, you will document your assessment findings using ISBAR.

CONFIDENTIALITY:

To preserve the educational value, integrity, and safety of the learning environment, you agree to maintain strict confidentiality about the proceedings of the simulation session, details of the training scenarios and the performance of all participants. You acknowledge that this expectation aligns with the guidelines related to the Health Insurance Portability and Accountability Act (HIPAA) as well as laws governing Protected Health Information (PHI) in client care environments.  You will not view, discuss, share, record or disclose any confidential information pertaining to the session. You understand that lapses in confidentiality are considered academic misconduct and could result in dismissal from the academic program. 

FICTION AGREEMENT:

You will suspend judgment of realism for any given simulation in exchange for the promise of learning new knowledge and skills, treating the simulated patients with the same care due an actual patient, act with a genuine desire to learn even when it may be difficult to do so.  

DUE DATE:

The virtual simulation is assigned to be completed during

Week 4
 prior to your scheduled debriefing with faculty/peers.

SIMULATION TIMING:

· Pre-simulation preparation: 30-60 minutes

· Pre-brief: 15 minutes

· Run Time: 2.75 hours

· Debriefing: 60 minutes

ASSESSMENT & EVALUATION

Faculty will utilize your participation measurements in the i-Human case, and debriefing discussions to identify areas of opportunity for enhancement of your clinical growth. Your experiences in i-Human will contribute to your overall completion of clinical requirements for the course as documented on the Clinical Learning Evaluation tool.

i-Human Evaluation – What does my total score mean?


REVIEW AND COMPLETE PRIOR TO THE START OF THE VIRTUAL SIMULATION:

In order to prepare for the simulation, you are
required to complete the pre-simulation questions below and submit this prework to the faculty via uploading your responses in Canvas prior to the start of the virtual simulation. If you do not complete the pre-simulation questions and upload them, you will

not
be able to access or participate in the simulation.

1. Describe the fluid and electrolyte imbalance that occur with chronic renal failure.

2. What are key patient education concepts related to chronic kidney disease?

3. Explore the CDC Tribal Data, Information, and Resources at
www.cdc.gov/tribal/data-resources and read the following article.

Mitchell, F. (2012). Reframing diabetes in American Indian communities: A social determinants of health perspective.
Health & Social Work, 37(2):71–79.

[Note: This article can be located through the Chamberlain University Library.]

4. Describe risk factors and conditions that lead to health disparities for American Indians.

Immediately following the completion of the virtual simulation, you will complete the evaluation of the simulation using the link provided.

©2023 Chamberlain University LLC. All rights reserved.

Chamberlain University | National Management Offices | 500 W. Monroe St., Suite 1300 | Chicago, IL 60661

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Fundamental M5

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Assignment Content

1. Complete the
ATI Systems Disorder template for your assigned respiratory topic. Every box on the template must be completed, a citation is needed for every box, and your reference list must be included (APA). 

research analysis

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Compare hypotension, hypertension, and hypotensive shock in the following areas: clinical manifestations, risk factors, differentials, diagnosis, and management/treatment recommendations. Next answer these questions:

What are the transmission and pathophysiology of the conditions?

What are the primary medical concerns for patients with these conditions?

What might be the primary psychosocial concerns for patients with these conditions?

What are the implications of these conditions for critical care and advanced practice nurses?

300-400 words. APA format. 

patient safety

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Read the following article and view the video on the same case. How can this example be used as an illustration of maintaining patient safety and providing safe, effective care? Identify some of the possible barriers that nurses face when acting on what they believe to be the morally correct action in this particular case. 

https://www.cpr.org/2015/02/17/for-colorado-mom-story-of-daughters-hospital-death-is-key-to-others-safety/

AGENDA COMPARISON GRID AND FACT SHEET

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1

Presidential Agendas

Name

Institution

Course

Instructor

Date

Presidential Agendas

When the presidents come into office several health issues are a priority to them. Likewise, when deciding on the topic of discussion many issues were considered. However, the selected topic is on mental health which has been an issue of concern and has been regarded as a priority health issue among presidents. Mental health is a concern that is attributed to many other factors, which include health factors like the coronavirus pandemic, and economic, social, and contextual factors. There have been significant milestones in mental health treatment among different administrations.

One of the significant progress made in mental health was made during the reign of President Obama. During his reign, Obama expanded mental health care by introducing health coverage under the Affordable Care Act. The ACA was responsible for eliminating the discrimination that existed when offering care to patients with mental health and substance abuse problems. Additionally, the president embarked on building health and behavioral care centers by investing millions of dollars from ACA (National Archives n.d). The services emphasized the importance of promoting mental health access among the police and other personnel involved in the protection of the citizens and their families.

President Trump was not left behind in making positive changes in the provision of mental health care among the citizens. However, Trump's strategy was marred with controversy regarding the eradication of ACA and Medicaid, which reduced the insurance coverage among those who used that program to access mental health services (Courtemanche et al., 2020). This means such strategies hurt low-income earners by denying them to access crucial mental health services. However, the president further implemented an executive order that saw increased access to mental health services among those with the condition, especially during the pandemic. Such services were aimed at prevention of related suicide, reduction of substance use, and improvement of overall mental health. However, the adoption of COVID-19 management measures such as lockdowns, unemployment, and isolation of people from others increased stress and mental health instances among the people.

These two presidents had excellent strategies for addressing the mental health menace that affected the American population. These strategies have been needed for a long time though they have not been put into practice until recently. However, I would focus on improving mental health training among caregivers as a strategy for ensuring everyone has access to mental health services including healthcare providers. It is prudent to ensure even healthcare providers have access to care because they equally share the experiences of dealing with hopeless patients that could potentially affect their emotional and psychological well-being. Availing such services could help caregivers deal with related trauma whenever it occurs.

References

Courtemanche, C., Marton, J., Ukert, B., Yelowitz, A., & Zapata, D. (2020). The impact of the Affordable Care Act on healthcare access and self‐assessed health in the Trump Era (2017‐2018).
Health services research,
55, 841-850.

National Archives.
Addressing Mental Health: Progress in Research, Prevention, Coverage, Recovery and Quality.
https://obamawhitehouse.archives.gov/sites/default/files/docs/mental_health_report_final.pdf

nursing

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  1. What are the barriers/challenges described in your readings that you also face in your environments as you attempt to provide family focused nursing? (e.g. family as client, family as context, family as barrier, family as caring process, family as resource)
  2. Reflect on nursing practice that views family as the unit of care and nursing practice that views family as contextual to the individual patient. Do you believe that current nursing practice most often views family as the unit of care or family as a context to the situation? How do these two views differ.
  3. Develop 5 questions focusing on one of Denham’s Core Processes.  Interview a client in your workplace or within your community and describe their answers to your questions.  Identify family routines and factors related to family health routines.
  4. From the Khalili article, what were the most significant aspects of the illness transition for the family? What resources did the family need/want? What were the barriers and facilitators to obtaining the needed resources or supports? What may have changed in the care situation for the family if the family would have been viewed as the unit of care?
  5. Using one of the family theories/frameworks described in the literature reflect on an illness experience in a family. (You can reflect on a family you have cared for in your nursing practice.) Consider how family structure, function, and process influenced the family health experience and outcomes. Analyze the experience from a family theory/framework perspective.
  6. Use your reading on a One Question Question by Duhamel et al (2009) to practice this questioning strategy with a family. Share your reflections and outcome.