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

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Unit 11 – Discussion Medications for Pain Management.

Name

Institution

Course Number and Title

Professor

Date

Concerns about the use of opioids for pain management

Many parties are concerned about the use of opioids for pain management because that which makes them effective also makes them dangerous. Opioids work by binding to opioid receptors in the central nervous system and incite a pleasurable sensation while dulling pain when they bind to receptors in the brain. However, opioids have a pleasurable, tempting effect for some, and their continuous use has a high risk of leading to misuse, abuse, and eventual addiction. At higher doses, opioids can cause fatal heart rate and respiration slowdowns, whereas, at lower dosages, they may only make patients drowsy. Increased attention has been brought about by the increasing incidence of opioid use disorder and the related health effects. Opioids are useful for numbing pain, but they have a double-edged impact since they may also cause tolerance, physical dependency, and addiction.

Furthermore, opioid overdose has elevated to a serious public health emergency, grabbing the attention of governments and medical professionals everywhere. Because of the rising death rates associated with opioid overdoses, with over 75% of overdose cases related to opioids in 2021 (CDC, 2021), the U.S. government, in particular, has taken the lead in fighting the opioid crisis. The illegal usage of synthetic opioids like fentanyl has contributed significantly to the rise in opioid overdose mortality observed in recent years. The American government has responded by enacting several laws, tightening prescription regulations, boosting access to alternative medication, and expanding the availability of addiction treatment programs. These efforts indicate a thorough effort to address the many problems related to the use of opioids in pain treatment.

Article “America’s opioid crisis: the need for an integrated public health approach”

The article presents a timely and comprehensive understanding of the opioid crisis in the U.S. and the need for a comprehensive approach to address the crisis. I agree with the article’s overall premise of the vital necessity of implementing an integrated public health strategy to successfully address this issue, particularly in light of the ongoing rise in overdose fatalities and the fall in life expectancy. Notably, I also think it is necessary to use a collaborative approach across different disciplines, such as neuroscience, pharmacology, epidemiology, treatment services, and prevention, and to integrate interventions across diverse settings for a holistic response.

The article highlights four interrelated themes that encompass the essential elements of a successful public health strategy: bridging the gap between implementation science and practice, person-centered approaches for prevention and treatment, social determinants of health and disease, and using data to build learning systems of care. These topics highlight how important it is to address the intricate relationships between biological and social elements and how development affects brain function and sensitivity to outside stimuli. However, one aspect I would add to the article is to emphasize the role that the pharmaceutical industry, companies, and the drive for profit played in the development and severity of the crisis. It is well-documented that companies such as Purdue Pharma marketed opioids aggressively and had sale agents and sponsored doctors who pushed for more prescriptions; this started the cycle of addiction (Arteaga et al., 2021). Therefore, any comprehensive approach to address the opioid crisis requires new legislation that prevents companies from pushing prescriptions for profit.

Disorders commonly associated with patients who also need pain relief

The demand for pain relief and mental health concerns frequently coexist, complicating healthcare situations. Depression and chronic pain are commonly associated and co-occur with anxiety in people with chronic pain problems (Murez, 2021). Psychological and physical distress co-occurrence can intensify pain perception and impede efficient treatment. Because of the complex relationship that exists between depression and chronic pain, treating both conditions at the same time requires an integrated strategy. The co-occurrence of anxiety disorders and chronic pain issues is another significant correlation. Anxiety can cause increased pain sensitivity and intensify one’s subjective perception of pain (Harvard Health Publishing, 2021). Additionally, it may exacerbate avoidance habits, preventing patients from participating in physical therapy or other non-pharmacological pain relief techniques.

MME

The Morphine Milligram Equivalent (MME) is a standardized metric used in the healthcare industry to quantify the strength and equivalence of different opioid drugs and facilitate simpler comparisons of their effects. When opioid doses must be translated to a standard measure for safety, effectiveness, and regulatory considerations, the MME is very helpful in clinical practice and research. An opioid’s potency in relation to a standard, usually morphine, is represented by a conversion factor, which is applied to determine the MME for a particular opioid. A uniform metric helps assess and compare the various amounts of opioids patients are given, facilitating safer and more effective pain management.

Since MME gives medical providers a common standard to discuss and track opioid doses, it is crucial to reduce the dangers associated with opioid medication. Because it enables a more thorough assessment of a patient’s opioid regimen, this method also helps lower the risk of an opioid overdose. In addition to being beneficial for healthcare professionals, MME is also a crucial instrument for legislators, allowing them to create policies and rules that promote safer prescription practices.

References

Arteaga, C., Barone, V., Lleras-Muney, A., Reber, S., Maclean, C., Aslan, M., Kroft, K., Zarate, R., Weisburst, E., Van Effenterre, C., & Price, D. (2021).
The Opioid Epidemic: Causes and Consequences.
http://www.carolinaarteaga.com/s/Opioids_ArteagaBarone_Nov12.pdf

Blanco, C., Wiley, T. R. A., Lloyd, J. J., Lopez, M. F., & Volkow, N. D. (2020). America’s opioid crisis: the need for an integrated public health approach.
Translational Psychiatry,
10(1).
https://doi.org/10.1038/s41398-020-0847-1

Centers for Disease Control. (2021).
Understanding the epidemic | CDC’s response to the opioid overdose epidemic |.
https://www.cdc.gov/opioids/basics/epidemic.html

Murez, C. R. (2021).
Chronic Pain and Mental Health: The Empowered Patient’s Guide.
https://www.healthcentral.com/pain-management/chronic-pain-and-mental-health

Publishing, H. H. (2021).
Pain, anxiety, and depression. Harvard Health.
https://www.health.harvard.edu/mind-and-mood/pain-anxiety-and-depression

Stahl, S. M. (2021).
Stahl’s Essential Psychopharmacology.
https://doi.org/10.1017/9781108975292

Introduction

Interprofessional collaboration is a critical aspect of a nurse’s work. Through interprofessional collaboration, practitioners and patients share information and consider each other’s perspectives to better understand and address the many factors that contribute to health and well-being (Sullivan et al., 2015). Essentially, by collaborating, health care practitioners and patients can have better health outcomes. Nurses, who are often at the frontlines of interacting with various groups and records, are full partners in this approach to health care.Reflection is a key part of building interprofessional competence, as it allows you to look critically at experiences and actions through specific lenses. From the standpoint of interprofessional collaboration, reflection can help you consider potential reasons for and causes of people’s actions and behaviors (Saunders et al., 2016). It also can provide opportunities to examine the roles team members adopted in a given situation as well as how the team could have worked more effectively.As you begin to prepare this assessment you are encouraged to complete the What is Reflective Practice? activity. The activity consists of five questions that will allow you the opportunity to practice self-reflection. The information gained from completing this formative will help with your success on the Collaboration and Leadership Reflection Video assessment. Completing formatives is also a way to demonstrate course engagement Note: The Example Kaltura Reflection demonstrates how to cite sources appropriately in an oral presentation/video. Your assessment will reflect on either a professional collaboration you experienced or a collaboration case study scenario that you imagine you experienced

References

Saunders, R., Singer, R., Dugmore, H., Seaman, K., & Lake, F. (2016). Nursing students’ reflections on an interprofessional placement in ambulatory care. Reflective Practice, 17(4), 393–402.Sullivan, M., Kiovsky, R., Mason, D., Hill, C., Duke, C. (2015). Interprofessional collaboration and education. American Journal of Nursing, 115(3), 47–54.

Demonstration of Proficiency

• Competency 1: Explain strategies for managing human and financial resources to promote organizational health.
  • Identify how poor collaboration can result in inefficient management of human and financial resources supported by evidence from the literature.
• Competency 2: Explain how interdisciplinary collaboration can be used to achieve desired patient and systems outcomes.
  • Reflect on an interdisciplinary collaboration experience noting ways in which it was successful and unsuccessful in achieving desired outcomes.
  • Identify best-practice interdisciplinary collaboration strategies to help a team to achieve its goals and work more effectively together.
• Competency 4: Explain how change management theories and leadership strategies can enable interdisciplinary teams to achieve specific organizational goals.
  • Identify best-practice leadership strategies from the literature, which would improve an interdisciplinary team’s ability to achieve its goals.
• Competency 5: Apply professional, scholarly, evidence-based communication strategies to impact patient, interdisciplinary team, and systems outcomes.
  • Communicate via video with clear sound and light.
  • The full reference list is from relevant and evidence-based (published within 5 years) sources, exhibiting nearly flawless adherence to APA format.

Professional Context

This assessment will help you to become a reflective practitioner. By considering your own successes and shortcomings in interprofessional collaboration, you will increase awareness of your problem-solving abilities. You will create a Kaltura video of your reflections, including a discussion of best practices for interprofessional collaboration and leadership strategies, supported by references to the literature.You may choose to reflect on a collaborative interprofessional project you worked on in your current or former place of practice, or you may choose to imagine that you worked on the collaborative interprofessional scenario presented in the Assessment 01 Supplement: Collaboration and Leadership Reflection Video [PDF] resource.

Scenario

As part of an initiative to build effective collaboration at a site where you work as a nurse, you have been asked to:

• Reflect on an interprofessional collaborative project.
• Examine what happened during the collaboration.
• Identify positive aspects and areas for improvement.
• Research best practice for interprofessional collaboration.
• Use lessons learned from your research and experience to create a video reflection (5-10 minutes) that share suggestions for improving interprofessional collaboration that can be shared with leadership and colleagues.

Instructions

Using Kaltura, record a video (5–10 minutes) where you reflect on an interprofessional collaboration experience, proposing recommendations for how to improve interprofessional collaboration that can be shared with leadership and colleagues. Support these recommendations with references to the literature.The interprofessional project that you reflect on may be one that you collaborated on at your current or former place of practice, or you may choose to imagine you collaborated on the interprofessional project presented in the Assessment 01 Supplement: Collaboration and Leadership Reflection Video [PDF] Download Assessment 01 Supplement: Collaboration and Leadership Reflection Video [PDF]resource and reflect on that.Be sure that your assessment addresses the following criteria. Please study the scoring guide carefully so you will know what is needed for a distinguished score:

• Reflect on an interdisciplinary collaboration experience, noting ways in which it was successful and unsuccessful in achieving desired outcomes.
  • Explain aspects of the collaboration that helped the team make progress toward relevant goals or outcomes.
  • Explain aspects of the collaboration that could have been improved.
• Identify how poor collaboration can result in inefficient management of human and financial resources, citing supporting evidence from the literature.
  • Discuss the ways in which the interdisciplinary team did not collaborate effectively.
  • Discuss the negative implications for the human and financial resources of the interdisciplinary team and the organization as a whole.
  • Cite the literature for support.
• Identify best-practice leadership strategies from the literature that would improve an interdisciplinary team’s ability to achieve its goals, citing at least one author from the literature.
  • Identify at least one leadership best practice or strategy that you believe would improve the team’s ability to achieve their goals.
  • Identify the strategy and its source or author and provide a brief rationale for your choice of strategy.
  • Cite the literature for support.
• Identify best-practice interdisciplinary collaboration strategies to help a team achieve its goals and work together, citing the work of at least one author.
  • Identify at least one best practice or strategy for interdisciplinary collaboration to help the team achieve its goals and work more effectively together.
  • Identify the strategy, its source, and reasons why you think it will be effective.
• Communicate in a professional manner, is easily audible, and uses proper grammar. Format reference list in current APA style.
  • Submit an APA-formatted reference list for any sources that you cited specifically in your video or used to inform your presentation.
  • The Example Kaltura Reflection will show you how to cite scholarly sources in the context of an oral presentation.
• Notes: 
• Refer to the Campus tutorial Using Kaltura [PDF] as needed to record and upload your reflection.
• If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact [email protected] to request accommodations.
• If, for some reason, you are unable to record a video, please contact your faculty member as soon as possible to explore options for completing the assessment.

Additional Requirements

• References: Cite at least 3 professional or scholarly sources of evidence to support the assertions you make in your video. Include additional properly cited references as necessary to support your statements.
• APA Reference Page: Submit a correctly formatted APA reference page that shows all the sources you used to create and deliver your video.
  • You may wish to refer to the Campus APA Module for more information on applying APA style.
• Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you complete the final Capstone course.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

• Competency 1: Explain strategies for managing human and financial resources to promote organizational health.
  • Identify ways poor collaboration can result in inefficient management of human and financial resources, supported by evidence from the literature.
• Competency 2: Explain how interdisciplinary collaboration can be used to achieve desired patient and systems outcomes.
  • Reflect on an interdisciplinary collaboration experience, noting ways in which it was successful and unsuccessful in achieving desired outcomes.
  • Identify best-practice interdisciplinary collaboration strategies to help a team to achieve its goals and work together more effectively.
• Competency 4: Explain how change management theories and leadership strategies can enable interdisciplinary teams to achieve specific organizational goals.
  • Identify best-practice leadership strategies from the literature that would improve an interdisciplinary team’s ability to achieve its goals.
• Competency 5: Apply professional, scholarly, evidence-based communication strategies to impact patient, interdisciplinary team, and systems outcomes.
  • Communicate via video with clear sound and light.
  • The full reference list is from relevant and evidence-based (published within 5 years) sources, exhibiting nearly flawless adherence to APA format.

Need to interview a nurse practitioner to answer some questions for an assignment regarding their experiences and educational journey ! Please reach out if willing to assist with this.

Examine 
Case Study: A Young Caucasian Girl with ADHD. 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 pharmacodynamic 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.

Case

BACKGROUND

Katie is an 8 year old Caucasian female who is brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katie’s teacher suggested that she may have ADHD. Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine whether or not she has this condition.

The parents give the PMHNP a copy of a form titled 
“Conner’s Teacher Rating Scale-Revised”. This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their family primary care provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. The teacher opined that she lacks interest in school work and is easily distracted. Katie is also noted to start things but never finish them, and seldom follows through on instructions and fails to finish her school work.

Katie’s parents actively deny that Katie has ADHD. “She would be running around like a wild person if she had ADHD” reports her mother. “She is never defiant or has temper outburst” adds her father.

SUBJECTIVE

Katie reports that she doesn’t know what the “big deal” is. She states that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds her other subjects boring, and sometimes hard because she feels “lost”. She admits that her mind does wander during class to things that she thinks of as more fun. “Sometimes” Katie reports “I will just be thinking about nothing and the teacher will call my name and I don’t know what they were talking about.”

Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. Offers no other concerns at this time.

MENTAL STATUS EXAM

The client is an 8 year old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. Affect is bright. Katie denies visual or auditory hallucinations, no delusional or paranoid thought processes readily appreciated. Attention and concentration are grossly intact based on Katie’s attending to the clinical interview and her ability to count backwards from 100 by serial 2’s and 5’s. Insight and judgment appear age appropriate. Katie denies any suicidal or homicidal ideation.

Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation

RESOURCES

§ Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998). Revision and restandardization of the Conners' Teacher Rating Scale (CTRS-R): Factors, structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279-291.

Decision Point One

Begin Wellbutrin (bupropion) XL 150 mg orally daily

RESULTS OF DECISION POINT ONE

·  Client returns to clinic in four weeks

·  Katie’s parents inform you that they stopped giving Katie the medication because about 2 weeks into the prescription, Katie told her parents that she was thinking about hurting herself. This scared the parents, but they didn’t want to “bother you” by calling the office, so they felt that it would be best to just stop the medication as they would be seeing you in two weeks

Decision Point Two

Educate the parents that Bupropion sometimes causes suicidal ideation in children and that this is normal, and re-start the drug at the previous dose

RESULTS OF DECISION POINT TWO

Client returns to clinic in four weeks

Katie's parents again report that after about a week of treatment with the Bupropion, Katie began telling her parents that she wanted to hurt herself and began having dreams about being dead. This scared her parents, and they stopped giving her the medication At this point, they are quite upset with the results of their daughter’s treatment and are convinced that medication is not the answer

Decision Point Three

Refer the parents to a pediatric psychologist who can use behavioral therapy to treat Katie’s ADHD.

Guidance to Student

Bupropion is used off-label for ADHD and is used more commonly in adults. It’s mechanism of action results in increasing the neurotransmitters norepinephrine/noradrenaline and dopamine. Since dopamine is inactivated by norepinephrine reuptake in frontal cortex, (which largely lacks dopamine transporters) bupropion can increase dopamine neurotransmission in this part of the brain, which may explain its effectiveness in ADHD. However, Bupropion as well as other antidepressants have been linked to suicidal ideation in children and adolescents- despite the fact that it was being used initially to treat ADHD, it is still an antidepressant.

At this point, the parents are probably quite frustrated as no parent wants to hear their child talking about hurting themselves or having dreams about being dead. If the parents are adamant about no more medications, referral to a pediatric psychologist or similar therapist skilled in the use of behavioral therapies to treat ADHD in children. However, it should be noted that behavioral therapies work best when combined with medication, however, if the parents are insistent, then behavioral therapy may be the only alternative left in the treatment of Katie.

In terms of the pathophysiology of ADHD, whereas it may be true that increasing age may demonstrate some improvement in symptoms (some people will actually experience complete resolution of symptoms by adulthood), it is not helping Katie in the here and now. Katie still needs help with her symptoms which are causing academic issues.

The PMHNP should attempt to repair the rupture in the therapeutic alliance (the parents now believe that medications are not the answer) by explaining rationale for the use of Bupropion (many people like to start with Bupropion because it has a low-risk for addiction). The family should be encouraged to allow the PMHNP to initiate Adderall as it has a very good track record in terms of its efficacy in treating ADHD.