SOAP note
SOAP note Heart Failure
SOAP note Heart Failure
Unit 12 Discussion Impulsivity and Compulsivity. 800w. 4 references. Due 11-13-23.
1. Please describe the role of the mesolimbic dopamine pathway in the development or continuation of impulsive/compulsive behaviors.
2. Please provide two examples of current research on interventions to reduce or eliminate compulsive/impulsive behavior related to addiction.
3. Summarize the following article “Behavioral Functions of the Mesolimbic Dopaminergic System: an Affective Neuroethological Perspective” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2238694/
Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.
Please be sure to validate your opinions and ideas with in-text citations and corresponding references in APA format.
1. Role of the mesolimbic dopamine pathway in the development or continuation of impulsive/compulsive behaviors. The mesolimbic pathway is the dopamine pathway. This pathway extends from the “VTA of the brainstem (mesencephalon) to the nucleus accumbens in the ventral striatum which is part of the limbic system (Stahl, 2021, p. 90). This pathway is important as it is involved in the regulating motivation and reward. Hyperactivity of the mesolimbic pathway called hyperdopaminergia, is significant in the display of positive symptoms seen in psychosis, schizophrenia, and depression and can result in impulse, agitation, hostile, and aggressive symptoms. In addition, the hyperactivity of the DA pathway can be because of various psychostimulants. Such as, cocaine and methamphetamine (Stahl, 2021, p.90). In terms of impulsivity and compulsivity Stahl (2020, p.541) states, “Impulsivity can be thought of as the inability to stop the initiation of actions and involves a brain circuit centered on the ventral striatum, linked to the thalamus (T), to the ventromedial prefrontal cortex (VMPFC), and to the anterior cingulate cortex (ACC). Compulsivity can be thought of as the inability to terminate ongoing actions and hypothetically is centered on a different brain circuit, namely the dorsal striatum, thalamus (T), and orbitofrontal cortex (OFC). Impulsive acts such as drug use, gambling, and obesity can eventually become compulsive due to neuroplastic changes that engage the dorsal habit system and theoretically cause impulses in the ventral loop to migrate to the dorsal loop.” 2. Two examples of current research on interventions to reduce or eliminate compulsive/impulsive behavior related to addiction. According to Hartney (2021), compulsions are considered obsessions with repeated thoughts that create a feeling of distress (Hartley, 2021). The person’s behavior reduces anxiety and fear. An example to consider is obsessive compulsive disorder. In this disorder, the obsession revolves around the need to wash their hands. In the case of addiction, the desire to use will far outweigh the reality that there may be negative consequences. Such as financial strains, health issues, social problems, legal problems and/or decreased self-esteem (Hartney, 2021). Hartney (2021), suggests for treatment of the OCD behavior should include antidepressant medications like serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). These medications may be augmented with antipsychotics at the discretion of the provider. In terms of impulsivity, Kozak and her colleagues (2018) denote there are strong overlaps in the neural circuitry and functional mechanisms between impulsivity traits and addiction, which has directed treatment approaches. Therefore, it has been recommended, SUD treatment should include subjective and objective data and target the pharmacological, behavioral, and neurophysiological areas to individualize the patient’s care (Kozak et al., 2018). This study source was downloaded by 100000769192234 from CourseHero.com on 10-22-2023 17:11:39 GMT -05:00 https://www.coursehero.com/file/139195954/Discussion-12-ImpulsivityCompulsivitydocx/ For example: Alcohol use disorder – Naltrexone, Aripiprazole, and Topiramate were successful in decreasing impulsivity behaviors and Problem gambling – paroxetine was found to be successful in impulsivity (Kozak et al., 2018). References: Hartney, E. (2021). The difference between an addiction and a compulsion. Retrieved on March 30, 2022, from https://www.verywellmind.com/the-difference-between-an-addiction-and-acompulsion-22240 Kozak, K., Lucatch, A. M., Lowe, D., Balodis, I. M., MacKillop, J., & George, T. P. (2019). The neurobiology of impulsivity and substance use disorders: implications for treatment. Annals of the New York Academy of Sciences, 1451(1), 71–91. https://doi.org/10.1111/nyas.13977 Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical application (5th ed.). p. 90 & 54, Cambridge: Cambridge University Press.
see below
Watch the videos listed below and answer the questions that follow:
Adolescents & Addiction:
Adolescent Drug Addiction
The Science of Relapse
Brain imaging on drugs
Please answer the following questions and indicate what videos helped you answer the question.
Thinking about what you’ve learned in this course about
1- If you had the power to change anything in this class that is assessment related, what would you change and why?
2- How will the concepts you learned in this class help you in your career?
The student must answer the graded discussion with a substantive reply to the graded discussion question(s)/topic(s) posted by the course instructor by Thursday, 11:59 p.m. Eastern Time. Two scholarly sources references are required unless stated otherwise by your professor.
The student provides a substantive response to the discussion question or topic on Thursday day and posts a minimum of two additional responses to peers on another day(s). The answers to classmates must be posted by Sunday, 11:59 pm Eastern Time. We expect each student to participate in the discussion board in a respectful manner.
Remember that a new discussion rubric was approved by the professors, committee members, and a majority of the students. Please review the rubric before posting to ensure a maximum of points.
Here are the categories of the new discussion rubric:
Initial Post relevance to the topic of discussion, applicability, and insight. (20%)
Quality of Written Communication Appropriateness of audience and words choice is specific, purposeful, dynamic, and varied. Grammar, spelling, punctuation. (20%)
Inclusion of APNA standards essentials explored in the discussion as well as the role-specific competencies as applicable.(10%)
Rigor, currency, and relevance of the scholarly references. (Use articles that are below 5 years). (20%)
Peer & Professor Responses. The number of responses, quality of response posts. (20%)
Timeliness of the initial post and the answers to the peers. (10%
Nursing Opportunities Assignment: Total Possible Points = 110
Students will select a Contemporary Nursing Career Opportunity to write about. Careers should focus on the role that requires education at the Bachelor’s level or higher. You must get approval from the instructor for the topic. Students are expected to discuss all of the following:
Career chosen: CERTIFIED NURSE MIDWIFE
Please see attachment for instructions.
Social determinants of health (SDOH).
Name the 5 domains of Healthy People 2030. What is the objective of Healthy People?
Select 1-2 overarching goals and describe the impact on health, well-being and quality of life.
Describe the current status of the overarching goals you selected.
Unit 8 Medications for Sleep Disorders —2 Peer Response 600w. due 10-25-23
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.
Ingrid A.
· There are multiple sleep disorders such as insomnia, sleep apnea, restless leg syndrome, hypersomnia, circadian rhythm disorders, and parasomnia which I think is “sleepwalking” or at least very similar to sleepwalking (Sleep Disorders, 2020).
Screening tools to diagnose sleep disorders can be just as gathering information from the patient, like history and physical. There are other screening tools such as actigraphy which is something like a watch the patient must wear and this tracks the movements the patient makes when sleeping and being awake (How is actigraphy used to evaluate sleep?, 2022)
Adding more we also have polysomnography also known as the “sleep study”, and this particular test records brain waves, oxygen level as well as heart rate (Polysomnography (Sleep Study) 2023). Epic (electronic health record) has something called the stop-bang questionnaire and it basically asks questions about snoring, blood pressure, and the size of the neck. There is also something called the Athens Insomnia Scale and Epworth Sleepiness Scale (Sleep disorders: Clinical tools, 2023).
Z-drugs such as zolpidem, zopiclone, and zaleplon are innovative hypnotics that aid with sleep, reduce sleep latency, and improve quality. These drugs are prescription dispensed only and they work by slowing the activity in the brain (Commissioner, 2023).
Benzodiazepines are medications such as lorazepam, diazepam, temazepam, alprazolam, and clonazepam among others that can have potential side effects such as respiratory depression, drowsiness, impaired judgment, nausea and vomiting, confusion, addiction, and even respiratory distress (Brandt & Leong, 2017).
References:
Brandt, J., & Leong, C. (2017). Benzodiazepines – statpearls – NCBI bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK470159/
Commissioner, O. of the. (2023). Taking z-drugs for insomnia? know the risks. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/taking-z-drugs-insomnia-know-risks
How is actigraphy used to evaluate sleep?. Sleep Foundation. (2022, May 10). https://www.sleepfoundation.org/sleep-studies/actigraphy
Mayo Foundation for Medical Education and Research. (2023, February 17). Polysomnography (Sleep Study). Mayo Clinic. https://www.mayoclinic.org/tests-procedures/polysomnography/about/pac-20394877#:~:text=Polysomnography%2C%20known%20as%20a%20sleep,measures%20eye%20and%20leg%20movements.
Sleep disorders: Clinical tools. CAMH. (2023). https://www.camh.ca/en/professionals/treating-conditions-and-disorders/sleep-disorders/sleep-disorders—clinical-tools
U.S. National Library of Medicine. (2020, January 3). Sleep disorders. MedlinePlus. https://medlineplus.gov/sleepdisorders.html
Week 8, Medications for Sleep Disorders
What screening tools can be used to affirm your initial diagnosis that a patient may meet the diagnostic criteria for a sleep disorder?
There are different tools for assessing sleep disorders. Among various rating scales, the Pittsburgh Sleep Quality Index (PSQI) was specifically designed to evaluate overall sleep quality and is among the recommended questionnaires for examining global sleep patterns and symptoms related to insomnia (Zitser et al., 2022). It is a self-report questioner and will assess the sleep quality over one month. Another useful scale is the Epworth Sleepiness Scale (ESS), which is a questionnaire designed to assess daytime sleepiness. A higher score on the ESS suggests the need for further evaluation for possible sleep disorders (Clinical application of headache impact test (HIT)-6 and Epworth Sleepiness Scale, 2023).
According to the literature, the gold standard for monitoring sleep and breathing is polysomnography (PSG). PSG observes various physiological factors during sleep, including brain activity, eye movement, heart rate, and muscle activity. It involves the use of special bands around the chest and abdomen, as well as sensors for temperature and airflow in the nose. PSG also utilizes a device to measure airflow and sensors for air pressure in the airway. However, it's important to note that these methods can be invasive and time-consuming to set up and understand (Naik et al., 2023). Home sleep apnea testing (HSAT) is a simplified version of PSG that can be conducted at home and offers several potential benefits compared to traditional PSG, such as increased accessibility, quicker treatment initiation, and cost savings (Johns et al., 2022).
Describe the pharmacological actions of non-z sleep medications?
Non-benzodiazepine (non-Z) sleep medications, such as zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata), function by enhancing the activity of the neurotransmitter known as gamma-aminobutyric acid (GABA) in the central nervous system. GABA is an inhibitory neurotransmitter that promotes relaxation and facilitates sleep. One key distinction between benzodiazepine medications and non-Z medications is their selectivity in targeting GABA receptors (Stahl, 2021).
Benzodiazepines act on various GABA receptor subunits (including alpha 1, alpha 2, alpha 3 and alpha 5 receptors) nonselectively. Benzodiazepines acting on alpha2 and alpha3 receptor subtypes have effects that reduce anxiety, promote muscle relaxation, and enhance the effects of alcohol. On the other hand, the alpha5 subtype, found in the hippocampus, may be implicated in cognitive processes. As a result, benzodiazepines are employed for the treatment of sleep disorders, seizure disorders, and anxiety disorders due to their broader spectrum of activity (Stahl, 2021).
In contrast, non-Z medications selectively target alpha 1 receptors, which are primarily associated with the sleep process. Therefore, non-Z medications are specifically designed to induce and improve sleep without affecting the full spectrum of GABA receptors. Another distinction to note is that benzodiazepines typically have longer half-lives, which means they remain in the body for a more extended period compared to non-Z medications. This difference in half-life can have implications for factors such as prolong sedation and potential for dependence or withdrawal when using these medications. Non- Z medications are usually used for short amount of time and do not cause dependence or withdrawal symptoms (Stahl, 2021).
What problems can occur when benzodiazepines are used to help with sleep?
Benzodiazepines are potent medications known for their effectiveness, but they come with a range of significant concerns and potential problems. They have sedative properties, leading to drowsiness and increased sleepiness in patients. Additionally, benzodiazepines exhibit a prolonged half-life, resulting in an extended duration of action within the body, which can impact a patient's overall quality of life. These medications have been associated with several adverse effects (Stahl, 2021).
Benzodiazepines can impair cognitive function, memory, and coordination, potentially leading to accidents and reduced overall performance. A major concern with benzodiazepines is the development of tolerance. Over time, patients may require higher doses to achieve the same therapeutic effect. This can lead to physical and psychological dependence, as patients become addicted to the sedative properties of the medication (Stahl, 2021).
Abruptly discontinuing benzodiazepines can result in unpleasant withdrawal symptoms, which can be challenging for patients. One study by Ritvo et al. (2023) revealed that over 40% of the respondents reported experiencing 17 or more symptoms persisting for at least one year after discontinuing their use of benzodiazepines. Common side effects associated with benzodiazepines include dizziness, drowsiness, and coordination problems, which can be especially problematic for individuals who need to remain alert and functional. It's essential to be mindful of potential drug interactions, as benzodiazepines can interact with other medications, potentially affecting their effectiveness or causing unexpected side effects (Stahl, 2021)
Given these concerns, it is advisable to use benzodiazepines cautiously and only for short durations. When discontinuing their use, a slow tapering approach is often recommended to minimize the risk of withdrawal symptoms. This ensures that the benefits of these medications are balanced against the potential risks and adverse effects they may cause.
References
Clinical application of headache impact test (HIT)-6 and Epworth Sleepiness Scale (ESS) for sleep apnea headache. (2023).
Sleep Science and Practice, 7, 1-9.
https://doi.org/10.1186/s41606-023-00084-2Links to an external site.
Johns, J. D., Armin, M., Alexandra, W., Jeffrey, K. H., Mikula, S. K., & Hoa, M. (2022). Reliability of home sleep apnea testing for diagnosing obstructive sleep apnea in patients with spontaneous cerebrospinal fluid leaks.
Cureus, 14(10)
https://doi.org/10.7759/cureus.29854
Naik, G. R., Breen, P. P., Jayarathna, T., Tong, B. K., Eckert, D. J., & Gargiulo, G. D. (2023). Morphic sensors for respiratory parameters estimation: Validation against overnight polysomnography.
Biosensors, 13(7), 703.
https://doi.org/10.3390/bios13070703Links to an external site.
Ritvo, A. D., Foster, D. E., Huff, C., Reid Finlayson, ,A.J., Silvernail, B., & Martin, P. R. (2023). Long-term consequences of benzodiazepine-induced neurological dysfunction: A survey.
PLoS One, 18(6) https://doi.org/10.1371/journal.pone.0285584
Stahl, S. M. (2021).
Stahl’s essential psychopharmacology: Neuroscientific basis and practical application (5th ed.).
Zitser, J., Allen, I. E., Falgàs, N., Le, M. M., Neylan, T. C., Kramer, J. H., & Walsh, C. M. (2022). Pittsburgh Sleep Quality Index (PSQI) responses are modulated by total sleep time and wake after sleep onset in healthy older adults.
PLoS one, 17 (6) https://doi.org/10.1371/journal.pone.0270095
Option 1
Democracy is a form of governance where people vote their elected representatives into parliament or power. A system of government of the people by the people and for the people. It is a system of control of an organization, country, or society by most of its members. It is the foundation of any country where the majority rules, thereby giving the common person the opportunity to have a voice in their political community. It gives its members power and civic responsibility directly or through their democratically elected representatives. Democracy also gives people the privilege to have the same rights, equal value and to be able to think and believe and express their views openly in writing or speech. According to Greenberg & Page, (2018) The basic idea behind democracy is for the citizens to express their political influence through regular elections.
Although it is a fundamental human right to vote, the struggles and challenges that have faced this system of government since its conception are undoubtedly enormous.” Although the right to vote is fundamental to democracy, African Americans in the South were not able to vote in any numbers until after 1965, despite passage of the Fifteenth Amendment in 1870, which prohibited discrimination in voting on the basis of race, color, or previous condition of servitude” (Greenberg & Page, p. 670). It is difficult during a crisis when problems need immediate attention, too many ideas or opinions by the people and can cause some to feel devalued if their ideas are not followed, and the multiple perspectives to consider, makes decision making of this system of government to be slowed down.
“Democracy works best when governments have incentives to pursue broadly encompassing policies that benefit the citizen as a whole.” Shapiro, I. and Froomkin,(2023). These benefits promote ways to resolve issues and conflicts, peaceful resolutions are encouraged. It creates involvement and respect for human dignity. The freedom to act, speak and think freely. Equality before the law. Promoting an egalitarian environment. Believing in the principle that all people are equal and deserve equal rights and opportunities, thereby discouraging sovereignty.
Finally, a democratic system of government benefits cannot be overlooked. Democratically governed nations are more likely to secure the peace of the people, deter aggression, expand open markets, promote economic development, protect American citizens, combat international terrorism and crime, avoid humanitarian crises and refugee flows, improve the global environment that allow for future reform for the betterment of its community and the society at large.
Reference
Greenberg, E. S., & Page, B. I. (2018).
The Struggle for Democracy, 2018 Elections and Updates Edition (12th ed.). Pearson.
Shapiro, I. and Froomkin, . David (2023, July 12). challenges to democracy. Encyclopedia Britannica. https://www.britannica.com/topic/challenges-to-democracy