In APA format and at least three pages, answer the following questions:

What do you feel are the greatest influences on clinical judgment? Is it experience, knowledge, or a combination of those things?

In your opinion, what part does intuition play in clinical judgment? How do you think you'll be able to develop nursing intuition?

Make a follow-up of a student's weekly discussion and respond with your opinion regarding to her post

——You don't have to post this in APA format necessarily, it's just giving feedback to the student .

Theresa Dinard

     Here, in the state of Florida, one of the main barriers was the clause that nurse practitioners must work on the sponsorship of a physician or within close proximity of a physician. That has been relaxed by legislation that says only nurse can work in most sectors of healthcare, without oversight of a physician, this allows APRNs autonomy in a medspa, primary care clinics and/or even telemedicine when working independently and as an entrepreneur.

    Since June of 2020, Florida operates under “Full practice”policy, which allows nurses that have proof of at least 3000 clinical hours of experience and graduate level pharmacology and differential diagnosis courses, the privilege to operate autonomously in primary care, med spas and even telemedicine under this regulation. This is considered to be the gold standard as APRNs are now able to register as an Autonomous Advanced Practice Registered Nurse and practice to the full extent of their role (Fla. BON, 2023) 

     With just just three short years ago, APRNs had to work under the supervision or sponsorship of a physician that was either either working in the practice or had a vested interest in a clinic where the APRN is practicing. Some states may also hold a prescriptive regulation or the APRN whereas they can only order certain schedules and medications. In some instances there may be pushback from physicians who do not co-sign the concept of nurse practitioners and or having the privileges that they are allowed believing that they are not trained like physicians. In some communities nurse practitioners may not be a choice of patients to be examined by and may just prefer their doctor instead.

     For midwives in Florida, some of the barriers include the need to have a supervisory agreement with a Florida licensed physician for post graduate supervisory hours A lack of recognition as primary care providers on Medicaid and Medicare and private insurance company provider panels and other restrictions. (Hastings, et al, 2018)

     CRNAs have barriers such a lack of fair reimbursement by third-party, payers,  stating that they are not trained on the same skill level as physicians and failure of some of the other surgical groups or colleagues to recognize CRNAs as board certified to administer anesthesia. (Toney, 2023)

     Rep. Cary Pigman (R-Sebring) and Sen. Jeff Brandes (R-St. Petersburg) joined members of the interest groups for APRNs the Florida Association of Nurse Anesthetists (https://www.fana.org/)and the Florida Nurse Practitioner Network (https://fnpn.enpnetwork.com/) in making new legislation that forwards, the causes nurse practitioners and pushes for more independence for them as well.

References 

Toney-Butler TJ, Martin RL. Florida Nurse Practice Act Laws and Rules. [Updated 2023 Jan 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. 

Hastings-Tolsma M, Foster SW, Brucker MC, Nodine P, Burpo R, Camune B, Griggs J, Callahan TJ. Nature and scope of certified nurse-midwifery practice: A workforce study. J Clin Nurs. 2018 Nov;27(21-22):4000-4017. doi: 10.1111/jocn.14489. Epub 2018 Jun 20. PMID: 29679403; PMCID: PMC7992184.

Advanced Psychopharmacology and Health Promotion

Unit 7 Medications for Psychosis and Schizophrenia Related Disorders 600W. APA. 4 references due 10-17-23.

Answer the following questions:

Which antipsychotics are considered first-generation and why are they used less often than second generation antipsychotics? Are second-generation antipsychotics more effective?

Compare and contrast the following conditions: Tardive Dyskinesia, Acute Dystonia, Athetosis, and Tics.

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.

Use as a guide please do not copy this information. Also please use the textbook

1. Which antipsychotics are considered first-generation and why are they used less often than second generation antipsychotics? Are second-generation antipsychotics more effective? First generation antipsychotics, also referred to as “typical antipsychotics” were developed in the 1950s. Commonly prescribed first-generation antipsychotics include: Loxitane (loxapine); Mellaril (thioridazine); Moban (molindone); Navane (thiothixene); Prolixin (fluphenazine); Serentil (mesoridazine); Stelazine (trifluoperazine); Trilafon (perphenazine); and Thorazine (chlorpromazine). These first-generation antipsychotics are used less often than second generation antipsychotics because these medications have a high risk of side effects and some of those side effects can be severe. Second-generation antipsychotics, also known as “atypical antipsychotics,” were developed in the 1980s. Second-generation antipsychotics have more metabolic symptoms, including obesity, diabetes and hyperlipidemia (Heldt, 2017; Stahl et al., 2021). Side effects from first-generation antipsychotics include extrapyramidal effects, such as tardive dyskinesia, rigidity, tremors, and seizures. There is no evidence that second generation antipsychotics are significantly more effective than first generation antipsychotics in the treatment of cognitive and negative symptoms of schizophrenia (Stahl et al., 2021; Stroup, et al., 2003). 2. Compare and contrast the following conditions: Tardive Dyskinesia, Acute Dystonia, Athetosis, and Tics. Tardive dyskinesia is one of the symptoms of long-term use of a first -generation antipsychotic. It is a condition where there is constant or rhythmic involuntary movements that usually involves the muscles of the mouth. It can appear as lip smacking, chewing, excessive eye blinking, grimacing. These symptoms appear slowly over time. Tardive dyskinesia will not go away once the antipsychotic is stopped, it can become irreversible if present for too long. The risk of a patient developing tardive dyskinesia goes up with every year of continuous treatment. TD is specific to the use of antipsychotics (Heldt, 2017). Acute dystonia can develop within the first few hours of a patient receiving an antipsychotic. It is a sustained and painful involuntary contraction of a muscle group- usually involving the face or neck muscles. This is an easily reversible side effect and is managed with an anticholinergic drug such as Benadryl or Cogentin. This condition This study source was downloaded by 100000769192234 from CourseHero.com on 10-16-2023 17:34:58 GMT -05:00 https://www.coursehero.com/file/123197773/Discussion-7docx/ can resolve within a few minutes of proper medication and will not leave any long-term effects (Heldt, 2017). Athetosis is slow, involuntary, writhing movements of fingers, hands, toes and feet. Patients with this condition cannot maintain a stable or still position and when patients attempt to try to control the movements, symptoms can get worse. Athetosis is often a longterm symptom of continued use of first-generation antipsychotics (Holland, 2018). Tics are distinguished from EPS symptoms by the fact that tics are most commonly brief movements are able to be suppressed. Tics are sudden, rapid and repetitive movement (motor tics) or vocalizations (vocal tics). Those with tics feel the urge building up inside them before the tic appears, they these individuals report a feeling of relief after the tic is over. Although tics are involuntary, tics stop during sleep and patients can suppress the urge for short periods of time with effort (Martino, 2020). Heldt, J. P. (2017). Memorable psychopharmacology. Createspace Independent Publishing Platform. Holland, K. (2018, July 18). What Is Athetosis? Healthline; Healthline Media. https://www.healthline.com/health/athetosis Martino, D. (2020). Update on the Treatment of Tics in Tourette Syndrome and Other Chronic Tic Disorders. Current Treatment Options in Neurology, 22(4). https://doi.org/10.1007/s11940-020-0620-z Stahl, S., Muntner, N., & Grady, M. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and clinical applications (5th ed.). Cambridge University Press. Stroup, T. S., McEvoy, J. P., Swartz, M. S., Byerly, M. J., Glick, I. D., Canive, J. M., McGee, M. F., Simpson, G. M., Stevens, M. C., & Lieberman, J. A. (2003). The National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE)

In a 300- to 500-word blog post written for a patient and/or caregiver audience, explain signs and symptoms for your diagnosis, pharmacological treatments, nonpharmacological treatments, and appropriate community resources and referrals.
Although you are not required to respond to colleagues, collegial discussion is welcome. 

Please choose one between those 2 :

• Anxiety Disorder. or
• Disruptive Mood Dysregulation Disorder  

Discussion(M3)

Watch one of these films and  then discuss anyone of these “dying and death” representations as  presented in movies or plays such as:

• Bringing Out the Dead
• Angela’s Ashes
• Beaches
• Philadelphia
• Terms of Endearment
• Wit
• Evan Mayday’s Good Death

Address the following questions if pertinent to the film you watched:

• What were the causes of death?
• Where did people die?
• Who cared for the dying?
• Who was present at the time of death?
• How did the significant other person respond?
• How did the community respond?
• What expectations or beliefs were associated with dying and death?
• How did people cope with loss?

Envision  yourself as one of the characters in the film, and, according to their  personal or professional (eg. the nurse in: “WIT”) expectations about  death:

• Dying well
• Bad death
• Good death
• Sad death