Discussion 5 Respond Patho

Discussion 5 Respond Patho

Discussion 5 Respond Patho

Discussion 5 Respond Patho

Musculoskeletal case study

Introduction and Definition

Osteoarthritis is the degeneration of joint cartilage and underlying bones characterized by stiffness and pain in the affected area (Roth, 2022). It mostly affects the thumb, hip and knee joints, but it can affect any joint in the body—the disease is commonly known to affect the middle-aged and elderly. Osteoarthrosis is the disorder of synovial joints. The most affected joints in osteoarthrosis are the hands, hip, knee and first metatarsophalangeal joint.

Risk factors

G.J presents with the following risk factors for osteoarthritis. She is older (71 years), overweight, and her sex (woman). The risk of osteoarthritis rises with age. Also, women are more susceptible to osteoarthritis compared to men. Increased weight adds weight to joints increasing the chances of individuals suffering osteoarthritis (Roth, 2022).

Differences Between Osteoarthritis and Rheumatoid Arthritis

Osteoarthritis is a degenerative joint disorder resulting from the wear and tear of cartilage, while rheumatoid arthritis is an autoimmune disorder that attacks tissues lining the joints (Roth, 2022). Also, osteoarthritis starts later in life, whereas rheumatoid arthritis starts at any age. Another distinctive feature is rheumatoid arthritis develops fairly quickly (weeks to months), but osteoarthritis develops slowly over time. Rheumatoid Arthritis is characterized by muscle aches, low-grade fever and fatigue affecting the entire body, including the lungs and heart, while osteoarthritis is limited to joint pain. Rheumatoid Arthritis commonly starts in smaller joints (fingers) with symmetrical symptoms, which might later affect larger joints. At the same time, osteoarthritis often develops in hands and sometimes fingers joints but is less symmetrical (Roth, 2022). Finally, the treatment modality for rheumatoid arthritis includes biologics and disease-modifying medications targeting the immune system, while osteoarthritis entails corticosteroid and anti-inflammatory medications.

Pharmacological and non-pharmacological treatment

Pharmacological treatment includes NSAIDs and steroid injections. NSAIDs are strong pain relievers and anti-inflammatories, for example, topical capsaicin cream and ibuprofen tablets making them effective in managing osteoarthritis (Versus, 2022). For non-pharmacological treatment, the patient should focus on reducing weight through lifestyle changes and exercise.

Health education on Osteoporosis

I will educate my patient on the link between osteoarthritis and osteoporosis and advise her to eat a healthy diet, avoid smoking and exercise more frequently.

Neurological Function Case Study

Risk Factor

The major risk factors for Alzheimer’s disease are cardiovascular disease, head injuries, down syndrome, genetics, older age, untreated depression, hearing loss and social isolation (NIH, 2022). Alzheimer’s interferes with the brain’s ability to store and retrieve new information while affecting cognitive brain functions, i.e. reasoning and problem-solving abilities (NIH, 2022). Vascular dementia is the most common form of dementia associated with brain blood vessels. In contrast, frontotemporal dementia is a less common type of dementia affecting the language and behavior of individuals.

Explicit and Implicit Memory

Both explicit and implicit memories memory are types of long-term memory. Explicit memory is the state of remembering information consciously to work, while implicit memory is remembering information effortlessly and unconsciously (Cherry, 2022).

Diagnosis criteria for Alzheimer’s disease

The diagnosis criteria for preclinical Alzheimer’s entail no dementia, concern about changes in cognition and cognitive abilities such as problem-solving skills and memory loss expected for the level of education and age (NIH, 2022). Also, preserved ability to function and work independently is an indicator of Alzheimer’s disease.

Therapeutic Approach

Firstly, health care providers should consider her overall health, the severity of the disease and past medical history before deciding on treatment modalities and therapies (Versus, 2022). Also, they should acknowledge family and patient’s preferences on medication and how it will affect their lifestyle.

References

Roth, E., 2022. What’s the Difference Between Rheumatoid Arthritis and Osteoarthritis?. [online] Healthline. Available at: </orders/www.healthline.com/health/rheumatoid-arthritis/ra-vs-oa#symptoms>

Versus, 2022. Osteoarthritis (O.A.). [online] Versus arthritis. Available at: </orders/www.versusarthritis.org/about-arthritis/conditions/osteoarthritis/>

Versus, 2022. Osteoarthritis (O.A.). [online] Versus arthritis. Available at: </orders/www.versusarthritis.org/about-arthritis/conditions/osteoarthritis/>

NIH, 2022. Alzheimer’s Disease Diagnostic Guidelines. [online] National Institute on Aging. Available at: </orders/www.nia.nih.gov/health/alzheimers-disease-diagnostic-

Discussion 2 ( Rajimol)

Case Study Questions

Osteoarthritis versus osteoarthrosis

According to the Arthritis Foundation (n.d), osteoarthritis is a degenerative disease affecting the joints and tissues surrounding the joints. It is a disease affecting a large part of the global population and is one of the significant causes of immobility among adults. It primarily affects the bones, ligaments, and tissues surrounding the joints (Arthritis Foundation, n.d). Osteoarthritis also impacts the cartilage, causing inflammation in the affected areas. This can cause pain as well as compromise mobility (Arthritis Foundation, n.d). It usually manifests in joints of the hands, knees, hips, neck, as well as lower back (Arthritis Foundation, n.d).

As for osteoarthrosis, similarities can be seen with osteoarthritis. Mostly, however, osteoarthrosis is seen around the synovial joints and is noted more in older adults. Still, it also impacts on knees, hands, and hips (Atkinson, 1984). It is not common around the ankles, shoulders, and wrists. Symptoms of osteoarthritis include morning pain, stiffness of the joints, and immobility (Atkinson, 1984).

Risk Factors contributing to osteoarthritis diagnosis

Risk factors for osteoarthritis include age, obesity, injury of the joints, female gender, and genetics (Arthritis Foundation, n.d). Older adults have a higher risk of being afflicted with the disease due to their advanced age when the joints have gone through more wear and tear and extended strain (Arthritis Foundation, n.d). Women are also more at risk for this condition. Weight gain and obesity also place a person at greater risk for this condition (Arthritis Foundation, n.d). The patient manifested weight gain which would have put her at risk for osteoarthritis. She is also female and her previous history of lower back pain further adds up to the risk factors for the condition.

Differences between osteoarthritis and rheumatoid arthritis

The nature of these diseases varies with osteoarthritis being a degenerative joint disorder and rheumatoid arthritis an autoimmune disorder (Texas Joint Pain Management, 2022). Osteoarthritis initially sets in at a gradual pace, with the full-blown condition settling in after years following gradual wear and tear of the joints. Rheumatoid arthritis usually sets in quickly, in as short a time as weeks or months. Most areas affected by osteoarthritis include the hip, knees, neck, and finger joints while rheumatoid arthritis affects any joint, but is often noted in the hands, feet, and wrists (Texas Joint Pain Management, 2022). Joint stiffness is experienced in the morning and after walking in cases of osteoarthritis while such stiffness usually lasts longer and can set in any time even without exertion in rheumatoid arthritis (Texas Joint Pain Management, 2022). Radiological tests are used to diagnose osteoarthritis (Dewing et al., 2012). Rheumatoid arthritis is detected via radiologic tests (ultrasound, X-Rays, and MRI) (Dewing et al., 2012). Laboratory results show synovial fluids in instances of osteoarthritis while serology tests would assess ESR or C-reactive proteins in rheumatoid arthritis (Dewing et al., 2012).

Treatment alternatives

Options in treating the patient include performing exercises as well as using pharmacological alternatives. The use of NSAIDs would help relieve inflammation and reduce pain (Cleveland Clinic, 2019). When the swelling subsides and pain is reduced or eliminated, she can engage in low-impact exercises. She can walk, use the stationary bike, swim, and do yoga (Cleveland Clinic, 2019). Acupuncture can also be recommended for the patient as it has been known to relieve pain and reduce inflammation (Cleveland Clinic, 2019).

Addressing patient concerns

The patient’s concerns can be managed by reassuring her that she can actually improve her pain levels and live a relatively normal life. I would educate her about her condition and what can exacerbate her symptoms and why she is experiencing these symptoms now. This would help her understand her disease and to be more compliant with the treatment (Elam, 2021). I would teach her that she can undergo a bone density test to determine if she has osteoporosis. This test can then be used to guide treatment. I would also encourage her to have a healthy diet, a diet rich in fiber and calcium in order to help strengthen her bones and muscles. I would also encourage at least getting 10-15 minutes of sun exposure daily for Vitamin D. Along with calcium, Vitamin D helps protect the bones and joints of the body, strengthening them and eventually helping in preventing injury.

References

Arthritis Foundation (n.d). Osteoarthritis. /orders/www.arthritis.org/diseases/osteoarthritis

Atkinson, M. (1984). Osteoarthrosis. /orders/www.ncbi.nlm.nih.gov/pmc/articles/PMC2153568/

Cleveland Clinic (2019). Osteoarthritis. /orders/my.clevelandclinic.org/health/diseases/5599-osteoarthritis (Links to an external site.)

Dewing, K., Setter, S., & Slusher, B. (2012). Osteoarthritis and rheumatoid arthritis 2012: pathophysiology, diagnosis, and treatment. /orders/www.clinicaladvisor.com/home/features/osteoarthritis-and-%E2%80%A8rheumatoid-%C2%ADarthritis-2012-pathophysiology-diagnosis-%E2%80%A8and-treatment/

Elam, R. (2021). How should patients be educated about osteoporosis?. /orders/www.medscape.com/answers/330598-82999/how-should-patients-be-educated-about-osteoporosis (Links to an external site.)

Texas Joint Pain Management (2020). Osteoarthritis vs rheumatoid arthritis – explaining the pain. /orders/www.texasjointpain.com/osteoarthritis-vs-rheumatoid-arthritis/ (Links to an external site.)

Neurological Function: Case Study Questions

Risk factors for Alzheimer’s disease

The risk factors for Alzheimer’s are advancing age, a strong family history, genetics, and a previous head injury (Alzheimer’s Association, 2022a). Those who are 65 years old and over have a greater risk for Alzheimer’s and as individuals get even older, the risk increases. Families with a strong history of the disease are also likely to have other family members later developing it. The closer and more direct the relationship, the more likely an individual would later develop the disease (Alzheimer’s Association, 2022a). There are also genes that may place an individual at risk for Alzheimer’s. Risk genes (APOE-e4) are more likely to lead to Alzheimer’s as compared to deterministic genes (Alzheimer’s Association, 2022b).

Head injuries can also later lead to Alzheimer’s. This head injury may occur due to a stroke, a sports injury (boxing and other high-contact sports), or automobile accidents (Alzheimer’s Association, 2022a). A heart-head connection can also lead to Alzheimer’s. This can be noted in instances where an individual has cardiovascular disease. This includes hypertension, coronary artery disease, and other issues which can elevate blood pressure (National Health Services, 2021). Those with Down Syndrome can also be at risk for Alzheimer’s. Those who may have a tendency towards loneliness and depression also carry a higher risk for Alzheimer’s (National Health Services, 2021).

Similarities and differences between Alzheimer’s, Vascular dementia, Dementia with Lewy bodies, and Frontotemporal dementia

Alzheimer’s, vascular dementia, dementia with Lewy bodies, and frontotemporal dementia are all types of dementia. These diseases, therefore, affect the memory of the individual, including their behavior and problem-solving skills (Alzheimer’s Society, 2022). They mostly also affect older adults.

Alzheimer’s is the most common of these diseases (Alzheimer’s Society, 2022). It is caused by neurofibrillary tangles as well as plaques in the amyloid (Better Health Victoria, 2022). These tangles and plaques give rise to cognitive issues as seen in the disorder (Better Health Victoria, 2022). In vascular Dementia, the blood vessels of the brain are mostly affected. There are issues and damage to the blood vessels which can then lead to cognitive issues (Better Health Victoria, 2022). The Lewy bodies are protein groupings that are noted in the nerve cells of the brain and they lead to symptoms of dementia (Alzheimer’s Society, 2022). Frontotemporal dementia mostly impacts the frontal and temporal lobes of the brain (Better Health Victoria, 2022). These symptoms cause changes in the individual’s behavior and in their personality (Better Health Victoria, 2022). Aside from memory loss, their self-control and judgment are also often compromised.

Explicit and implicit memory

Implicit memory also refers to unconscious memories. These can be hard to express as they are mostly emotional. They often affect current attitudes but sometimes individuals may not be conscious that their memory is affecting their behavior (McLaughlin, 2020). Memories like playing games or playing music are for example part of unconscious memories and usually become second nature to individuals (McLaughlin, 2020). Individuals often have a specific reaction to stimuli due to their implicit memory. These memories can therefore manipulate their reactions and behavior (McLaughlin, 2020). Classical conditioning is associated with implicit memories (McLaughlin, 2020).

Explicit memory notes the presence of more conscious memories, intentionally remembered and consciously expressed (McLaughlin, 2020). These are memories that are anchored on personal experiences and actual events taking place which are recalled by the individual (McLaughlin, 2020). As for semantic memories, these refer to more specific data and ideas (McLaughlin, 2020). Autobiographical memories are more related to events.

Diagnosis and criteria for Alzheimer’s disease

The diagnostic criteria set by the National Institute of Aging and the Alzheimer’s Association cover primary clinical standards related to mild cognitive impairment. This would refer to the symptomatic stage. Updates in the stages of Alzheimer’s now include three new stages (National Institute of Aging, n.d). In the preclinical stage, there are changes in the brain as seen in the amyloid buildup and differences in nerve cells (National Institute of Aging, n.d). No symptoms are present as yet. For mild cognitive impairment, symptoms are present. Most symptoms are related to thinking issues not matching the individual’s knowledge and age (National Institute of Aging, n.d). They are still independent. The disease progresses at this point, with symptoms becoming more pronounced. The memory loss worsens and there is a greater difficulty in finding the right words to use. The individual’s independence is now affected (National Institute of Aging, n.d).

Best Therapeutic Approach

CJ needs diagnostic tests to establish if she has Alzheimer’s. When this is confirmed, she needs to be prescribed the appropriate medications. These medications would help manage the symptoms. Cholinesterase inhibitors work to stem the progression of the disease. Memantine helps with memory and learning. Antidepressants help manage mood and anxiety while antipsychotics can also help reduce aggression (Salamon, 2020). Cognitive Stimulation Therapy can be applied to CJ to help promote mental engagement (Salamon, 2020). Reality Orientation Time Therapy can also improve the individual’s awareness of her surroundings, where she is, what she is doing, what day it is, and what she has done (Salamon, 2020).

References

Alzheimer’s Association (2022a). Causes and risk factors for Alzheimer’s disease. /orders/www.alz.org/alzheimers-dementia/what-is-alzheimers/causes-and-risk-factors

Alzheimer’s Association (2022b). Is Alzheimer’s Genetic?

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Please Reply To The Following 2 Discussion Posts:

Please Reply to the following 2 Discussion posts:

Requirement

APA format with intext citation

Word count minimum of 150 words per post, not including references

References at least one high-level scholarly reference per post within the last 5 years in APA format.

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DISCUSSION POST # 1 Betsy

Nurses are very instrumental in influencing change in the healthcare sector as such if they are given the opportunity, they can be the reason for driving innovation at their place of work. There are various ways that nurses can spearhead change and some of them include becoming proactive leaders that entails creating solutions which can move the nursing profession to the future. Further it is important that nurses become advocates that can support the patient’s interest while at the same time representing the family’s role in the caring for the patient. Nsiah et al (2019), indicates that advocacy comprises pleading the course of the patient in the court of justice while at the same time supporting their justice and individual rights.

As a nurse leader the leadership style adopted can hinder the achievement of the goals planed. Clearly the nurse leader should act in liaison with their team and exhibit mutual trust which can encourage collaborative work. As leader one ought to encourage communication and charisma as charismatic leadership moves people as such making leader excel (Keating et al., 2020). Therefore, an example when a nurse leader became instrumental in spearheading change is Clara Barton that created the American Red Cross. The American Red Cross helped nurses manage emergencies and treat patients in need.

Clara Barton encountered many challenges while implementing their theory as it was during the war. As such she based her effort on helping individuals at war to assisting those in natural disasters. Some of the obstacles included the prevailing war that prevented the capacity to implement her views.

DISCUSSION POST # 2 Jennifer

One major nursing movement that impacted healthcare policy was the passage of A.B. 394, the historic bill that made minimum, specific staffing ratios the standard in California . The registered nurses of the California Nurses Association successfully sponsored and lobbied the California Legislature to pass. (Ratios: Learning From the California Experience, 2021). The law came in response to growing concern about patient safety as the complexity of care in hospitals increased and California experienced a severe nurse shortage in the 90’s (Ratios: Learning From the California Experience, 2021). It was not easy to get this bill to pass. It took a decade of hard work and multiple efforts by RN’s. The Influence from unions, including the California Nurses Association and the Service Employees International Union, which helped propel staffing issues into the political agenda, despite opposition from organizations such as the California Healthcare Association, which represents hospitals (McHugh et al, 2011).

RN’s had to participate in extensive campaigns. There was support by patients and the general public that included thousands of letters, calls, and a massive rally on the steps of the Capitol in Sacramento (Ratios: Learning From the California Experience, 2021). Nurses were persistent and didn’t give up. Obstacles continued even after passage of the bill. Hospital executives and the hospital industry, including the California Hospital Association, lobbied extensively to defeat the law (McHugh et al, 2011). The industry has filed lawsuits to block enforcement of the ratios at all times by permitting averaging, encouraging hospital managers to evade the letter and spirit of the law, and recruiting compliant allies to propose measures to overturn A.B. 394 (Ratios: Learning From the California Experience, 2021). After implementation of the bill nursing became a much more rewarding career. The California ratios attracted nurses from across the country who appreciated being able to practice nursing under a safe working environment and actually get to spend time with their patients. Most importantly, staffing ratios have improved safety and saved lives.

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Discussion – Week 3 Peer Responses

Peer Responses

Peer Responses

Peer 1

Jerri-Ann Rowell

RE: Discussion – Week 3

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The Affordable Care Act (ACA) expanded and improved health insurance coverage in two primary ways (Willison & Singer, 2017). First, the number of individuals receiving insurance coverage expanded by increasing access to coverage through Medicaid expansion and providing subsidies to purchase private insurance on the health care exchanges (Willison & Singer, 2017). The first way provides an outlook as to how ACA helped those who have Medicaid and those who have private insurance. However we were all soon to learn how most do not benefit from ACA.  Second, the ACA upgraded the quality and scope of coverage by improving benefit design, including implementing the essential health benefits (EHBs) (Willison & Singer, 2017). Essential health benefits are minimum insurance benefits encompassing 10 categories of care, which the ACA required all individual and small-group market plans, as well as all plans sold on the health care exchanges, to cover (Willison & Singer, 2017). Mandating benefits for individual and small-group markets was a historic step, improving population health by providing access to crucial health care services for millions of Americans (Willison & Singer, 2017). Although some components of the ACA are popular with Republican policymakers, including coverage for preexisting conditions and Medicaid expansion, the EHBs’ future is in doubt (Willison & Singer, 2017). “Be careful what you wish for” could be directed towards those who pushed aggressively for the passage of the Affordable Care Act (Blackburn, 2018). Even though the failings of the law are now apparent, the administration continues to peddle untrue promises to the American public with false hopes such as: “If you like your doctor, you can keep your doctor,” and “if you like your plan you can keep your plan” or “it is affordable once you get the subsidy” (Blackburn, 2018). Even prior to the passage, Republicans correctly predicted none of those pledges would hold true and sadly, Americans are seeing the devastating consequences of this government-run approach to health coverage (Blackburn, 2018). In regard to this, it is making it easier for the people to vote for those opposed to ACA (Blackburn, 2018). No one will vote for someone who is advocating for something they cannot afford and has clearly been shown that it is not in the people’s best interest.  It’s important to highlight not only the failures of Obamacare, but the work being done by the House GOP to repeal and replace it as well. (Blackburn, 2018). We recently learned, via Health and Human Services, that premiums for 2017 will rise by an average of 25% (Blackburn, 2018).  In many states, those increases will be much higher; Arizona (116%), Oklahoma (69%), Minnesota (59%), and in my state of Tennessee, 63% (Blackburn, 2018). After this news, you would think President Obama and the administration would show humility and admit Obamacare is too expensive to afford and is simply imploding (Blackburn, 2018). Instead, the president has said “The bottom line is most people are going to be pleasantly surprised by just how affordable their options are, if we can just get them to see for themselves” (Blackburn, 2018). Just like in 2010 when he signed Obamacare into law, the president is ignoring the facts. (Blackburn, 2018). The truth is people tried it and they do not like it (Blackburn, 2018).

Legislators are constantly being asked to make decisions; decisions on how to vote, who to support, and what causes to champion (Ames, 2020). Understanding a legislator’s decision-making process can make a difference as a group seeks to influence the legislator toward their argument (Ames, 2020). Voters vote according to their views and beliefs.  Therefore, candidates may alter their agenda and policies to receive more votes. Voters have easier access to agenda and polices of their candidates now more than ever before due to most having direct access to internet. With the ease of access, it is more important to the candidate’s beliefs and intent while in office to coincide with their voters.

References

Ames, K. (2020). How legislators make decisions. Social Studies. Retrieved June 8, 2022, from /orders/www.socialstudies.org/advocacy/how-legislators-make-decisions

Blackburn, R. M. (2018, July 9). The ACA is a disaster. we’re offering a better way. gop.gov. Retrieved June 8, 2022, from /orders/www.gop.gov/aca-disaster-offering-better-way/

Willison, C. E., & Singer, P. M. (2017, August). Repealing the affordable care act essential health benefits: Threats and obstacles. American journal of public health. Retrieved June 8, 2022, from /orders/www.ncbi.nlm.nih.gov/pmc/articles/PMC5508159/#bib1

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Peer 2

Christina Bradford 

RE: Discussion – Week 3 Main Post

Top of Form

Discussion: Politics and the Patient Protection and Affordable Care Act

With the goal of the legislator to be reelected to the following term, the cost of winning yields not only votes, but a large price tag. Legislators are asked to vote and make decisions constantly. “Laws put into place begin as ideas” (United State House of Representatives, n.d.). To remain in office, most elected officials must be aware of how their opinions and votes on policies will affect the ability to remain in office (National Council for the Social Studies, n.d.).   The Affordable Care Act has been a hot election topic for years.  Cost benefit analysis “allows you to consider all costs and benefits over time, even beyond the length of the intervention”(Centers for Disease Control and Prevention [CDC], 2021). Politics are so diverse and those running for reelection use the current healthcare issues to their advantage. The cost on getting reelected means during elections a politician must focus on raising money. “The return on the investment must be beneficial, if not the money invested in political campaigns would not continue to increase” (Milstead & Short, 2017, p. 48).

The Affordable Care Act has been highly controversial over the past few years. It was put into place in hopes to provide affordable health insurance to all Americans and to those with preexisting illnesses, but not without a price tag.  Medicaid cost continue to rise in the United States with more Americans living in poverty. During the Obama presidency, he made many promises about Obamacare that were not upheld. Patients were not allowed to keep the same physician, as many of them left the private sector. Businesses were also hit as they were forced to provide insurance to employees creating more expenses for small companies and a strain on the companies. Penalties were also put in place initially for those not signed up for a qualified health plan.  What most studies saw is that those that even had insurance did not seek medical care, which is not what they wanted to happen.

In 2017, the Trump administration tried to repeal and replace the entire law. The bill got through the House of Representatives and failed at the Senate.  During his presidency the ACA was continuously under fire and many opportunities were lost to rebuild the plan.   The repeal would cost millions to replace and will leave millions without insurance. Many plans propose to replace Medicaid expansion with unspecified block grants. This would leave a large number without insurance.  Another option is to eliminate subsidies and retain reductions in payments to hospitals and providers.  Replacing the ACA’s subsidies with fair tax credits could lead to a collapse of the health care market. The ACA is not perfect, and the alternative designs may generate improvements, but the details are critical.  Many advocates of the ACA repeal promise to replace the ACA with an alternative health reform design and vast improvements. I am not sure what the answer is, but I know that American healthcare is at stake.

References

Centers for Disease Control and Prevention. (2021). Cost-Benefit Analysis.  /orders/www.cdc.gov

Milstead, J. A., & Short, N. M. (2017). Government response: Legislation. In Health policy and politics: A nurse’s guide (6th ed., p. 48). Jones & Bartlett Learning.

National Council for the Social Studies. (n.d.). How legislators make decisions.  /orders/www.socialstudies.org

United State House of Representatives. (n.d.). The legislative process.  /orders/www.house.gov

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Nutritional Principal In Nursing

1. What types of resources are available to communities in terms of learning about nutrition and healthy eating?
2. What types of resources are available to global populations in terms of learning about nutrition and healthy eating?
3. What are three challenges communities and global populations have in accessing these resources and how can these be overcome?
4. What specific nutritional knowledge and skills that you learned about in this course had the most impact on you personally?
5. Were there any areas that you wished you could have learned more? If so, what were they?
    

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ASSIGNMENT 2 PRESCRIBING FOR CHILDREN & ADOLESCENT

PRESCRIBING FOR CHILDREN & ADOLESCENT

PRESCRIBING FOR CHILDREN & ADOLESCENT

PRESCRIBING FOR CHILDREN & ADOLESCENT

PRESCRIBING FOR CHILDREN & ADOLESCENT

Assignment 1: Prescribing for Children and Adolescents with Major Depressive Disorder

Off-label prescribing is when a physician gives you a drug that the U.S. Food and Drug Administration (FDA) has approved to treat a condition different than your condition. This practice is legal and common. In fact, one in five prescriptions written today are for off-label use.

—Agency for Healthcare Research and Quality

Photo Credit: Getty Images/Ingram Publishing

Psychotropic drugs are commonly used for children and adolescents to treat mental health disorders, yet many of these drugs are not FDA approved for use in these populations. Thus, their use is considered “off-label,” and it is often up to the best judgment of the prescribing clinician. As a PMHNP, you will need to apply the best available information and research on pharmacological treatments for children in order to safely and effectively treat child and adolescent patients. Sometimes this will come in the form of formal studies and approvals for drugs in children. Other times you may need to extrapolate from research or treatment guidelines on drugs in adults. Each individual patient case will need to be considered independently and each treatment considered from a risk assessment standpoint. What psychotherapeutic approach might be indicated as an initial treatment? What are the potential side effects of a particular drug?

For this Assignment, you consider these questions and others as you explore FDA-approved (“on label”) pharmacological treatments, non-FDA-approved (“off-label”) pharmacological treatments, and nonpharmacological treatments for disorders in children and adolescents.

Reference:

Agency for Healthcare Research and Quality. (2015). Off-label drugs: What you need to know.  /orders/www.ahrq.gov/patients-consumers/patient-involvement/off-label-drug-usage.html

To Prepare

· Your Instructor will assign a specific disorder for you to research for this Assignment.

· Use the Walden library to research evidence-based treatments for your assigned disorder in children and adolescents. You will need to recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating this disorder in children and adolescents.

The Assignment (1–2 pages)

· Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your assigned disorder in children and adolescents.

· Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?

· Explain whether clinical practice guidelines exist for this disorder and, if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.

· Support your reasoning with at least three scholarly resources, one each on the FDA-approved drug, the off-label, and a non-medication intervention for the disorder. Attach the PDFs of your sources.

Assignment 2 Assignment 2: Focused SOAP Note and Patient Case Presentation

Photo Credit: Pexels

Psychiatric notes are a way to reflect on your practicum experiences and connect them to the didactic learning you gain from your NRNP courses. Focused SOAP notes, such as the ones required in this practicum course, are often used in clinical settings to document patient care.

For this Assignment, you will document information about a patient that you examined during the last three weeks, using the Focused SOAP Note Template provided. You will then use this note to develop and record a case presentation for this patient.

To Prepare

· Review this week’s Learning Resources and consider the insights they provide. Also review the Kaltura Media Uploader resource in the left-hand navigation of the classroom for help creating your self-recorded Kaltura video.

· Select a patient of any age (either a child or an adult) that you examined during the last 3 weeks.

· Create a Focused SOAP Note on this patient using the template provided in the Learning Resources. There is also a completed Focused SOAP Note Exemplar provided to serve as a guide to assignment expectations. Please Note:

· All SOAP notes must be signed, and each page must be initialed by your Preceptor. Note: Electronic signatures are not accepted.

· When you submit your note, you should include the complete focused SOAP note as a Word document and PDF/images of each page that is initialed and signed by your Preceptor.

· You must submit your SOAP note using SafeAssign. Note: If both files are not received by the due date, faculty will deduct points per the Walden Grading Policy.

· Then, based on your SOAP note of this patient, develop a video case study presentation. Take time to practice your presentation before you record.

· Include at least five scholarly resources to support your assessment, diagnosis, and treatment planning.

· Ensure that you have the appropriate lighting and equipment to record the presentation.

The Assignment

Record yourself presenting the complex case for your clinical patient.

Do not sit and read your written evaluation! The video portion of the assignment is a simulation to demonstrate your ability to succinctly and effectively present a complex case to a colleague for a case consultation. The written portion of this assignment is a simulation for you to demonstrate to the faculty your ability to document the complex case as you would in an electronic medical record. The written portion of the assignment will be used as a guide for faculty to review your video to determine if you are omitting pertinent information or including non-essential information during your case staffing consultation video.

In your presentation:

· Dress professionally and present yourself in a professional manner.

· Display your photo ID at the start of the video when you introduce yourself.

· Ensure that you do not include any information that violates the principles of HIPAA (i.e., don’t use the patient’s name or any other identifying information).

· Present the full complex case study. Include chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; current psychiatric diagnosis including differentials that were ruled out; and plan for treatment and management.

· Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value.

· Be succinct in your presentation, and do not exceed 8 minutes. Specifically address the following for the patient, using your SOAP note as a guide:

· Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?

· Objective: What observations did you make during the psychiatric assessment?

· Assessment: Discuss their mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses and why you chose them. List them from highest priority to lowest priority. What was your primary diagnosis and why? Describe how your primary diagnosis aligns with DSM-5 diagnostic criteria and supported by the patient’s symptoms.

· Plan: In your video, describe your treatment plan using clinical practice guidelines supported by evidence-based practice. Include a discussion on your chosen FDA-approved psychopharmacologic agents and include alternative treatments available and supported by valid research. All treatment choices must have a discussion of your rationale for the choice supported by valid research. What were your follow-up plan and parameters? What referrals would you make or recommend as a result of this treatment session?

· In your written plan include all the above as well as include one social determinant of health according to the HealthyPeople 2030 (you will need to research) as applied to this case in the realm of psychiatry and mental health. As a future advanced provider, what are one health promotion activity and one patient education consideration for this patient for improving health disparities and inequities in the realm of psychiatry and mental health? Demonstrate your critical thinking.

· Reflection notes: What would you do differently with this patient if you could conduct the session again? If you are able to follow up with your patient, explain whether these interventions were successful and why or why not. If you were not able to conduct a follow up, discuss what your next intervention would be.

By Day 7 of Week 3

Submit your Video and Focused SOAP Note Assignment. You must submit two files for the note, including a Word document and scanned pdf/images of each page that is initialed and signed by your Preceptor.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

· Please save your Assignment using the naming convention “WK3Assgn2+last name+first initial.(extension)” as the name.

· Click the Week 3 Assignment 2 Rubric to review the Grading Criteria for the Assignment.

· Click the Week 3 Assignment 2 link. You will also be able to “View Rubric” for grading criteria from this area.

· Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK3Assgn2+last name+first initial.(extension)” and click Open.

· If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.

· Click on the Submit button to complete your submission.

Grading Criteria

The case study

DX: Psychosis. A 21-year-old Caucasian American female presented to the clinic with complaint of hearing voices, sleeplessness, and disorganized thinking which she mention as “I could not think clearly”. Patient record indicates that she had being initially diagnosed with schizophrenia at the age of 19 and was placed on Invega monthly deaconate. Record indicates that patient had been missing medication for 6months. New diagnosis of medication non-compliance and cannabis use disorder due to UDS result of positive cannabis. Patient denied suicidal or homicidal ideation at this time. Safety is not a concern, but medication compliance is. Patient admitted to be monitored with new medication and continuation of monthly Invega. Group therapy is started to make patient more compliant and acceptance of self. Day 1 of 25sessions.

DQ 15/2

DQ 15/2

DQ 15/2

Describe a clinical situation in which you have directly applied evidence-based data to produce a successful patient outcome. If you have not yet done so in practice, describe a clinical situation in which you envision this as a possibility. Explain your process. What steps in the process would you either add or eliminate if you were to encounter this particular set of circumstances again? How could your actions lead to better patient advocacy or a community action? Support your summary and recommendations plan with a minimum of two APRN approved scholarly resources.

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Analysis Of Local State Or Federal Health Policy. Module 5. Influencing HP

1. Select a state health policy reform innovation.
2. Discuss the rationale for the policy, how it was adopted (e.g., federal waivers, passage by the state legislature), the funding structure, and (to the extent statistical data are available) its impact. ethical outcome based on evidence.
3. Examples of state innovations include Maryland’s hospital rate-setting, Vermont’s single-payer system, and Massachusetts’ health reforms
    

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Issues In Today’s Workforce Culture

Based on your reading in chapter 60, why do you think the issues presented in this chapter persist in today’s workforce culture?

These are the book

Mason, D. J., Gardner, B. D., Outlaw, H. F., & O’Grady, T. E. (2016). Policy and Politics: In Nursing and Health Care. (7th ed.). St. Louis, MO: Saunders. ISBN: 978-0-323-24144-1

– American Psychological Association. (2019). Publication manual of the American Psychological Association (7th ed.). ISBN: 9781433832154

Submission Instructions:

• Your initial post should be at least 500 words, formatted, and cited in the current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.

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  Who We Are
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Health Care Disparities in LGBTQ

How to close the health care disparities gap in the LGBTQ community?

• initial post should be at least 500 words, formatted, and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.

  
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Module 6 Assignment. Influencing HP. POLICIES & POLITICS IN ASSOCIATIONS

Interest Groups

1. Select an interest group (AARP, AHIP, Coalition for Health Services Research, Emergency Nurses Association, Pharma)
2. Discuss how they are pushing their agenda (i.e., mechanisms used to influence policy makers), key obstacles, and spending (consult the Center for Responsible Politics, www.opensecrets.org)
3. Investigate the interest group’s website and review their position statements, testimony, and consult media reports to obtain more information on the group’s lobbying efforts.
    

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