2

Insomnia
31-year-old Male

BACKGROUND

This week, we examine a 31-year-old male who presents to the office with a chief complaint of insomnia.

SUBJECTIVE

Patient is a 31-year-old male. He states that his insomnia has gotten progressively worse over the past 6 months. Per the patient, he has never been a “great sleeper” but is now having difficulty both falling asleep and staying asleep at night. The problem began approximately 6 months ago after the sudden loss of his fiancé. The patient states this is affecting his ability to perform his job, which is a forklift operator at a local chemical company. The patient states he has used diphenhydramine in the past to sleep but does not like the way it makes him feel the morning after. He states he has fallen asleep on the job due to lack of sleep from the night before. The patient's medical record from his previous physician states that he has a history of opiate abuse, which began after he broke his ankle in a skiing accident and was prescribed hydrocodone/apap (acetaminophen) for acute pain management. The patient has not received a prescription for an opiate analgesic in 4 years. The patient states recently he has been using alcohol to help him fall asleep, approximately four beers prior to bed.

MENTAL STATUS EXAM

The patient is alert and oriented to person, place, time, event. He makes good eye contact and is dressed appropriately for time of year. He denies auditory/visual hallucinations. Judgement, insight, and reality contact are all intact. Patient denies suicidal/homicidal ideation, and is future oriented.

Decision Point One

Select what you should do:

Zolpidem: 10 mg daily at bedtime

Trazodone 50 mg po at bedtime

Hydroxyzine: 50 mg daily at bedtime

Examine
 Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult. 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.

I need some assist on this question 

Develop a 4-6 page plan that will allow you to evaluate your intervention.

You will also be required to submit your completed practicum hours using CORE ELMS. You must submit a minimum of 20 confirmed hours with each assessment deliverable to receive a grade for the entire assessment.

Introduction

Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, you must complete the assessments in this course in the order in which they are presented.

Once an intervention is planned and implemented it is important to evaluate the degree to which the outcomes of the project were achieved. By evaluating the desired outcomes of an intervention, it is possible to make more informed decisions about opportunities for continuous improvement. It is also possible to identify strategies and approaches that could be useful in improving one’s personal practice in other contexts or care areas.

Preparations

• Read Guiding Questions: Evaluation Plan Design [DOC]. This document is designed to give you questions to consider and additional guidance to help you successfully complete this assessment.
• As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.
  • What specific piece or pieces of technology did you propose using in your implementation plan?
  • How did the type of technology you chose impact the development of your implementation plan?
  • How will the incorporation of the technology you propose make your implementation plan more successful?

Instructions

Note: The assessments in this course are sequenced in such a way as to help you build specific skills that you will use throughout your program. Complete the assessments in the order in which they are presented.

Your evaluation plan design will be the forth section of your final project submission. The goal for this is to finalize the outcomes that your plan is seeking to achieve and to create a plan to evaluate the degree to which those outcomes would have been achieved if your intervention plan has been implemented. This will allow you to determine the degree to which the plan was successful in addressing the identified need of your target population and setting.

You will also discuss ways in which your role allows you to lead change and drive quality improvement, and to potentially improve the project in the future. In addition, you will reflect on how the project will leave you better prepared for success in other aspects of your current and future career. Provide enough detail so that the faculty member assessing your implementation plan design and discussion will be able to provide substantive feedback that you will be able to incorporate into the final draft of your project.

At minimum, be sure to address the bullet points below, as they correspond to the grading criteria. You may also want to read the scoring guide and the Guiding Questions: Evaluation Plan Design [DOC] document to better understand how each criterion will be assessed. In addition to the bullet points below, provide a brief introduction that refreshes the reader’s memory about your problem statement, your planned intervention, and how you intended to implement your intervention (this should only be a single paragraph).

Reminder: These instructions are an outline. Your heading for this this section should be Evaluation of Plan and not Part 1: Evaluation of Plan.

Part 1: Evaluation of Plan

• Define the outcomes that are the goal of an intervention plan.
• Create an evaluation plan to determine the impact of an intervention for a health promotion, quality improvement, prevention, education, or management need.

Part 2: Discussion

Advocacy

• Analyze the nurse’s role in leading change and driving improvements in the quality and experience of care.
• Explain how the intervention plan affects nursing and interprofessional collaboration, and how the health care field gains from the plan.

Future Steps

• Explain how the current project could be improved upon to create a bigger impact in the target population as well as to take advantage of emerging technology and care models to improve outcomes and safety.

Reflection on Leading Change and Improvement

• Reflect on how the project has impacted your ability to lead change in personal practice and future leadership positions.
• Reflect on the ways in which the completed intervention, implementation, and evaluation plans can be transferred into your personal practice to drive quality improvement in other contexts.

Address Generally Throughout

• Integrate resources from diverse sources that illustrate support for all aspects of an evaluation plan for an intervention, as well as for professional discussion about the plan.
• Communicate evaluation plan and discussion of the project in a professional way that helps the audience to understand how the outcomes will be evaluated, as well as what was learned through the project process.

Please complete all 6 simulation opportunities and upon completion upload the certificate with answered questions for grading purposes.

Discussion

Purpose

The purpose of this discussion is to discuss organizational changes and ethical-legal influences in a clinical scenario at an out-patient family practice. Students will explore potential effects on patient outcomes and ethical and legal implications for members of the heath care team as a result of illegal behaviors.  Students will develop strategies that result in prevention of untoward outcomes that result in a positive practice culture. 

Preparing the Discussion

You are a family nurse practitioner employed in a busy primary care office. The providers in the group include one physician and three nurse practitioners. The back office staff includes eight medical assistants who assist with patient care as well as filing, answering calls from patients, processing laboratory results and taking prescription renewal requests from patients and pharmacies. Stephanie, a medical assistant, has worked in the practice for 10 years and is very proficient at her job. She knows almost every patient in the practice, and has an excellent rapport with all of the providers. 

Mrs. Smith was seen today in the office for an annual physical. Her last appointment was a year ago for the same reason. During this visit, Mrs. Smith brought an empty bottle of amoxicillin with her and asked if she could have a refill. You noted the patient's name on the label, and the date on the bottle was 1 week ago. You also noted your name printed on the label as the prescriber. The patient admitted that she called last week concerned about her cough and spoke to Stephanie. You do not recall having discussed this patient with Stephanie nor do the other providers in the practice. 

Case Study Questions: 

1. What are the potential ethical and legal implications for each of the following practice members? 

· Medical assistant

· Nurse Practitioner

· Medical Director

· Practice

2. What strategies would you implement to prevent further episodes of potentially illegal behavior? 

3. What leadership qualities would you apply to effect a positive change in the practice?  Be thinking about the culture of the practice.

4. A scholarly resource must be used for EACH discussion question each week.