Unit 7 Discussion Case Study —2 Peer Response 600w. Due 10-20-23

Unit 7 Discussion Case Study —2 Peer Response 600w. Due 10-20-23

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.

Unit 7: Initial Discussion-Case Study RM

· A 70-year-old woman has scheduled an initial evaluation with you. Her medical diagnoses include hypertension, hyperglycemia, mild obesity, and hyperlipidemia. Her psychiatric diagnoses include anxiety and depression. Her current medications are atorvastatin 20 mg daily for seven years, Ozempic 1 mg injection weekly for three years, lisinopril 10 mg daily for 10 years, and Abilify 5 mg daily for six years. 

· Labs: Fasting Blood Glucose – 115, HbgA1C – 6.9, Total Cholesterol – 200, LDL – 100, HDL – 37. Her height is 5’2” and her weight is 176 pounds. Her blood pressure was 146/83 upon arrival at the office.  

· During your interview, she explains she became depressed following the death of her husband seven years ago. She became anxious about performing everyday tasks without him present.  After starting Abilify, she gained 25 pounds and required an increased dose of atorvastatin and Ozempic. She has been unable to lose the weight she gained and tries to closely monitor her dietary intake due to her persistently elevated glucose but reports still craving carbohydrates.  Her depression has improved slightly but she is still anxious to go out alone, so she no longer goes for daily walks to exercise. 

Subjective: 

CC: initial evaluation 

HPI: A 70-year-old female presents to the clinic for initial evaluation. She is a new patient in the practice. She reports a current history of hypertension, hyperglycemia, mild obesity, and hyperlipidemia. She also reports currently being diagnosed with anxiety and depression. She reports taking atorvastatin 20 mg daily for 7 years for hyperlipidemia, Ozempic 1 mg injection weekly for three years for hyperglycemia, lisinopril 10 mg daily for 10 years for hypertension, and ability 5 mg daily for 6 years for depression. 

PMH: Hypertension, hyperlipidemia, hyperglycemia, mild obesity, anxiety, and depression.  

Allergies: none reported 

Medications: atorvastatin 20 mg daily for 7 years for hyperlipidemia, Ozempic 1 mg injection weekly for three years for hyperglycemia, lisinopril 10 mg daily for 10 years for hypertension, and Abilify 5 mg daily for 6 years for depression. 

SH: Patient lost her husband seven years ago and became depressed. The patient reports her anxiety increased to perform everyday tasks without her husband. The patient states, that after starting Abilify she gained 25 pounds and required an increased dose of atorvastatin and Ozempic.  She has been unable to lose the weight she gained and tries to closely monitor her dietary intake due to her persistently elevated glucose but reports still craving carbohydrates.  Her depression has improved slightly but she is still anxious to go out alone, so she no longer goes for daily walks to exercise. 

FH: N/A 

Health promotion and maintenance: N/A 

ROS:  

Constitutional 

reports weight gain of 25 lbs. 

Head 

N/A 

Eyes 

N/A 

Ears, Nose, Mouth, Throat 

N/A 

Neck 

N/A 

Cardiovascular/Peripheral Vascular 

N/A 

Respiratory 

N/A 

Breast 

N/A 

 

 

Gastrointestinal 

Reports increased cravings for carbohydrates. 

Genitourinary 

N/A 

Musculoskeletal 

N/A 

Integumentary 

N/A 

Neurological 

Alert and oriented x 3.  

Psychiatric (screening tools: Ex: PHQ-9, MMSE, GAD-7) 

Reports anxiety to go out of her house alone and depression slightly improved 

Endocrine 

Reports persistent elevated glucose and carbohydrate cravings. 

Hematologic/Lymphatic 

N/A 

Allergic/Immunologic 

N/A 

Other 

  

Objective:   

Her height is 5’2” and her weight is 176 pounds. Her blood pressure was 146/83 upon arrival at the office.  Labs: Fasting Blood Glucose – 115, HbgA1C – 6.9, Total Cholesterol – 200, LDL – 100, HDL – 37. 

·
What advice or modifications to his treatment regimen would you recommend for your new patient? (Discuss a minimum of two). Please support your answer with research-based evidence.  

This 70-year-old female patient presents with diabetes as evidenced by a FBS of 115 

and a HgbA1C of 6.9. A HgbA1C level equal to 6.5% or greater indicates a diagnosis of diabetes mellitus 

(Centers for Disease Control and Prevention, 2023). The patient is currently at considerable risk for cardiovascular disease due to her borderline total cholesterol level of 200, LDL of 100, and HDL 37. The patient’s height is 5’2″ and weight is 176 lbs, BMI is 32.2 as per CDC (Centers for Disease Control) guidelines patient is obese which also contributes to cardiovascular disease (Centers for Disease Control and Prevention, 2022). The normal weight for the height of this patient is between 101lbs-136lbs (Centers for Disease Control and Prevention, 2022). According to Healthline, total cholesterol levels should be less than 200, LDL less than 100, HDL greater than 60, and triglycerides less than 149 for adult patients (2021). The patient has also been experiencing high blood pressure, BP 146/83 upon arrival. The patient has currently been taking lisinopril 10 mg daily for hypertension, atorvastatin 20 mg daily for 7 years for hyperlipidemia and Ozempic 1 mg injection weekly for three years for hyperglycemia. 

The patient has also been taking Abilify 5 mg daily for 6 years for depression. During this time, the patient gained twenty-five pounds and required an increased dose of Ozempic and atorvastatin. The patient has been unable to lose the weight she gained and reports closely monitoring dietary intake due to persistently increased glucose levels and carbohydrate cravings. The patient’s states depression slightly improved, however, anxiety has not improved and now the patient is having trouble leaving the house alone.  

According to the patient’s assessment, my treatment plan would be to continue Ozempic 1 mg injections weekly for diabetes management and add metformin IR 500mg PO BID with meals (Corcoran & Jacobs, 2023). Patient to check finger stick blood glucose levels 1-2 times daily on an empty stomach. Recommend the patient to a diabetes education program. To manage her cholesterol levels, I would titrate her atorvastatin from 20 mg to 40 mg PO daily. Re-check patient's lipid levels in 2-4 weeks (Drugs, 2023). To manage her high blood pressure, I would increase her lisinopril to 10 mg PO BID as a study shows that prescribing lisinopril twice daily vs once daily shows more improvements in SBP. Mean adjusted SBP reduction was 10.2 mm Hg greater in the twice‐daily cohort compared with the once‐daily cohort (Tsai et al., 2017). The patient will be coming back for follow-up in 2-4 weeks for further treatment outcome and if necessary, treatment plan adjustment.  

The patient has chronic depression that has improved slightly; however, she does voice increased anxiety and new symptoms of fear of going out alone since her husband died seven years ago. The patient is now restricting herself from going out for walks and exercise. She is starting to exhibit symptoms of agoraphobia. The patient is currently taking Abilify 5 mg PO daily for 6 years. Typically, second-generation antipsychotics are not the first line of treatment for depression, they are used once they have tried many antidepressants with no effect. I suggest treatment augmentation with an antidepressant. Zoloft is an SSRI that does not counteract Abilify, start Zoloft at 25 mg PO daily and increase the dose weekly as needed. Zoloft is used for depression and social anxiety disorder (Psych Central, 2021). The patient will also benefit from psychopharmacology, psychotherapy, cognitive behavioral therapy. 

Lastly, lifestyle change recommendations include diet and exercise modification. Work your way up to 150 minutes of moderate-intensity aerobic activity each week. This could be brisk walking 30 minutes a day, 5 days a week. Or you could do 75 minutes of vigorous-intensity aerobic activity each week, such as swimming laps. Regular physical activity provides immediate and long-term 

health benefits.Links to an external site.
 Physical activity and weight loss will Improve sleep quality, reduce high blood pressure, and reduce risk for type 2 diabetes, heart attack, stroke, and 

several forms of cancerLinks to an external site.
. It can help reduce arthritis pain and associated disability, reduce the risk for osteoporosis and falls, and reduce symptoms of depression and anxiety (Centers for Disease Control and Prevention, 2023). 

·
If you suggested additional medication, look up your state’s prescribing laws. Are PMHNP’s able to prescribe the medication you recommended?  

 Yes, as a practicing PMHNP for the state of Pennsylvania, prescribe drugs, devices, and Schedule II-V controlled substances if there is a written collaboration agreement with a physician (Pennsylvania Coalition of Nurse Practitioners, n.d.).  

References: 

Balaram, K., & Marwaha, R. (2023). Agoraphobia.
 NIH


https://www.ncbi.nlm.nih.gov/books/NBK554387/Links to an external site.
 

Centers for Disease Control and Prevention. (2022). Adult BMI calculator. CDC. 


https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.htmlLinks to an external site.
 

Centers for Disease Control and Prevention. (2023). Diabetes tests. 
CDC

  

https://www.cdc.gov/diabetes/basics/getting-tested.htmlLinks to an external site.
 

Centers for Disease Control and Prevention. (2023). Physical activity for a healthy weight. 
CDC. 


https://www.cdc.gov/healthyweight/physical_activity/index.htmlLinks to an external site.
 

Corcoran, C., & Jacobs, T.F. (2023). Metformin. 
NIH

https://www.ncbi.nlm.nih.gov/books/NBK518983/Links to an external site.
 

Drugs. (2023). Atorvastatin dosage. 


https://www.drugs.com/dosage/atorvastatin.html#Usual_Adult_Dose_for_HypertriglyceridemiaLinks to an external site.
 

Pennsylvania Coalition of Nurse Practitioners. (n.d.). Scope of Practice. PACNP. 


https://www.pacnp.org/page/ScopeofPractice#:~:text=In%20Pennsylvania%2C%20an%20NP%20may,collaboration%20agreement%20with%20a%20physicianLinks to an external site.

Psych Central. (2021). Zoloft: What you want to know? 

https://psychcentral.com/drugs/zoloft#basicsLinks to an external site.
 

Tsai, T., Kroehl, M. E., Smith, S. M., Thompson, A. M., Dai, I. Y., & Trinkley, K. E. (2017). Efficacy and 

safety of twice- vs once-daily dosing of lisinopril for hypertension. 
Journal of clinical hypertension (Greenwich, Conn.)
19(9), 868–873. https://doi.org/10.1111/jch.13011 

Unit 7 Discussion Case Study MV

What would be your approach to managing this patient’s weight concern? (Discuss at least two aspects of your approach). Support your answer with research-based evidence.

In managing this patient's weight concern, a comprehensive approach that addresses both behavioral and pharmacological aspects would be necessary. First and foremost it's crucial to evaluate if the patient is prepared to make changes and how motivated she is to lose weight. We can use motivational interviewing techniques to delve into her reasons, for wanting to shed pounds and uncover any obstacles or difficulties she might encounter (Bischof et al., 2021). To address her worries, about how her weight might affect her ability to care for her child it could be advantageous to involve a team of professionals that includes a registered dietitian, an exercise specialist and a psychologist or therapist. The dietitian can work with the patient to develop a personalized meal plan that takes into consideration her busy schedule and frequent eating out habits. Emphasizing portion control, incorporating healthier food choices, and encouraging mindful eating practices have been shown to be effective in managing obesity (Foster et al., 2018). In terms of physical activity, an exercise specialist can help the patient create an individualized exercise routine that is feasible given her current responsibilities as a stay-at-home mother. Promoting regular physical activity has been found to aid in weight loss so finding activities that she enjoys and can incorporate into her daily routine will enhance adherence maintenance (Posadzki et al., 2020).

What would be our approach to the sexual side effects she is experiencing?

Regarding the sexual side effects experienced by the patient, it is crucial to address these concerns openly and compassionately. It's important to determine whether the issues are primarily caused by medication use or if they're influenced by factors, like stress or relationship dynamics. It might be beneficial to educate the patient about how fluoxetine and olanzapine can affect sexual functioning. If it is determined that the medication is causing these problems switching from fluoxetine to another antidepressant that has a less impact on sexual function could be considered. Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine have been linked to sexual dysfunction (Yuan et al., 2021). Bupropion, which is an atypical antidepressant, with a lower likelihood of causing sexual side effects could be an alternative option worth exploring (Montejo et al., 2019).

If you suggest additional medication, look up your state’s prescribing laws. Are PMHNPs able to prescribe the medication you recommend?

Before suggesting any additional medication options such as Bupropion, it is essential to review prescribing laws specific to Illinois. As a PMHNP prescribing additional medication for the above concerns would depend on state laws. According to the Illinois Nurse Practice Act (2017), advanced practice registered nurses (APRNs) including PMHNPs have prescriptive authority. However, there are specific conditions and restrictions outlined in the Act (AANP, 2022). Therefore, it is necessary to review the current regulations and guidelines set forth by the Illinois Department of Financial and Professional Regulation (IDFPR) to ensure compliance with prescribing laws when considering Bupropion as a treatment option for this patient (Kleinpell et al., 2023). Psychiatric Mental Health Nurse Practitioners (PMHNPs) in Illinois have prescriptive authority to reduce practice. Illinois state law requires a career-long regulated collaborative agreement with a psychiatrist in order for the NP to prescribe medication. The nurse practitioner-psychiatrist collaborative practice agreement outlines their working relationship. It describes the categories of care, treatment, and procedures the nurse practitioner expects to perform (AANP, 2022). In Illinois, psychiatrists are not required to be physically present with the PMHNP. The psychiatrist must be available for consultation whether in person or by phone. A collaborating psychiatrist and PMHNP are required to meet at least once a month (AANP, 2022).

Include the subjective and objective information in this post.

Subjective information:

The patient reports concerns about her weight and its impact on her ability to care for her disabled child after her husband's death. She has tried numerous 'fad diets' without long-term success, losing only 15 pounds at most and maintaining it for three months. The patient expresses feelings of shame related to sexual dysfunction, specifically difficulty achieving orgasm during intimate moments with her husband.

Objective information:

The patient's objective data include being morbidly obese at 340 pounds with a height of 5'5″. She also has type II diabetes, hypertension, and hyperlipidemia. Additionally, she eats out frequently due to her children's busy schedules and leads a sedentary lifestyle with no regular physical activity.

References

American Association of Nurse Practitioners (2022). State practice by type. Retrieved from https://www.aanp.org/legislation-regulation/state-legislation/state-practice-environment/66-legislation-regulation/state-practice-environment/1380-state-practice-by-typeLinks to an external site.

Bischof, G., Bischof, A., & Rumpf, H.-J. (2021). Motivational interviewing: An evidence-based approach for use in medical practice. Deutsches Ärzteblatt international. https://doi.org/10.3238/arztebl.m2021.0014Links to an external site.

Foster, D., Sanchez-Collins, S., & Cheskin, L. J. (2018). Multidisciplinary team–based obesity treatment in patients with diabetes: Current practices and the state of the science. Diabetes Spectrum, 30(4), 244–249. https://doi.org/10.2337/ds17-0045Links to an external site.

Kleinpell, R., Myers, C. R., & Schorn, M. N. (2023). Addressing barriers to aprn practice: Policy and regulatory implications during covid-19. Journal of Nursing Regulation, 14(1), 13–20. https://doi.org/10.1016/s2155-8256(23)00064-9Links to an external site.

Montejo, A., Prieto, N., de Alarcón, R., Casado-Espada, N., de la Iglesia, J., & Montejo, L. (2019). Management strategies for antidepressant-related sexual dysfunction: A clinical approach. Journal of Clinical Medicine, 8(10), 1640. https://doi.org/10.3390/jcm8101640Links to an external site.

Posadzki, P., Pieper, D., Bajpai, R., Makaruk, H., Könsgen, N., Neuhaus, A., & Semwal, M. (2020). Exercise/physical activity and health outcomes: An overview of cochrane systematic reviews. BMC Public Health, 20(1). https://doi.org/10.1186/s12889-020-09855-3Links to an external site.

Yuan, S., & Deban, C. E. (2021). Ssri-induced hypersexuality. American Journal of Psychiatry Residents' Journal, 16(3), 9–12. https://doi.org/10.1176/appi.ajp-rj.2021.160305Links to an external site.

Training, New Information System, & Evaluation

 

  • What training is provided when a new information system is implemented in your organization?
  • Are nurses involved in evaluating the systems?

QUESTION

Please see attached

Power Point

Assignment

Create a Power Point

Purpose

This assignment will focus on developing a health policy analysis presentation that includes a problem statement, background, landscape, options, and recommendations from the week’s readings. The health policy analysis presentation is based on an identified healthcare issue in one’s local community. 

As Family Nurse Practitioner:

1. Research healthcare issues that have been identified in your local community. Develop a PowerPoint presentation with speaker notes. You will then use the PowerPoint during your Kaltura recording. Structure a health policy analysis presentation that addresses the following topics particular to your health problem:

· Problem Statement 

· Background 

· Landscape 

· Options 

· Recommendations 

Please provide FootNotes

2. Next, record your Kaltura presentation showing your PowerPoint and yourself speaking. Upload your Kaltura presentation into the week 4 assignment. How to use Kaltura resources are in Home/Resources/Technology Resources.

3. Posting your recording:

· Go to the week four assignment tab and hit Submit Assignment

· Use the Text Entry Tab. You will have the option of selecting the Kaltura icon.

· It will take you to your My Media Gallery and upload it from there.

Determination of Death / Informed Consent

 

After studying the course materials located on Module 6: Lecture Materials & Resources page, answer the following:

  1. Uniform Determination of Death Act (UDDA):
    • How this law was created
    • Legal definition of death, describe
  2. Define dying within context of faith, basic principle about human life
  3. Bioethical Analysis of Pain Management – Pain Relief
  4. What is the difference between Pain and suffering? Explain
  5. Diagnosis / Prognosis: define both.
  6. Ordinary / Extraordinary means of life support. Explain the bioethical analysis.
  7. Killing or allowing to die? Define both and explain which one is ethically correct and why?
  8. Catholic declaration on life and death; give a summary of this document: https://www.cfocf.org/wp-content/uploads/Combined-Catholic-Declaration-and-Understanding-ENGLISH.pdfLinks to an external site.
  9. What is free and informed consent from the Catholic perspective?
  10. Define Proxi, Surrogate
  11. Explain:
    • Advance Directives
    • Living Will
    • PoA / Durable PoA
    • DNR

Nursing Assignment

 

Discussion

 Consider a population health topic that rises to the presidential agenda level. Which social determinant most affects this health issue? How did two recent presidents handle the problem? What would you do differently? 

BRAIN DEATH DISCUSSION

see attached file for detail scenarios and questions 

interview

You will conduct a professional interview with a staff nurse and a staff nurse leader ( charge nurse, shift lead, house supervisor, etc) to discover their intra/inter-professional communications styles. It will be important to incorporate learning objectives regarding therapeutic communication styles including their method of caring, assertive, and responsible communication in your discussion/analysis of the interview.

The paper should utilize APA 7th format using Times New Roman 12pt font and include a title page. There should be less than 10% of direct quotations used in your paper, sources should be paraphrased and cited appropriately. The use of headings should be incorporated in the paper design. Additionally, provide citation for the personal communication with the interviewees (use initials only). Support from at least 3 peer reviewed journal articles in addition to your textbooks must be used. Use initials and avoid the use of patient names, staff names, and facility names for HIPPA compliance. Complete the Contact Information Form for Experiential Learning for all individuals interviewed and submit with your completed assignment to the drop box Sunday by 11:59pm.

You should use headings and subheadings from the Instructions to set up your paper

The following information should be included in your interview:

Description the facility i.e.: a large metropolitan hospital, rural nursing home or urban clinic

Staff Nurse Interview

Interview a staff nurse regarding:

· What (s)he perceives are the main communication issues/barriers

· how they communicate with patients,

· how they communicate with colleagues

· how they communicate with leadership/administration.

Describe your findings in no more than 2 pages using terms and vocabulary from course learning. Relates each interview question to content learned in the class by providing analysis and synthesis of question and response and includes minimum of one citation per question- you may cite the texts & or other peer reviewed journal articles.

Nurse Manager Interview

Interview a nurse in a leadership/administrative position regarding:

· What the manager perceives as the main communication issues/barriers

· how they communicate with patients,

· how they communicate with colleagues, and

· how they communicate with leadership/administration.

Describe your findings in no more than 2 pages using terms and vocabulary from course learning. Relates each interview question to content learned in the class by providing analysis and synthesis of question and response and includes minimum of one citation per question- you may cite the texts & or other peer reviewed journal articles.

Analysis of Interviews

· Cohesive analysis of part I & II. Clearly describe your main findings/ communication styles

· List at least 3 actions that would improve communication/ remove barriers. supported with 3 citations- you may cite the texts & or other peer reviewed journal articles.

Conclusion- Write a one-two paragraph conclusion summarizing importance of Intra/interpersonal communication

References- Create an APA reference page including all paraphrased and quoted sources.

Element

Element

Fully

Addressed

Element Partially Addressed

Element In-sufficiently Addressed

Points possible

Points

Earned

Part I: Staff Nurse Interview (this should be approximately 1 page of the paper length) and follows APA 7th ed. Format.

· Introduction : includes importance of Interprofessional communication and description of facility

2

· Asks the 4 assigned questions during interview that relate to course content/learning objectives: 2 points

· Appropriately and adequately summarizes interview responses (not verbatim) 4 points

6

·
Relates each interview question to content learned in the class by providing analysis and synthesis of question and response and includes:

Minimum : one citation per question- you may cite the text &/or other source(s) 8 pts

8

Part II: Staff Nurse Manager Interview: (this should be approximately 1 page of the paper length) and follows APA 7th ed. Format.

· Asks the 4 assigned questions during interview that relate to course content/learning objectives: 2pts

· Appropriately and adequately summarizes interview responses (not verbatim) 4 pts

6

· Relates each interview question to content learned in the class by providing analysis and synthesis of question and response and includes:

Minimum : one citation per question- you may cite the text &/or other source(s) 8 pts

8

Analysis of Interviews

· Cohesive analysis of part I & II. Clearly describe your main findings of the interviews. 4pts

· List at least 3 actions that would improve communication/ remove barriers supported by 3 citations 6 pts

10

· Conclusion: summarizes importance of Intra/Interpersonal communication 4 pts

4

Spelling, Grammar, 7th ed. APA Format

· Free of spelling, typographical, & grammatical errors, cites interviewee . Uses headings and subheadings from the Instructions 4 pts

· Reference Page Complete and follows APA format 2 pts

· Includes contact information forms (2)

6

Total

50

TO PREPARE

  

· Refer to the “Population-Focused Nurse Practitioner Competencies” in the Learning Resources, and consider the quality measures or indicators advanced practice nurses must possess in your specialty.

· Refer to your “Clinical Skills Self-Assessment Form” you submitted in Week 1 and consider your strengths and opportunities for improvement.

· Refer to your Patient Log in Meditrek; consider the patient activities you have experienced in your practicum experience and reflect on your observations and experiences.

DISCUSSION BOARD 5

Describe incidence, prevalence, morbidity, mortality and hospitalizations of COVID-19, compared to the rate of vaccinations in different counties in Maryland. What is your analysis of vaccination rates in the state? 

Please give 3 scientific citation.